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AKORAH UCHE.
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OUTLINE
INTRODUCTION
ANATOMY
CLASSIFICATION
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT CONCLUSION
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INTRODUCTION
Hair follicle disorders are very common
cases in dermatological clinics. They
present in various forms. Loss of hair or
excessive hair growth causepsychological distress to the patients.
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ANATOMY
Humans have 5million hair follicles at birth.
No follicle is formed after birth, size changes
under the influence of androgen. Hair is
found on every part of the body except onthe palms, soles, penis, distal phalanges.
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Anatomy contd
The cuticle protects and holds the cortex
cells together. The pigment in hair shaft
is produced by melanocytes.
Mature hair follicle contains a hair shaft,2 surrounding shealths and a bulb
The hair follicle is divided anatomically
into 3 sections The infundibulum........extend from the
surface to sebaceous gland
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The Isthmus........from duct down to
insertion of erector muscle.
The inferior segment.......muz insertion
to base of matrix.
Hair shaft has 3 layers, an outer cuticle,
cortex and medulla. All of which are
composed of dead protein..
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TYPES OF HAIR
Hair varies in length (short or long),
thickness, colour and appearance (curly or
straight)
Hair can be: 1. Lanugo hair- fine hair covering the
fetus but shed one month before birth
2. Vellus-fine short unmedullated haircovering much of the body, replaces
lanugo. Adult form of lanugo hair
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Types of hair contd
3.Terminal- long coarse medullated hair
seen on scalp, axilla, beard and pubic
hair.
Hair grows 0.35mm per day, 1-2cm permonth
6inches per year.
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Physiology
Cycle of hair follicles depends on theinteraction of the follicular epithelium withthe dermal papilla.
Stems cells migrate out of the follicle and
regenerate the epidermis after injury Rapidly proliferating matrix cell in hair bulb
produces the hair shaft
The rigid inner root sheath compress the
matrix cells into their shape. The shape ofthe inner root sheath determines the shapeof hair
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Hair cycles
3 phases
Anagen (growing) phase......... 90-95%
catagen(transitional) phase.....
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Patchy loss scarring/Cicatrical
Lichen planopilaris
Discoid lupus erythematosus
Folliculitis decalvans
Pseudopelade
Follicular degeneration syndrome
Trauma Infection folliculitis
Perifolliculitis capitis abscensens
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Patchy loss non scarring
Alopecia localized/areata
Tinea capitis
Traction alopecia
Trichotillomania
Syphilis
Hair breakage Iron def
drugs
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Diffuse
Telogen effluvium
Androgen Alopecia
Androgenetic Alopecia
Systemic disease (thyroid,iron
def,SLE,Dermatophysis)
Physiologic ..... Neonate, postpartum,
Common male baldness
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EFFLUVIUM
Anagen effluvium is loss of hair from
follicles in their growing phase.it is due
to insult to metabolic and follicular
reproductive apparatus on the hair. Cancer chemotherapy and radiotherapy
thallium and arsenic poisoning are the
cause. Only hair left are those in thetelogen phase
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Telogen effluvium
Premature termination of anagen phasecause abnormal no of hairs to enter restingphase.
The hair follicle is not disease but has itsbiologic clock reset
Causes are Febrile illness, postpartum loss,emotional and physical trauma, poor diet
Drugs e.g Aminosalicylic,amphetamine,bromocriptine,cimetidine,captopril,danazol, propanolol,enapril,levodopa.
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treatment
Superfacial folliculitis may heal
spontaneously within 2wks
Antibiotic ointment Bacitracin, mycitracin
Bactrobam(mupirocin)
Dicloxacillin or cephalosporin in Deep
folliculitis
Electric razors preferably
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Trichotillomania
This is usually seen in children who are
emotionally disturbed and nervous. They
compulsorily pull out their hairs. It is
commonly seen in secondary andtertiary students that pull their hair while
reading.
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Traction Alopecia
This results from chronic tension on hair
shaft due to certain hair styles, braids,
hair rollers, hot straigthening combs.
Traumatic marginal alopecia occur inNigerian women who braid their hair and
from traumatic friction from hair ties.
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Alopecia Areata
It is a common disease characterised byrapid total hair loss in a rounded welldefined area
in people less than 40years, both sexesare equally affected.
Aetiology is unknown but is usuallyassociated with an autoimmune disorder
like vitiligo, Hashimotos thyroiditis .Sometimes, stress is said to be a cause.Follicles prematurely enter the catagenand telogen phase.
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Clinical features of Alopecia
areata
The lesion is asymptomatic
Px notices a patch devoid of hairs
Scalp looks normal with visible hair
follicles but devoid of hair.
They may be erythema or faint depression
An actively extending bald patch shows at
periphery, broken off hairs which taper to asmall bulb (exclamation mark hairs)
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Exclamation mark hairs
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Alopecia totalis ......... Whole scalp
Alopecia universalis........ Whole body
Alopecia recovers spontaneously but
relapses are common Prognosis is bad in both.
Earlier age of onset, the poorer the
diagnosis Nail changes (nail plate is pitted like a
thimble) shows a higher severity.
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TREATMENT
Corticosteroids
Photochemotherapy
Contact allergen therapy
Minoxidil
Inosiplex(isoprinosine)
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Folliculitis
This is a bacterial infection with irritation
of the affected hair follicles
Folliculitis occurs when the hair follicles
are damaged by shaving, clothfriction,scratching or obstruction
The lesions are pustular around the hair
The infected hair can easily be removedbut new papules develop.
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Sites
Occurs anywhere on the body at anyage and usually last for few days orweeks
Occurs in the bearded area in men,scalp, upper trunk, buttocks, thighs andgroin.
Superfacial folliculitis affects the upper
part of hair follicle n Deep affects thewhole hair.
Deep folliculitis is more painful.
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FOLLICULITIS
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Folliculitis barbae
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Folliculitis
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Folliculitis Decalvans
This presents as pruritic or burning
follicular pustules and papules.
Spreads peripherally
It is idiopathic
Old lesion heals leaving scarring
alopecia
It does not respond to treatment
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Perifolliculis capitis abscedens
et suffodiens
A chronic persisting disease seen
almost exclusively in Male blacks
Aetiology is both pathogenic and non
pathogenic
Often associated with acne vulgaris or
hidradenitis suppurativa
The lesions present as numerous firmoften painless 5-10mm nodules
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Contd
Affects the occiput and the vertex
Sinus tract draining purulent material
may form in severe cases
The hairs are loose and easily plucked
off from the lesions unlike Dermatitis
papillaris capillitii
Severe scarring alopecia occurs in latestage.
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Hypertrichosis
Implies excessive hair or
Hair on abnormal regions
Hirsutism is androgen controlled
excessive hair growth CAUSES
1. CONGENITAL- which can be
Generalised-dog or ape man Localised- hairy naevus, spina bifida
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ACQUIRED
Localised- use of irritants
Generalized-endocrine (virilism),
nutritional (anorexia nervosa),
idiopathic(hereditary or familial)
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Treatment
X-ray epilation
low dose oxytetracyncline
Warm water shampoo with selenium
sulphide daily
Topical antibiotics
Benzoyl peroxide or erythromycin
Antibiotics and topical steroids
combination
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MANAGEMENT OF
HYPERTRICHOSIS
Take a history
Examination of the whole body
Endocrine Tumour........ Surgery
hormonal ........ GonadotrophinsAnorexia nervosa....... Improve on
nutrition
Removal of the hair viaelectrolysis/thermolysis, bleaching usinghydrogen peroxide
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Keratosis pilaris
It is a condition in which the hair follicle
become blocked with hair and dead cells
from outermost layer of skin(epidermis).
The follicles reddened and inflamebumps (papules develop). Papules of
KP usually occur on the upper arms,
thighs but also occur on the face buttock
and back.
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Causes and Risk Factors
Keratosis pilaris (KP) is a hereditarydisorder. One can inherit it from one orboth parents. KP stems fromoverreproduction of keratinocytes, the cellsthat manufacture the protein keratin, animportant skin component (calledhyperkeratosis). Some researchers
describe KP as one of a whole spectrum ofdisorders, rather than as an independentdisease.
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KP is more prevalent among children and
adolescents and less common in adults. It
seems to improve after puberty. Individuals
with dry skin and eczema (skin disorder)tend to have more severe cases. The
condition improves during warm summer
months and worsens during the winter.
Rx ..... Rub off top layer with loofah spongeand fruit acid cream e.g salicylic aid
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Trichomycosis
It is an asymptomatic infection of the
axillary or pubic hair caused by a
corynebacterium. The hair shaft
becomes coated with the adherentyellow firm secretion. It may be red or
black occcasionally.
Hyperhidrosis is often present. Hair isshaved and hyperhidrosis is controlled
with antiperspirant.
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Conclusion
The psychological aspect of hair
disorders have to be well managed
through adequate counselling and
artificial aids used in very severe casesof hair loss.
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THANKYOU!!!