Discontinuation of finasteride or minoxidil results in loss of any positive effects on hair growth within 12 and six months, respectively. Begin by determining if hair loss is focal or diffuse; if focal, look for scarring. Patients with scarring should be referred to a dermatologist. In nonscarring focal alopecia, alopecia areata or tinea capitis are most common. In alopecia areata, the lesion is round and smooth, whereas in tinea capitis, the skin can look slightly scaly and erythematous, and there may be occipital adenopathy.
A scraping of the lesion to evaluate for fungi may help. Traction alopecia and trichotillomania tend to cause more patchy hair loss and can usually be determined from the history. Consider a scalp biopsy if the diagnosis of the focal hair loss is not clear.
In diffuse hair loss, ask if the loss is predominantly hair thinning or shedding, if there is a relationship to any inciting event, and if there are symptoms of anemia, hyperandrogenism, or thyroid disease. The patient who presents with gradual hair thinning most likely has male or female pattern hair loss recognized by the typical patterns.
The hair pull test will be positive where the hair is thinning, but negative away from the thinning areas. Patients with hair shedding may have telogen effluvium or diffuse alopecia areata, both of which cause a positive hair pull test.
The history may reveal the precipitating event in telogen effluvium, whereas patients with alopecia areata may have exclamation point hairs. In all patients with diffuse hair loss, serum ferritin and thyroid function tests should be ordered. Patients with suspected telogen effluvium can be observed until spontaneous resolution occurs, usually within six months, provided the provoking stimulus has been removed. If hair loss does not resolve, a scalp biopsy to differentiate between alopecia areata, telogen effluvium, and male or female pattern hair loss should be obtained.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. SEAN W. Address correspondence to Anne L. Reprints are not available from the authors. Price VH. Treatment of hair loss. N Engl J Med. Incidence of alopecia areata in Olmsted County, Minnesota, through Mayo Clin Proc. Profile of alopecia areata: a questionnaire analysis of patient and family.
Int J Dermatol. The pathogenesis of alopecia areata. Dermatol Clin. Interventions for alopecia areata. Cochrane Database Syst Rev. Guidelines for the management of alopecia areata. Br J Dermatol. Efficacy of topical sensitizers in the treatment of alopecia areata. J Am Acad Dermatol. Androgenetic alopecia in the female. Arch Dermatol.
Dawber RP, Rundegren J. Hypertrichosis in females applying minoxidil topical solution and in normal controls. J Eur Acad Dermatol Venereol.
Treatment of female pattern hair loss with oral antiandrogens. Carmina E, Lobo RA. Treatment of hyperandrogenic alopecia in women. Fertil Steril. Finasteride in the treatment of men with frontal male pattern hair loss.
Finasteride in the treatment of men with androgenetic alopecia. Chronic treatment with finasteride daily does not affect spermatogenesis or semen production in young men. J Urol. Biologic variability of prostate-specific antigen and its usefulness as a marker for prostate cancer: effects of finasteride.
Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Alopecia areata: a long term follow-up study of patients. Hubbard TW. The predictive value of symptoms in diagnosing childhood tinea capitis. Arch Pediatr Adolesc Med. Systemic antifungal therapy for tinea capitis in children. Guidelines for the management of tinea capitis.
British Association of Dermatologists. Terbinafine in the treatment of Trichophyton tinea capitis: a randomized, double-blind, parallel-group, duration-finding study. Report of two cases. Read our updated information about wearing a mask for your visit , and our visitor policy.
NYU Langone dermatologists are experienced in recognizing the signs of hair loss, whether the cause is genetic, medical, or environmental. If your doctor suspects that an underlying medical condition may be the cause of hair loss, a blood test or scalp biopsy may be recommended. To determine the cause of hair loss, your dermatologist asks a variety of questions about when hair loss began, what the patterns of hair loss are, what kind of hairstyles you usually wear, whether hair loss runs in your family, and other details about your symptoms.
He or she may ask about any other medical conditions you have. Details that may seem unrelated—such as what foods you eat or whether you recently gave birth—may provide a clue about the cause of the hair loss. A dermatologist examines your scalp to check for inflammation, redness, sores, or scarring. The doctor looks closely at your hair to determine how much is being lost, the pattern of the hair loss, and whether there is hair breakage. During a physical exam, your doctor may perform simple tests to learn more about the health of your hair.
These may include the following. This simple test measures the severity of hair loss. During a pull test, a dermatologist grasps small sections of hair, about 40 strands, from different parts of the scalp and gently tugs. During a tug test, the doctor grasps a section of hair and holds it with two hands, one near the root and one near the tip, then tugs to see if any of the strands break in the middle. This test gives the dermatologist information about the brittleness or fragility of your hair strands.
A doctor may use the tug test when he or she suspects a hair shaft abnormality, which causes hair strands to thin, weaken, and possibly break. A dermatologist uses a card test to examine the health of hair shafts and to evaluate the number of new hair strands that are growing.
A scalp biopsy is a quick, simple procedure that involves removing a sample of skin from your scalp for testing and analysis. Your healthcare provider may suggest a biopsy if you have hair loss without a clear, obvious cause, or to get more information about a skin condition.
Getting a scalp biopsy typically only takes a few minutes. Your healthcare provider will recommend an appropriate treatment option based on the results of your biopsy test, your symptoms, personal needs and other factors. Worried about your scalp health? You can learn more about rashes, hair loss and other issues that may affect your scalp in our detailed guide to the most common scalp conditions.
We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice.
Always talk to your doctor about the risks and benefits of any treatment. Insider tips, early access and more. Top Treatments. Top Conditions Erectile Dysfunction. What Is a Scalp Biopsy? A biopsy can also show signs of hair damage from autoimmune conditions or scalp disorders. When Is a Scalp Biopsy Necessary? There was an increase in the expression of the anchoring fibril and collagen component antigens in the BMZ with gross thickening and protrusion into the dermis in active DLE lesions Fig 7.
Anti-type IV collagen staining in DLE with an exaggerated expression as demonstrated by thickness of the basement membrane and protrusions. LPP is a rare type of lichen planus which characteristically affects the scalp Figure 8 with perifollicular erythema, keratotic follicular spines and with patchy or diffuse hair loss which may result in scarring alopecia as its end stage.
LPP of the scalp is a scarring disease and it is difficult to treat comparing to the glabrous LP and this has major psychological consequences for the affected patients. The therapeutic management often is quite challenging, as relapses are common after local or systemic treatments. The recommended treatments are ultrapotent topical or intralesional injections of corticosteroid. Some cases may need systemic treatment including oral corticotherapy and cyclosporine.
LPP of the scalp. Histologically Fig 9 has been reported to show two different patterns [ 11 ], each pattern characterized by the presence of specific histological features that reflects the specific stage of the progression of the disease. In the first pattern, hair follicles and the perifollicular dermis were mainly involved in the pathologic process, with no involvement of the interfollicular structures.
In the second pattern, the pathologic changes extended to the interfollicular epidermis and the papillary dermis. LPP pathology. The inflammation is mainly perifollicular with some involvement of the basal cell layers which also show basal cell degeneration. Direct immunofluorescence highlights the presence of colloid bodies in the peri-infundibular area staining with IgM less frequently with IgG, IgA and C3.
By immunohistochemistry staining [ 12 ], there is a significant alteration in the basement membrane structure in lesions of LPP which could differentiate it from active lesions of scalp DLE lesions.
Interrupted expression of type IV collagen in an affected hair follicle in an LPP lesion with projections into the underlying dermis, with the adjacent epidermis showing normal expression of the collagen.
The diagnosis of this type of alopecia is usually based on a thorough history and a focused physical examination. In some patients, punch biopsy may be necessary if the cause of hair loss is unclear as has been described previously.
The focus in the following discussion will be on alopecia areata and androgenetic alopecia the skin biopsies will be needed in some of cases. Alopecia areata Fig 11 is one form of non-scarring alopecia characterize by patchy hair loss of autoimmune origin. It usually presents as a single or multiple confluent patches of non-scarring alopecia. Spontaneous regression of the disease is common in this disease and the hair may grow back if the affected region is small. Topical treatment is effective including corticosteroids clobetasol or fluocinonide, corticosteroid injections, or cream, steroid injections, topical minoxidil, irritants anthralin or topical coal tar , and topical immunotherapy.
Oral corticosteroids decrease the hair loss, but only for the period during which they are taken. Diagnostic pathological findings Fig 12 are more prominent in this type of alopecia which characterize by peribulbar lymphocytic inflammation which is usually considered to be an essential finding in establishing the diagnosis [ 13 ].
The lymphocytic. Despite this, it may be absent in many scalp biopsy specimens. In the acute stage; a moderate to dense inflammatory cell infiltrate mainly lymphocytes and langerhans cells [ 14 ] develops around anagen hair and this leads finally to anagen arrest and inhibition which weakens the lowest portion of the.
Using follicular counts [ 15 ] related to the stage of disease is a useful way to establish the histologic features of alopecia areata in scalp biopsy specimens taken from different types of alopecia areata; alopecia areata should be suspected when high percentages of telogen hairs are present, even in the absence of a peribulbar infiltrate [ 15 ].
Alopecia areata in a child presented with diffuse hair loss.
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