Tuesday, April 29

Types of alopecia

Alopecia causes › Different types of alopecia
what are the types of alopecia?
Alopecia is loss of hair from the head and body. Alopecia can be broadly grouped into familial (genetic) type or acquired type.
Androgenetic Alopecia and its subgroups come under genetic types. The androgenetic hair loss tend to run in families. Alopecia areata, an autoimmune disorder, appear to have genetic predisposition in some cases.

Acquired baldness encompasses all other types of hair loss. Acquired alopecia is further categorized with respect to the causative factors and the extent of affliction. The triggering factors include certain medical conditions, diseases, febrile illness, psychological disorders, chemicals, cancer chemotherapy, parturition and habits. Certain types of alopecia disappear on their own whereas some types have no cure. Identifying the type of hair loss is essential for an effective treatment.

Androgenetic Alopecia

Androgenetic alopecia is a common type of androgen induced hair loss disorder affecting genetically predisposed men and women. The genetic predisposition and the presence of increased androgen gradually convert terminal hair into short, fine, light-colored, and barely noticeable . Androgenic hormones have different effect on follicles at different areas of the body.
diffuse type of alopecia
Hair loss
Androgens stimulate growth of terminal hair on the face, armpits and pubic area on reaching puberty. The same type of androgens lead to catagenic miniaturization and dormancy of follicles on the scalp and temples. Early androgenic alopecia is associated with insulin resistance and metabolic syndrome.
Male pattern hair loss
Androgenic loss of hair in men begins above the temples, frontal hairline and vertex. With advancing age a rim of hair at the sides and rear of the head remains. In some rare cases it can progress into total loss of hair. Though loss of hair may cause psychological stress due to its effect on appearance, men are able to cope and retain integrity of personality. In Hamilton–Norwood scale of classification of hair loss in men, the progression is graded from type I to VII.
  • Dr. James Hamilton introduced the measurement scale in 1951 and it was later revised and updated by Dr O'Tar Norwood in the 1975. Hamilton-Norwood scale is frequently used for clinically assessing the severity of androgenetic alopecia in men.
    Female pattern hair loss
    Female pattern hair loss is becoming more common and the prevalence increases with advancing age. In female pattern there is thinning of hair all over the head. However unlike the male pattern, the frontal hairline does not recede. Further, in female pattern very rarely there is total loss of hair. Female pattern is considered androgenetic type if there is androgen increase. Affected women suffer psychological distress and their social life is impaired. In Ludwig's classification of hair loss in women, the progression is graded as minimal (type I), moderate (type II), and severe (type III).

    Alopecia areata

    Alopecia areata typically appears as small round patches of hair loss with underlying smooth unscarred skin. It is a non contagious disorder believed to be caused by autoimmunity. The body's immune system attacks its own anagen hair follicles, suppressing or stopping hair growth in the affected area of skin. This type of loss of hair can appear on scalp, beard or any other hair bearing part of the body. In many cases the hair grows back after a few months or years. In some rare cases hair loss may progress to cause total loss of hair on the head or total loss of hair all over the body including head.
    Alopecia totalis
    (AAT) is a rare severe hair loss. In this type there is total loss of hair on the head. Autoimmunity is considered to be the cause of this disorder. In many cases the hair regrows. Methotrexate, an antimetabolite and antifolate drug used for some autoimmune diseases and cancer may suppress the disorder.
    Alopecia universalis
    (AAU) is also a rare and severe hair loss. In this type hair fall is rapid and there is total hair loss from the body including head, eyelashes and eyebrows. The condition may appear at any age and in both the genders. The condition may resolve fast and the hair may start regrowing. In some individuals the regrowth may start after several years and in some it may not regrow at all. AAU is believed to be a autoimmune disorder.
    Alopecia barbae
    This is a condition affecting only men wherein alopecia areata is restricted to the beard. This is again an autoimmune condition wherein the body's immune mechanism mistakenly destroys or suppresses the hair follicles.

    Alopecia mucinosa

    Alopecia mucinosa (follicular mucinosis) is rare skin disorder with characteristic hairless scaly pink, flat patches without hair on the scalp and face. When observed under microscope, mucin is seen deposited around hair follicles. The exact cause of alopecia mucinosa is not known and cell mediated immunity may be the causative factor.

    Anagen effluvium

    Anagen effluvium is loss of hair under growth phase.
  • Primarily This type of alopecia is caused by chemotherapy and radiation therapy. In most of the individuals the hair grows after the cessation of the therapy.

    Telogen effluvium

    Telogen effluvium is the loss of hair during the telogen phase (hair follicle resting phase). Usually emotional or physical stress is the cause of this type of alopecia. prolonged febrile illness, childbirth, major surgery, chemicals and drugs can be the causative factors.

    Scarring Alopecia

    Cicatricial alopecia (aka scarring alopecia) is a group of hair loss conditions wherein the hair follicles are destroyed and replaced by scar tissue. The scar may be apparent or invisible and deeper inside the skin. The hair loss is permanent. This type of alopecia can affect both men and women. The causes are inflammatory diseases affecting the hair follicles where the stem cells and sebaceous glands are located. With the destruction of stem cells and sebaceous glands there is no regeneration of follicles. Hair follicle destructive inflammatory process and external injuries such as severe scalp infections, burns, radiation, tumors, and traction are some of the causative factors.

    Traction Alopecia

    Traction Alopecia is a type of alopecia caused by application of pulling force. Wearing tight pigtails, ponytail or braids causes the hairline to recede due to constant hair pulling. Extended use of hairpiece, wig, headgear or tightly fitting safety helmet may also cause this type of alopecia.

    Trichotillomania

    Trichotillomania is hair pulling disorder. The affected individuals have a compulsive urge to pull out their own hair. In this type of alopecia patches of hair loss occur. It is a psychological disorder and may get triggered by stress and depression. Affected individuals have tendency to keep pulling hair from head, eyelashes, eyebrows, nose and hands. Most of the patients with trichotillomania do not realize that they are pulling their hair. If the disorder is present in childhood, the child may outgrow the habit. If this type of habit persists a psychiatrist may be consulted for behavioral evaluation and treatment.

    Pressure alopecia

    Pressure alopecia is often seen in infants and bedridden patients. Lying in the same position and constant pressure on the rear of the head causes alopecia.

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    Imagesource: http://en.wikipedia.org/wiki/File:Alopecia.jpg
    Author: Welshsk | License: CC BY 3.0
    Reference:
    1.Camacho-Martínez FM. Hair loss in women. Semin Cutan Med Surg. 2009 Mar;28(1):19-32. doi: 10.1016/j.sder.2009.01.001.
    2.Banka N, Bunagan MJ, Shapiro J. Pattern hair loss in men: diagnosis and medical treatment. Dermatol Clin. 2013 Jan;31(1):129-40. doi: 10.1016/j.det.2012.08.003. Epub 2012 Sep 21.
    3.Sinclair R, Patel M, Dawson TL Jr, Yazdabadi A, Yip L, Perez A, Rufaut NW. Hair loss in women: medical and cosmetic approaches to increase scalp hair fullness. Br J Dermatol. 2011 Dec;165 Suppl 3:12-8. doi: 10.1111/j.1365-2133.2011.10630.
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    Post inflammatory hypopigmentation

    Post inflammatory hypopigmentation - Causes and treatment
    What is post inflammatory hypopigmentation?
    Hypopigmentation is the partial or total loss of skin pigment.
    Many inflammatory skin conditions lead to hypopigmentation, post cessation of the inflammation. Skin inflammation is caused by skin injuries, reactions, infections and dermatological procedures. In most of the cases, the hypopigmentation improves with the resolution of the causative factor. For complete recovery and repigmentation, it may take several days to several months.

    Post inflammatory hypopigmentation is very common and appears post skin inflammation. It can affect both the genders of all ages. In persons with darker skin tone it becomes over emphasized. Basically the depigmentation occurs due to loss of melanin pigment, inhibition of melanogenesis, dysfunction of melanocytes, or loss of melanocytes. If there is complete destruction of melanocytes or melanocyte death, the post inflammatory hypopigmentation may become permanent. The size, shape and distribution of hypopigmentation is directly related to original causative inflammation.

    Causes of post inflammatory hypopigmentation

    The causes of post inflammatory hypopigmentation [1] include many inflammatory skin conditions, skin trauma and injuries, dermatological procedures and infective diseases.
    Skin injuries and trauma
    Abrasions (grazes)
    Avulsions
    Burns
    Crush injury
    Freezing
    Hematomas
    Incisions (cuts)
    Insect bites
    Lacerations
    Puncture and penetration wounds
    Surgical incision closures
    Skin inflammatory conditions
    Allergic contact dermatitis
    Atopic dermatitis
    Bullous pemphigoid
    Discoid lupus erythematosus
    Eczema
    Granuloma annulare
    Lichen planus
    Lichen striatus
    Psoriasis
    Scleroderma
    Seborrheic eczema
    Skin infections and diseases
    Acne
    Carbuncle
    Cellulitis
    Chickenpox
    Cutaneous candidiasis
    Herpes simplex
    Herpes zoster (shingles)
    Impetigo
    Tinea Versicolor
    Dermatological procedures
    Chemical peels
    Cryotherapy
    Dermabrasion
    Dermaplaning
    Laser resurfacing
    Laser therapy
    Microdermabrasion
    Punch grafts
    Tattoos

    Post inflammatory hypopigmentation treatment and management

  • The primary cause of the post inflammatory hypopigmentation must be diagnosed and treated. In many cases the hypopigmentation improves over time post resolution of the inflammation. The treatment and management options of post inflammatory hypopigmentation include sun exposure, phototherapy, topical repigmenting medication, laser therapy, camouflage procedures, skin transplants and autologous melanocyte transplantation.

    Coal tar topical preparations have been successively used for stimulating repigmentation. Coal tar causes increased skin sensitivity to sunlight, so treated area should be protected from sunlight. Coal tar in combination with topical steroid has been found to be more effective.

  • Topical pimecrolimus is an immunomodulating agent found useful in treating atopic dermatitis which results in repigmentation. Long term use of the topical application is considered to have increased risk of lymph node or skin cancer.

    Exposure to sunlight or phototherapy with ultraviolet light induces the melanogenesis. The dose of exposure must be closely monitored so as not cause sunburn or tan.

    Choi KH et al [2] in their study "Treatment of Vitiligo with 308-nm xenon-chloride excimer laser: therapeutic efficacy of different initial doses according to treatment areas"
  • concluded that 308-nm xenon-chloride excimer laser was effective in inducing repigmentation of the hypopigmentation patches of vitiligo.

    Camouflage procedures like tattoo had been successfully used to cover small areas of post inflammatory hypopigmentation.

    In cases where the melanocyte loss is permanent, skin transplants and autologous melanocyte transplantation have been successfully done to manage post inflammatory hypopigmentation. In autologous melanocyte transplantation, cultured melanocytes are introduced into the hypopigmentation skin.

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    Reference:
    1.Vachiramon, V. and Thadanipon, K. (2011), Postinflammatory hypopigmentation. Clinical and Experimental Dermatology, 36: 708–714. doi: 10.1111/j.1365-2230.2011.04088.
    2.Choi KH, Park JH, Ro YS. Treatment of Vitiligo with 308-nm xenon-chloride excimer laser: therapeutic efficacy of different initial doses according to treatment areas. J Dermatol. 2004 Apr;31(4):284-92.

    Current topic on natural skin care: Post inflammatory hypopigmentation
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    Monday, April 28

    Nevus anemicus - Congenital skin nevus

    Nevus anemicus
    What is nevus anemicus?
    Nevus anemicus is a rare congenital skin anomaly present at birth or in early childhood.
    The nevus is more prevalent in women than men. The skin anomaly persists lifelong. It is asymptomatic, neither causing nor exhibiting any symptoms. The macules appear blanched with respect to surrounding skin. The patches are ill-defined having no particular shape or size. Large nevus patches may have small patches of normal skin in between them.

    These macules are usually localized appearing mostly on the trunk. A rare case of generalized form had been reported. The anomaly is more prevalent in patients with neurofibromatosis type I. Nevus anemicus was first described by Hans Vorner in the year 1906. He demonstrated that there was reduced dermographism in the nevus when compared to normal surrounding area.

    Causes

    Nevus anemicus is not a hypopigmentation disorder. In hypopigmentation disorders there is absence or decrease of melanin skin pigment.
  • In this anomaly there is normal pigmentation. The pallor is due to localized decreased blood supply to the skin caused by constriction of blood vessels. In this congenital anomaly of vasculature, there is localized vasoconstriction caused by hypersensitivity to catecholamines.

    Differential diagnosis

    The lesions can be differentiated easily from other hypopigmented lesions with loss of melanin. To differentiate from vitiligo and other hypopigmentation disorders, diascopy, a test for blanchability, is performed on the lesion by applying pressure with a glass slide to observing color changes.
  • On application of pressure, the lesion becomes indistinguishable from the surrounding skin.
  • Under Wood's lamp, unlike fungal infections and hypomelanosis disorders, the macules do not become more emphasized.
  • The macules, unlike the surrounding normal skin, do not show erythematous responses or change color on rubbing, heating or cooling.
  • Histological studies reveal normal pigmentation of the epidermis with no decrease in pigment or melanocytes when compared to the surrounding area.

  • Treatment

    There is no cure for this anomaly. Most of the lesions appear in covered areas of the body. If the macules are present in uncovered area of the skin, for cosmetic purposes camouflaging makeup may be tried.

    Nevus anemicus diagnostic value in Neurofibromatosis type I patients

    nevus anemicus
    nevus anemicus on leg
    Faustine Ferrari et al [1] in their study on diagnosis of Neurofibromatosis type I (NF1), have found that in 72% NF1 cases nevus anemicus was present on the chest and neck. A high frequency of NA in patients with NF1 was observed, especially in children younger than 2 years. They concluded that "NA appear helpful in improving early diagnosis of NF1 in young children and infants."

    Acquired nevus anemicus?

    The anomaly is generally considered congenital and non familial. However, Suhyun Cho et al [2] reported a case of the appearance of pale patch on the neck, one month after a cyst excision in a 53-year-old man. Application of pressure made the patch indistinguishable from the surrounding skin. Rubbing the lesion area made it appear clearly paler than the surrounding reddened area. Application of cold or heat did not induce any change in the lesion. The authors postulate that "the acquired anemic patch that developed after a cyst excision in this case can be explained as a variant of nevus anemicus."
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    References:
    1.Ferrari F, Masurel A, Olivier-Faivre L, Vabres P4. Juvenile xanthogranuloma and nevus anemicus in the diagnosis of neurofibromatosis type 1. JAMA Dermatol. 2014 Jan;150(1):42-6.
    2.Suhyun Cho, Jeong Eun Do, Sang Ho Oh. Acquired Anemic Patch Developed after a Cyst Excision: Is It a Variant of Nevus Anemicus?. Ann Dermatol. Feb 2012; 24(1): 84–86.
    Image source: http://en.wikipedia.org/
    Image author: Birthmarkshare | License: Public domain
    Current topic in natural skin care: What is nevus anemicus?
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    Saturday, April 19

    What is alopecia - Definition of alopecia - Hair loss

    What is alopecia hair loss and its definition
    What is alopecia?
    Alopecia is the medical term for loss of hair from any part of the body.
    Alopecia means generalized hair loss as patches or total in hairy parts of the body such as head, chin, eyebrows or eyelashes. Unlike alopecia, baldness is specific to head and is usually defined as the condition of having no hair on the top of the head. The pattern of hairlessness may be focal, multifocal, symmetric, or generalized.
    Definition of alopecia
    thefreedictionary.com definition: "Alopecia simply means hair loss (baldness)."
    merriam-webster.com definition: "loss of hair, wool, or feathers :  baldness."
    National Library of Medicine definition: "Partial or complete loss of hair is called alopecia."

    What are the types of alopecia?

    The condition can be broadly categorized into genetic and acquired types. Types with genetic predisposition are:
    • Androgenetic alopecia is male pattern and female pattern baldness.
    • Alopecia areata is a condition caused by autoimmune disorders.
    • A. universalis is total hairlessness on the head, eyebrows, eyelashes and body.
    • In a. totalis there is total baldness of the head.
    Acquired baldness encompasses all other types of hairlessness:
    Hair loss
    • Trichotillomania is a psychological disorder in which the patient develops the compulsive urge to pull out his own hair.
    • Telogen effluvium is rapid excessive hair loss brought about by stress factors such as parturition, febrile illness, major surgery, poisoning, and psychological stress.
    • Anagen effluvium is the loss of the growth phase, usually brought about by cancer chemotherapy.

    What are alopecia symptoms?

  • There are several symptoms denoting the presence of this problem. Early symptoms include unusual thinning and shedding while brushing and washing. Appearance of bald patches, thinning of eyebrows, thinning of eyelashes, presence of dandruff, skin lesions and skin scarring are some of the signs and symptoms.

    What are the causes of alopecia?

    Causes of hairlessness are not completely understood and can be caused by several factors.
    Anorexia nervosa,
    autoimmune disorder,
    burns,
    fungal infection,
    chemotherapy,
    chronic debilitating illness,
    extreme physical stress,
    genetic predisposition,
    heavy metal poisoning,
    hormonal effects,
    thyroid diseases,
    nutritional deficiencies,
    parturition,
    psychological disorder,
    psychological stress,
    radiotherapy,
    sudden blood loss,
    seborrheic dermatitis and
    traumatic damage are some of the known triggering factors.

    Alopecia treatment and management

  • There is limited success in the treatment of hairlessness. Medications like finasteride, dutasteride and minoxidil have been found to effective in preventing further loss of hair and with limited success in stimulating regrowth. Periodical corticosteroid injections are also given in the scalp to prevent the progression of the condition.

    Minoxidil, a nonprescription topical medication, is found to effective in treating male and female pattern baldness. Finasteride is an oral medication to be taken daily to get results. With the discontinuance of medication the loss may resume. There are many side effects. Expensive procedures like follicle transplants and hair transplants can be done with great success.

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    Imagesource: http://en.wikipedia.org/wiki/File:Alopecia.jpg
    Author: Welshsk | License: CC BY 3.0
    Current topic in natural skin care: What is alopecia hair loss and its definition.
    Get fair glowing skin complexion. Remove acne scars and blemishes from face.