3. Hirsutism
• Definition:
Hirsutism is defined as excessive terminal
hair growth in androgen-dependent areas
of the body in women,
which grows in a typical male distribution
pattern
• Epidemiology:
Ethnic differences – Asian women tend to
have little body and facial hair, while
Middle Eastern, Mediterranean, and East
Indian women have moderate amounts
The condition is often associated with a
loss of self--esteem.
• Symptoms :
Irregular period
Male-pattern baldness
Acne
4. • Etiology and Pathogenesis:
Women with excessive growth of terminal
hairs in a “male pattern” due to
ANDROGEN OVERPRODUCTION (ovaries or
adrenal glands) or increased sensitivity to
androgens
Ovarian origin – PCOS, insulin resistance,
ovarian Tumors.
• Diagnose:
• clinically
• Laboratory testing
o Sex hormone-binding globulin level
• Image
– CT/MRI abdomen or pelvis
Hirsutism
5. Management
Cosmetic methods
Physical methods of removing hair(shaving)
Permanent hair reduction
(laser and intense pulsed light)
Non-pharmacological methods
• Lifestyle therapies are first-line
treatments in women with PCOS
Pharmacologic management
Oral Contraceptives
Gonadotropin-Releasing Hormone Agonists (GnRH-A)
Hirsutism
6. Suppression of androgen
synthesis:
◊Androgen antiagonist:
• Spirolucton 100-200 mg.
• Ketoconazole 400 mg
• Finasteride 2.5 mg daily
◊Medroxyprogeste one acetate:
• Dose: 150 mg intramuscularly every 3
months.
• Indications: severely androgenized patients
refractory to other therapies.
◊Corticosteroids:
• Indications: severe cases of adrenal
hyperplasia (CAH).
Hirsutism
7. Alopecia areata (spot baldness)
Definition
AA is a condition in which hair is lost from some or all areas of
the body.
Psychological stress may result.
Epidemiology
The condition affects 0.1%–0.2% of the population,
occurs equally in both males and females.
Patients also tend to have a slightly higher incidence of conditions related to the
immune system, such as
asthma,
allergies,
atopic dermatitis, and
hypothyroidism.
8. • Etiology
• Cause is still unknown
• It is an autoimmune disease
• Modified by genetic factors
• Pathogenesis
• Hair matrix cells are impaired
temporarily for unknown
reason.
• Theories include nutritional
failure, heredity and mental
stress; however, the
pathogenesis is unknown.
Some cases are accompanied
by autoimmune.
Alopecia areata (spot baldness)
9. Classification of alopecia areata
diffuse alopecia
areata
Alopecia areata
monolocularis
Alopecia areata
multilocularis
alopecia areata
barbae
alopecia
areata totalis
alopecia areata
universalis
Hair may also be lost more diffusely over the whole scalp, in which case the condition is
called diffuse alopecia areata.
Alopecia areata monolocularis describes baldness in only one spot. It may occur anywhere
on the head.
Alopecia areata multilocularis refers to multiple areas of hair loss.
Ophiasis refers to hair loss in the shape of a wave at the circumference of the head.
The disease may be limited only to the beard, in which case it is called alopecia areata
barbae.
If the person loses all the hair on the scalp, the disease is then called alopecia areata totalis
If all body hair, including pubic hair, is lost, the diagnosis then becomes alopecia areata
universalis
Alopecia areata (spot baldness)
10. Clinical features
• Round, sharply margined hair loss suddenly
occurs.
• Hair regrows spontaneously in several
months
• Rapid and complete loss of hair in one or
several patches.
• Size – Patches of 1-5 cm in diameter.
Associated disease
1.Atopic dermatitis.
2.Autoimmune disease –
* SLE
*Thyroiditis.
*Myasthenia gravis.
*Vitiligo.
3.Lichen planus.
4.Down syndrome.
Alopecia areata (spot baldness)
11. • Diagnosis
AA is usually diagnosed based on
clinical features
• The hairs are characteristically thin
and atrophic at the end of the hair
root, giving them the appearance of
exclamation marks
(“exclamation-point hair”).
• Differential diagnosis
1) Tinea capitis.
2) Trichotilomania.
3) Congenital triangular alopecia.
4) .Alopecia neoplastica.
.
Alopecia areata (spot baldness)
12. Management
Spontaneous recovery is extremely common
for patchy alopecia areata.
Psychological support.
in severe cases give topical:
Corticosteroid
PUVA therapy
• Steroids and immunosuppressant are administered
orally in alopecia totals or universals.
Alopecia areata (spot baldness)
13. Androgenic alopecia
• Definition:
It is a very common, potentially
reversible scalp hair loss that generally spares
parietal and occipital areas
(Hippocratic wreath) of the scalp.
• dihydrotestesterone)
• Epidemiology
• Androgenetic alopecia is a very common
disorder, affecting at least 50% of men by the
age of 50.
• Female androgenic alopecia has become a
growing problem
• affects around 30 million women in the United
States.
• The hairline recedes to form an M shape (with
vellus hair at the frontal region of the head) or
an O shape.
15. • Adrenal cause
- Congenital adrenal hyperplasia
(androgenital syndrome)
due to deficiency of –
21 hydroxylase (most common)
11-β hygroxylase.
3-β hydroxysteroid dehydrogenase.
- Tumor
Adrenal adenoma
Carcinoma.
Androgenic alopecia
16. • CLINICAL FEATURE
• Hair loss starts any time after puberty
“Whisker hairs” – first sign of impending male
pattern alopecia, appear at the temple.
• “Professor’s angle” – anterior hair line
recedes backward on each side.
• Eventually entire top of the scalp become
devoid of hair.
Christmas tree pattern”- diffuse and progressive
reduction of density and diameter of hairs in
the mid scalp.
• Maintenance of frontal hair lines with only
slight recession.
Androgenic alopecia
17. TREATMENT
Topical
Minoxidil (2% & 5%)
-non specific hair growth promoter
affecting anagen induction.
Systemic
Finesteride (1mg daily).
In women – spironolactone
( >100 mg daily).
Flutamide (250-500 mg bid or tid).
Cyproterone actate.
Surgical treatment-
Micrograft & minigraft from non-androgen
dependent site (occiput).
Androgenic alopecia
18. DEFINATION
• A neurotic practice of plucking or
breaking hair from scalp or
eyelash resulting usually localized
or widespread areas of alopecia
contains hairs of varying length.
• Mostly girls under age of 10
years.
• Disturbed mother- child
relationship.
Trichtillomania
19. •Clinical features
• Patchy or full alopecia of the scalp (and
sometimes eyebrows, eyelashes)
• Areas of alopecia often have bizarre shapes,
irregular borders, and contain hairs
• of varying lengths
• Plucking associated with hair shaft fractures
making hair ends feel rough
• Regrowth
• DDX
• alopecia areata,
• tinea capitis
Trichtillomania
20. TREATMENT
• Behavioral modification therapy
• Selective serotonin reuptake
inhibitor (SSRI) such as
fluvoxamine, fluoxetine,
• paroxetine, sertraline,
citalopram, etc.
• Topical minoxidil to help regrow
hair
Trichtillomania
21. • Defination
• cicatricial alopecia, is the loss
of hair which is accompanied
with scarring.
• It can be caused by a diverse
group of rare disorders that
destroy the hair follicle,
• replace it with scar tissue, and
cause permanent hair loss.
• Scarring hair loss occurs in
otherwise healthy men and
women of all ages and is seen
worldwide
Cicatricial alopecia
22. Group 1: Lymphocytic
Chronic cutaneous lupus
erythematosus (DLE)
Lichen planopilaris (LPP)
Classic LPP
Frontal fi brosing alopecia
Graham-Little syndrome
Brocq’s alopecia
Central centrifugal cicatricial
alopecia (CCCA)
Alopecia mucinosa
Keratosis follicularis spinulosa
decalvans
Group 2:
• Neutrophilic
• Folliculitis Decalvans – used by
different authors to mean different
things; usually means the infl
ammatory phase of CCCA ○
Dissecting cellulitis
• Group 3:
• Mixed
• Acne keloidalis
• Acne necrotica
• Erosive pustular dermatosis
• Group 4: Nonspecific
Cicatricial (scarring) Alopecia
27. • This condition has been linked to mutations in the ribosomal GTPase BMS1 gene
Congenital alopecia
congenital
aplasia
congenital
hypotricosis
Atrichia
congenita
28. • .
Aplasia cutis congenita
• ACC is a rare disorder characterized
by congenital absence of skin
Hypotrichosis congenita
• Normal hair is present at birth; however,
alopecia gradually
• leads to thin, sparse hair
Atrichia congenita
• It is autosomal recessive. Hair may be
present at birth; however, it falls out
between several months after birth and
puberty,
• until no hair remains on the body.
Involvement of the hairless
• (hr) gene has been identified as a cause in
some cases of certain subtypes
Congenital alopecia
30. Alopecia pityrodes
• Pityriasis capitis
(“dandruff”) occurs in combination with
alopecia most frequently in men after puberty.
grayish-white scaling occurs constantly on the scalp.
The hair is thin and the natural gloss is not present. Itching
and reddening of.
• Medical management
• Topical therapies for mild disease
• Best initial therapy: emollients and non-
medical shampoos (zinc containing)
• Low-potency topical steroids (e.g.,
hydrocortisone)
• Topical antifungals (e.g., ketoconazole or
selenium sulfide)
• selenium or zinc pyrithione or tar
shampoo
• Systemic therapies for severe or resistant
disease
• oral antifungals (e.g., ketoconazole)
• oral steroids
