Characteristic clinical signs of myxoedema are changes in the texture of the hair as well as alopecia of the scalp, eyebrow and other body hair.
This type of temporary hair loss has been attributed to the toxic effects of anti-thyroid drugs such as carbimazole and propylthiouracil. After replacement therapy with thyroid hormone hair growth resumes. Male-pattern baldness may be treated medically with either oral finasteride or topical minoxidil, with the latter also used for female-pattern baldness. Depending on the cause, several treatment options are available for alopecia areata including steroid injections, which are the most effective steroid treatment, or steroid creams or ointments.
If there is a link to an autoimmune disease, anti-inflammatory drugs injections, pills or cream or immunotherapy can be used to treat the condition and to help the hair grow back.
Immunotherapy involves the creation of an intentional allergic reaction on the affected areas of skin to stimulate hair growth. Patients will then need to be monitored through treatment as everything depends on how the body and immune system react to the treatment and whether hair loss is stemmed or not.
In many cases hair will grow back within a few months. Surgical options include hair transplants. These techniques are performed under local anaesthesia and the transplant process usually takes four to six hours. Some recent advances in hair transplant surgery include the use of Platelet Rich Plasma PRP with the aim of increasing the survivability of the hair following a hair transplant to improve future growth.
Topical minoxidil is a hair regrowth medicine used for treating pattern baldness in men, and thinning hair and hair loss in women. Several studies have shown that topical minoxidil yields successful results in women. Minoxidil stimulates hair growth and results can be observed between three to six months after the start of treatment.
Minoxidil is not recommended for those under 18 years of age. In general, hair loss is often the symptom of the natural ageing process and does not pose a health risk, but it can be distressing and may be the result of other underlying causes so patients should see their GP if they have concerns. GPs can easily diagnose the type of hair loss via examination and, if necessary, screen for systemic diseases then make suitable recommendations regarding the various treatment options available, or refer them to a specialist dermatologist.
If a patient wants to treat hair loss for aesthetic reasons, GPs can refer them to a specialist to discuss patient suitability for hair transplantation. Telogen effluvium , an extremely common form of alopecia, is a condition that causes hair to shed excessively and can be caused by a number of factors.
Causes include sex hormone imbalances, which can occur due to a variety of reasons such as pregnancy, menopause, toxins or an unbalanced lifestyle, which can be diagnosed through blood tests. Other reasons may include reactions to medications, short or long-term illnesses or psychological issues as stress, dietary problems or other external factors.
If the root cause can be isolated, the best method is to treat that condition — for example, by using stress reduction techniques or mental health advice, or supplements or dietary advice if a dietary deficiency appears on a blood test.
A deficiency in thyroid hormones can be treated with hormone supplements. A Thinning hair in females caused by the effects of male hormones androgens is called androgenic alopecia and is frequently observed in women with polycystic ovary syndrome PCOS , congenital adrenal hyperplasia, and other conditions of excessive male hormones.
The medical management of baldness associated with PCOS consists of a number of options of combination therapy. Options commonly used include oral contraceptive OCP in combination with spironolactone, Diane, OCP in combination with finasteride, OCP with flutamide, multiple drug modalities or in combination with minoxidil.
Medical management of hair loss in relation to PCOS can be much more difficult than some of the others problems related to PCOS, such as acne or hirsutism, and a combination of drugs is likely only to slow the progress of androgenetic alopecia rather than reversing it. A first step is to control the overproduction of male hormones before further treatment for baldness.
Finasteride works by preventing testosterone an androgen from becoming a stronger form of testosterone inside the cells. Few side effects have been reported by the NHS when finasteride is used in women. To prevent breakage, hairstyles that pull on the hair, such as cornrows, tight ponytails, and braids, should be avoided. Treatment varies according to the type or cause of alopecia. As mentioned previously, hair regrowth often occurs without pharmacologic intervention.
In some instances, medications may be warranted. Commonly used pharmacologic options include minoxidil and corticosteroids, and other medications are being investigated for use in females. Any underlying causes should be corrected. For example, in the case of alopecia related to iron deficiency, the underlying deficiency must be corrected before pharmacologic measures for hair loss are initiated. Minoxidil: This drug is indicated for androgenetic alopecia in males and females.
Although its exact mechanism is unclear, minoxidil prolongs the growth phase of the hair cycle and increases the size of hair follicles. Additionally, minoxidil maintains and thickens the hair already present.
While some patients may see immediate results, others may require at least 4 months of therapy. Patients should be counseled to apply the minoxidil solution to a clean, dry scalp and to wait 4 hours before allowing any water to contact the scalp. The minoxidil solution should dry completely prior to the application of any styling agents, such as gel, mousse, or spray. The minoxidil must be completely washed from the hair and scalp before any color treatments, permanent solutions, or hair relaxers are applied.
Corticosteroids: High-dose corticosteroids, although not curative, have been used off label for management of alopecia areata when spontaneous remission does not occur. Corticosteroids may be administered topically, orally, intralesionally injected directly into the affected area , or IV.
Not all patients respond to corticosteroid treatment. If there is a response, minoxidil may be used in conjunction with the corticosteroid therapy to help prevent relapses. Topical preparations such as triamcinolone acetate are associated with the fewest adverse events. The most common adverse event with topical therapy is folliculitis. Oral prednisone given at mg per week for 3 months is sometimes used. However, this therapy is usually avoided because of the increased incidence of adverse events.
Triamcinolone acetate is administered every 2 to 6 weeks as an intralesional injection. This therapy has a high response rate approximately two-thirds of patients compared with other routes of administration. Common adverse events include pain, localized skin atrophy, and skin depigmentation. High-dose IV methylprednisolone may be used in more extensive cases of alopecia areata.
It is administered at a dosage of mg for 3 consecutive days. Regardless of the route of administration, all corticosteroid therapies are associated with a high rate of relapse.
Additional Management Options: Several pharmacologic options are under investigation for use in female alopecia. Finasteride 1 mg Propecia is a 5-alpha-reductase inhibitor used in male-pattern baldness. Research is ongoing about its possible use in females, but its use in females may be limited owing to its contraindication in women of reproductive age. This approach is more commonly used in Europe, and large peer-reviewed studies showing efficacy are lacking.
Aromatherapy involving the combination of oils such as lavender, thyme, rosemary, and cedarwood has been studied for use in patients with alopecia areata. Hair loss can be a traumatic experience for many females.
The psychological impact in females tends to be greater than in males, because females often place more importance on their physical appearance than do males. It is also more socially acceptable and understood when hair loss occurs in males, since hair loss is more recognized in this population.
Females often utilize hair as a way to alter and enhance their physical appearance, through changing style, length, or color. When hair loss occurs, the ability to alter hair is compromised.
The investigational study mentioned above found that females suffering from hair loss tend to have a less positive body image, more social anxiety, poorer self-esteem, and decreased quality of life compared with females without hair loss.
It is important to understand that not all females will be affected by alopecia to the same degree. Some females may more easily accept hair loss and be less bothered by it. Other females may find it extremely unsettling, even to the point of trauma resulting in psychological illness e. Female patients have different ways of coping with alopecia.
Patients may choose to wear eye-catching clothing, jewelry, or makeup to draw attention away from the scalp. Another method is to conceal the area of hair loss with accessories such as hats, scarves, and wigs. Alopecia is a significant problem for many females that should not be casually disregarded. Whether or not a patient decides to utilize pharmacologic treatment, there are minimization strategies that can help reduce hair loss.
Therefore, it is important to address both the medical and the emotional health needs of female patients with alopecia. American Academy of Dermatology.
Hair loss. The cause of focal hair loss may be diagnosed by the appearance of the patch and examination for fungal agents. A scalp biopsy may be necessary if the cause of hair loss is unclear.
Alopecia areata presents with smooth hairless patches, which have a high spontaneous rate of resolution. Tinea capitis causes patches of alopecia that may be erythematous and scaly.
Male and female pattern hair losses have recognizable patterns and can be treated with topical minoxidil, and also with finasteride in men. Sudden loss of hair is usually telogen effluvium, but can also be diffuse alopecia areata. In telogen effluvium, once the precipitating cause is removed, the hair will regrow.
Hair loss is a common problem that affects up to 50 percent of men and women throughout their lives. Family physicians need to be able to distinguish hair loss that represents true disease from the more common age-related hair loss. Hair loss is commonly categorized into scarring and nonscarring alopecia. Scarring alopecia is rare, and most cases of hair loss seen in primary care will be nonscarring. Hair loss on the scalp can be further classified as focal or diffuse.
This distinction is the first step in diagnosis. In alopecia areata, there is no long-term benefit of topical steroids, minoxidil Rogaine , cyclosporine, oral steroids, or photodynamic therapy. Women presenting with hair loss associated with abnormal menses, history of infertility, hirsutism, unresponsive cystic acne, virilization, or galactorrhea should have a targeted endocrine work-up i. Discontinuation of finasteride or minoxidil results in loss of any positive effects of treatment hair growth in 12 and six months, respectively.
The causes of hair loss can be broadly divided into focal or diffuse hair loss Table 1. Focal hair loss is secondary to an underlying disorder that may cause nonscarring or scarring alopecia.
Nonscarring focal alopecia is usually caused by tinea capitis or alopecia areata, although patchy hair loss may also be caused by traction alopecia or trichotillomania. Scarring alopecia is rare and has a number of causes, usually discoid lupus erythematosus. Diffuse hair loss can be further categorized into conditions that cause hair shedding, of which the most common is telogen effluvium, and predominant hair thinning caused by male or female pattern hair loss previously called androgenetic alopecia.
Female pattern hair loss. Presents with hair thinning; frontal hairline intact; negative pull test away from hair loss. Alopecia areata. Tinea capitis. Traction alopecia. Alopecia areata is characterized by areas of nonscarring hair loss that range from single oval patches to multiple patches that can become confluent. Men and women are equally affected, and, although it can occur at any age, the most common presentation is in children and young adults, with 30 to 48 percent of patients affected before 20 years of age.
In case series, alopecia totalis and universalis are less common than alopecia areata and account for 4. The lifetime risk of developing alopecia areata is 1. In most studies, 20 to 42 percent of those affected have a family history of the disease. Alopecia is associated with autoimmune conditions, such as vitiligo, diabetes, thyroid disease, rheumatoid arthritis, and discoid lupus erythematosus. Patients with a history of atopy are also at an increased risk of developing alopecia.
The patient with alopecia areata Figure 1 typically presents with bald patches on the scalp that often have developed rapidly with sudden loss of hair. In diffuse alopecia, there is more widespread hair loss, often associated with graying of the hair. The classic finding is a smooth, hairless patch surrounded by so-called exclamation point hairs. These are 2- to 3-mm broken hairs that have a club-shaped root with a thinner proximal shaft and a normal caliber distal shaft on microscopic examination Figure 2.
Exclamation point hair showing distal broken end of shaft and proximal club-shaped hair root. Treatment may induce hair growth, but usually does not change the course of the disease.
When treatment is stopped, hair loss recurs. Many patients with one or two small patches can be managed without treatment and with reassurance of the benign nature of the condition. A systematic review of 17 randomized controlled trials of topical and oral steroids, topical minoxidil Rogaine , topical cyclosporine, and photo-dynamic therapy found no long-term benefit of these interventions.
Evidence for short-term growth, but none for long-term growth 5. Unlicensed treatment; may cause severe dermatitis 7. Continued treatment is needed to maintain hair growth; risks of prolonged steroid use outweighs the benefits 6. Triamcinolone acetonide Kenalog 5 to 10 mg per mL; 0. Hair regrowth lasts a few months; effect on long-term outcome is unknown 6.
Hair staining prevents use in fair-haired patients 6. Treatment for one year resulted in a modest improvement in alopecia; 32 percent of participants experienced elevated liver function tests while taking the medication, resulting in some safety concerns Promotes hair growth for more than two years, with the effect waning by year three 12 , 13 ; does not significantly affect sperm production and poses no risk to a female sex partner; when screening men on finasteride for prostate cancer, the upper limit of normal prostate specific antigen levels should be doubled to ensure appropriate interpretation 14 , Consistent evidence showing moderate to dense regrowth of hair Increased hair density, size, and proportion of anagen follicles after shampooing two to four times per week for 21 weeks Information from references 5 through Children are most likely to be affected by tinea capitis and typically present with a round patch of hair loss, often with scaling, erythema, and lymphadenopathy.
In a study of the predictive signs and symptoms of tinea capitis in children, those with occipital adenopathy were more likely to have cultures positive for fungi positive likelihood ratio of 7.
Skin scrapings can also be sent for fungal culture, but this is less helpful because the fungi can take up to six weeks to grow. Tinea is caused by the microsporum species, which fluoresces under a Wood lamp; however, in the United States, most tinea is caused by trichophyton, which does not fluoresce, so this test is less useful.
In its most severe form, tinea capitis causes a boggy inflammatory mass called a kerion, which may heal with scarring and subsequent localized alopecia. Tinea capitis can be treated with oral terbinafine Lamisil , fluconazole Diflucan , itraconazole Sporanox , or griseofulvin Grifulvin ; topical treatments by themselves are not effective. Dosing of griseofulvin is 10 to 20 mg per kg per day for six to eight weeks in children 21 or mg per day for six to eight weeks in adults.
Traction alopecia is a form of unintentional hair loss associated with specific social, cultural, and cosmetic practices. Patients primarily women wearing wigs, tight braids, or using curling rollers are at risk. Hair processing including bleaching, coloring, and waving also puts patients at risk. Hair loss usually occurs in the frontotemporal area, although it can vary. Eliminating the stressor or source of traction on the hair commonly cures the problem and returns hair growth to normal.
Trichotillomania is a psychiatric compulsive disorder that involves repeated hair plucking. It is most common in children, but may persist into adulthood. On close inspection, twisted and broken off hairs are visible in patchy areas across the scalp. In chronic cases, scarring alopecia may result. Cicatricial or scarring alopecia causes permanent hair loss from destruction of the hair follicles by inflammatory or autoimmune diseases.
The most common cause of this is discoid lupus erythematosus, which produces atrophied erythematous patches, sometimes with telangiectasia. Telogen effluvium occurs when an increased number of hairs enter the telogen resting phase of the hair cycle from the anagen growing phase, and these hairs are lost approximately three months later.
Usually, an average of hairs are lost each day, but this becomes significantly more in telogen effluvium, in which 30 to 50 percent of body hair can be lost. Telogen effluvium may be precipitated by severe illness, injury, infection, surgery, crash diets, psychological stress, giving birth, thyroid disorders, iron deficiency, anemia, or drugs.
Hyperthyroidism and hypothyroidism can cause telogen effluvium, which is usually reversible when the thyroid status is corrected except in long-standing hypothyroidism. Severe iron deficiency anemia may be associated with it, but this remains controversial. No cause is found in approximately one third of cases. Patients with telogen effluvium usually present with an increased number of hairs in their hairbrush or shower, and sometimes thinning of the hair in the scalp, axillary, and pubic areas.
A detailed history may indicate the cause of the hair loss, which usually has occurred two or three months before the hair falls out. On examination, there is generalized hair loss with a positive hair pull test, indicating active hair shedding, particularly at the vertex and scalp margin. The hair pull test is done by grasping approximately 40 to 60 hairs between the thumb and fore-finger and applying steady traction slightly stretching the scalp as you slide your fingers along the length of the hair.
Generally, only a few hairs in the telogen phase can be plucked in this fashion. Less than 10 percent is considered normal, whereas greater than this is considered indicative of a pathologic process.
0コメント