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ALOPECIA
Rhett J. Drugge, MD
Internet Dermatology Society
Stamford, Connecticut
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Alopecia
areata
(patient
advocates ) This is a moderately easy to diagnose with generally
a good prognosis except in marginal ophiasis (poor). It can be
treated by a variety of methods. Intracutaneous injection of dilute
suspensions of Kenalog is the method of choice. This can be done with
ethyl chloride (Fluoroethyl) spray prior to the quick insertion of 1
cc/sq. in. (50-50 dilution with water). Repeat it monthly for 3
months, and if this does not grow hair, then switch to daily
application of anthralin or contact sensitization with dibutyl
squaric acid 1% solution. Many patients give a family history.
Occasional cases progress to alopecia totalis or
universalis
.
Androgenic Alopecia. -- Diffuse
hair loss is a very common and insidious thinning of the vertex and
frontal scalp in young or middle-aged women who have both male and
female relatives demonstrating partial baldness. There is often
seborrhea. Preservation of the frontal hairline is much more common
in women than in men. Topical minoxidil 2% solution applied twice
daily may be of benefit.
Telogen
effluvium:
Hyperthyroidism
Follicular
degeneration syndrome in black patients
Folliculitis Decalvans
(sycosis of the scalp). -- This condition sometimes responds to
Betadine shampoo, systemic antibiotics over a long period of time,
and locally applied antibiotic creams at night as
well.
Perifolliculitis
capitis abscedens et suffodiens. -- this is a tunneling pyoderma
like hidradenitis suppurativa, and it responds to similar treatment.
Lupus erythematosus. --
Chronic cutaneous (discoid) lupus may respond to intralesional
corticosteroids or antimalarials.
Fungal Kerion. -- the scarring induced by a kerion is often
permanent.
Scleroderma. -- the striking
form, coup de sabre, often induces follicular loss.
Nevus Sebaceous.-- this is a orange-yellow birthmark which becomes warty with puberty and often degenerates to carcinomas of various types. Surgical removal is advised.
At puberty and menopause, was well as during pregnancy, there may be temporary spurts in hair growth, which often are self-correcting. There are certain families who are hirsute, and all their endocrine studies are normal. There are other cases of hirsutism, however, associated with acne, menstrual disorder, obesity and even, on occasion, hypertension, where an endocrine explanation has to be considered. Cushing's syndrome, adrenal virilism, polycystic ovary (Stein-Leventhal syndrome), ovarian tumors and basophilic adenoma of the pituitary are some of the entities producing hirsutism. Elevation of the entities producing hirsutism. Elevation of the urinary 17-ketosteroid level indicates that an endocrine testis needed. Treatment. -- Shaving with an electric razor is often suitable for elderly women with bristles. Depilatories, applied for a definite time and then washed off, destroy the hair chemically, though they can be irritating to the skin. Plucking is the usual method, although poor eyesight and inaccurate plucking may lead to inflamed papules and scarring. Electrolysis is tedious with the galvanic current, and the diathermy can leave pits. however, a skilled operator can achieve satisfactory results if the work is repeated carefully. Wax depilatories strip the hair off by pulling it out. Bleaching with peroxide and ammonia, equal parts, produces transparent bleached hair that sometimes is acceptable cosmetically.
This document is a resource from the
Internet Dermatology Society
Send your comments to:
Rhett Drugge, M.D.
Last update: September 8, 1996
