8/8/2019 Alopecia and Vitiligo (1)
1/48
ALOPECIA & VITILIGOALOPECIA & VITILIGO
GHADA BINSAIF, MD
ASSISTANT PROFESSOR & CONSULTANT
DERMATOLOGIST
KSU & KKUH
8/8/2019 Alopecia and Vitiligo (1)
2/48
ALOPECIAALOPECIA
8/8/2019 Alopecia and Vitiligo (1)
3/48
8/8/2019 Alopecia and Vitiligo (1)
4/48
8/8/2019 Alopecia and Vitiligo (1)
5/48
Hair TypesHair Types
VellousVellous
TerminalTerminal Androgen dependant terminalAndrogen dependant terminal
8/8/2019 Alopecia and Vitiligo (1)
6/48
Hair CycleHair Cycle
Hair growth is very dynamic
8/8/2019 Alopecia and Vitiligo (1)
7/48
How many hairs in the body?5 millions hairs; 100,000 in the scalp
Growth rate?0.3mm/day for scalp hair
8/8/2019 Alopecia and Vitiligo (1)
8/48
AlopeciaAlopecia
Scaring
(Irreversible)
NoneScaring
(Reversible)
8/8/2019 Alopecia and Vitiligo (1)
9/48
8/8/2019 Alopecia and Vitiligo (1)
10/48
Alopecia AreataAlopecia Areata
8/8/2019 Alopecia and Vitiligo (1)
11/48
Sudden hair loss ( localized orgeneralized)Alopecia Areata affects up to 2%75% : Self recovery, 2-6 m
Causes :30%: +ve Family historyautoimmune
8/8/2019 Alopecia and Vitiligo (1)
12/48
Clinical findingsClinical findings Well demarcatedWell demarcated
Exclamation pointExclamation point
Normal scalpNormal scalp
Nail: pitting, ridgesNail: pitting, ridges
8/8/2019 Alopecia and Vitiligo (1)
13/48
8/8/2019 Alopecia and Vitiligo (1)
14/48
8/8/2019 Alopecia and Vitiligo (1)
15/48
Types of alopecia areataTypes of alopecia areata
-- Localized partialLocalized partial
-- Localized extensiveLocalized extensive
-- Alopecia ophiasisAlopecia ophiasis
-- Alopecia totalisAlopecia totalis
-- Alopecia universalisAlopecia universalis
8/8/2019 Alopecia and Vitiligo (1)
16/48
8/8/2019 Alopecia and Vitiligo (1)
17/48
8/8/2019 Alopecia and Vitiligo (1)
18/48
Bad prognostic factorsBad prognostic factors Young ageYoung age
AtopyAtopy
Alopecia totalis, universalis,Alopecia totalis, universalis,ophiasisophiasis
Nail changesNail changes
8/8/2019 Alopecia and Vitiligo (1)
19/48
8/8/2019 Alopecia and Vitiligo (1)
20/48
DiagnosisDiagnosis ClinicallyClinically
H/E: sworm beesH/E: sworm bees
8/8/2019 Alopecia and Vitiligo (1)
21/48
Treatment
11.. ObservationObservation
22.Intralesional
Corticosteroids.
Intralesional
Corticosteroids
33.. Skin Sensitizers
Anthraline
Diphencyclopropenone (DPCP)others
8/8/2019 Alopecia and Vitiligo (1)
22/48
Others
Topical steroids
Systemic
Steroids
Cytotoxic Rx
Phototherapy
Minoxidil
Hair Transplant ( NO)
8/8/2019 Alopecia and Vitiligo (1)
23/48
Androgenetic Alopecia
(Male and Female Pattern Hair Loss)
8/8/2019 Alopecia and Vitiligo (1)
24/48
Androgen dependent loss of scalp hairAndrogen dependent loss of scalp hair
Androgenetic Alopecia affects up toAndrogenetic Alopecia affects up to 5050%%
of males andof males and 4040% of females% of females Autosomal dominant with variableAutosomal dominant with variable
penetrancepenetrance
8585% : +ve family history% : +ve family history
8/8/2019 Alopecia and Vitiligo (1)
25/48
5 ALPHA Reductase
Testosterone
DihydorTestosterone(Active)
Miniaturization ofTerminal Hairs
8/8/2019 Alopecia and Vitiligo (1)
26/48
Male Pattern Hair Loss
8/8/2019 Alopecia and Vitiligo (1)
27/48
8/8/2019 Alopecia and Vitiligo (1)
28/48
Female Pattern Hair Loss
8/8/2019 Alopecia and Vitiligo (1)
29/48
8/8/2019 Alopecia and Vitiligo (1)
30/48
TreatmentTreatment TopicalTopical: Neoxidil: Neoxidil 22%%-- 55% solution% solution
SystemicSystemic::
FenastrideFenastride
SpironolactoneSpironolactone
8/8/2019 Alopecia and Vitiligo (1)
31/48
Anagen effluviumAnagen effluvium
Telogen effluviumTelogen effluvium
8/8/2019 Alopecia and Vitiligo (1)
32/48
Telogen effluviumTelogen effluvium
Chronic alopeciaChronic alopecia
Reversible (but may be become chronic)Reversible (but may be become chronic)33--44 monthsmonths
8/8/2019 Alopecia and Vitiligo (1)
33/48
CausesCauses
8/8/2019 Alopecia and Vitiligo (1)
34/48
DrugsDrugs associatedassociated with telogen Effluviumwith telogen Effluvium
8/8/2019 Alopecia and Vitiligo (1)
35/48
8/8/2019 Alopecia and Vitiligo (1)
36/48
Anagen effluviumAnagen effluvium Always related to cytotoxicAlways related to cytotoxic
chemotherapychemotherapy
Acute and severe alopeciaAcute and severe alopecia
Mostly reversible but not alwaysMostly reversible but not always
8/8/2019 Alopecia and Vitiligo (1)
37/48
Scaring AlopeciaScaring Alopecia SLESLEDLEDLE
LPLP
SarcoidosisSarcoidosis
LeprosyLeprosy
KerionKerion -- FavusFavus TraumaTrauma
8/8/2019 Alopecia and Vitiligo (1)
38/48
8/8/2019 Alopecia and Vitiligo (1)
39/48
8/8/2019 Alopecia and Vitiligo (1)
40/48
8/8/2019 Alopecia and Vitiligo (1)
41/48
VitiligoVitiligo
8/8/2019 Alopecia and Vitiligo (1)
42/48
--Acquired cut. depigmentationAcquired cut. depigmentation--Kobner phenomenaKobner phenomena
CausesCauses-- GeneticGenetic-- Autoimmune dis.Autoimmune dis.-- NeuralNeural
Natural coarse?Natural coarse?
VariedVaried
8/8/2019 Alopecia and Vitiligo (1)
43/48
8/8/2019 Alopecia and Vitiligo (1)
44/48
8/8/2019 Alopecia and Vitiligo (1)
45/48
8/8/2019 Alopecia and Vitiligo (1)
46/48
Why? Loss of normal melanocytesDopa stain
8/8/2019 Alopecia and Vitiligo (1)
47/48
Special studiesSpecial studies
TT44, TSH, FBS, TSH, FBS
ANA/Ro/La (prior to PUVA)ANA/Ro/La (prior to PUVA)
8/8/2019 Alopecia and Vitiligo (1)
48/48
TREATMENTTREATMENT
Sunscreen (sunburn, koebnerization, tanning)Sunscreen (sunburn, koebnerization, tanning)
Limited:Limited:ClassClass 33 topical GCtopical GC
Topical TacrolimusTopical Tacrolimus
Topical PUVATopical PUVA
Excimer laserExcimer laser
Resistant, Stable ofResistant, Stable of 22 years : Surgicalyears : Surgical
GeneralizedGeneralizedPhototherapyPhototherapy
Universal:Universal:
Bleaching agentBleaching agent