AKORAH UCHE.

OUTLINE
INTRODUCTION ANATOMY CLASSIFICATION CLINICAL FEATURES INVESTIGATIONS MANAGEMENT CONCLUSION

INTRODUCTION

Hair follicle disorders are very common cases in dermatological clinics. They present in various forms. Loss of hair or excessive hair growth cause psychological distress to the patients.

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 on the palms, soles, penis, distal phalanges.

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

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..

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 hair covering much of the body, replaces lanugo. Adult form of lanugo hair

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 per month 6inches per year.

Physiology
Cycle of hair follicles depends on the interaction of the follicular epithelium with the 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 of the inner root sheath determines the shape of hair

Hair cycles
3 phases Anagen (growing) phase......... 90-95% catagen(transitional) phase..... <1% Telogen (resting)phase.......5-10% Telogen last for abt 2-3mths b4 entering another cycle Telogen is longer in the eyebrow, eyelash, trunk ,arms and leg h airs

Patchy loss scarring/Cicatrical

Lichen planopilaris Discoid lupus erythematosus Folliculitis decalvans Pseudopelade Follicular degeneration syndrome Trauma Infection folliculitis Perifolliculitis capitis abscensens

Patchy loss non scarring

Alopecia localized/areata Tinea capitis Traction alopecia Trichotillomania Syphilis Hair breakage Iron def drugs

Diffuse
Telogen effluvium Androgen Alopecia Androgenetic Alopecia Systemic disease (thyroid,iron def,SLE,Dermatophysis) Physiologic ..... Neonate, postpartum, Common male baldness

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 the telogen phase

Telogen effluvium
Premature termination of anagen phase cause abnormal no of hairs to enter resting phase. The hair follicle is not disease but has its biologic clock reset Causes are Febrile illness, postpartum loss, emotional and physical trauma, poor diet Drugs e.g Aminosalicylic, amphetamine,bromocriptine,cimetidine,cap topril,danazol, propanolol,enapril,levodopa.

treatment
Superfacial folliculitis may heal spontaneously within 2wks Antibiotic ointment Bacitracin, mycitracin Bactrobam(mupirocin) Dicloxacillin or cephalosporin in Deep folliculitis Electric razors preferably

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 and tertiary students that pull their hair while reading.

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 in Nigerian women who braid their hair and from traumatic friction from hair ties.

Alopecia Areata
It is a common disease characterised by rapid total hair loss in a rounded well defined area in people less than 40years, both sexes are equally affected. Aetiology is unknown but is usually associated with an autoimmune disorder like vitiligo, Hashimotos thyroiditis . Sometimes, stress is said to be a cause. Follicles prematurely enter the catagen and telogen phase.

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 a small bulb (exclamation mark hairs)

Exclamation mark hairs

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.

TREATMENT
Corticosteroids Photochemotherapy Contact allergen therapy Minoxidil Inosiplex(isoprinosine)

Folliculitis
This is a bacterial infection with irritation of the affected hair follicles Folliculitis occurs when the hair follicles are damaged by shaving, cloth friction,scratching or obstruction The lesions are pustular around the hair The infected hair can easily be removed but new papules develop.

Sites
Occurs anywhere on the body at any age and usually last for few days or weeks Occurs in the bearded area in men, scalp, upper trunk, buttocks, thighs and groin. Superfacial folliculitis affects the upper part of hair follicle n Deep affects the whole hair. Deep folliculitis is more painful.

FOLLICULITIS

Folliculitis barbae

Folliculitis

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

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 firm often painless 5-10mm nodules

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 late stage.

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

ACQUIRED Localised- use of irritants Generalized-endocrine (virilism), nutritional (anorexia nervosa), idiopathic(hereditary or familial)

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

MANAGEMENT OF HYPERTRICHOSIS
Take a history Examination of the whole body Endocrine Tumour........ Surgery hormonal ........ Gonadotrophins Anorexia nervosa....... Improve on nutrition Removal of the hair via electrolysis/thermolysis, bleaching using hydrogen peroxide

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 inflame bumps (papules develop). Papules of KP usually occur on the upper arms, thighs but also occur on the face buttock and back.

Causes and Risk Factors Keratosis pilaris (KP) is a hereditary disorder. One can inherit it from one or both parents. KP stems from overreproduction of keratinocytes, the cells that manufacture the protein keratin, an important skin component (called hyperkeratosis). Some researchers describe KP as one of a whole spectrum of disorders, rather than as an independent disease.

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 sponge and fruit acid cream e.g salicylic aid

Trichomycosis
It is an asymptomatic infection of the axillary or pubic hair caused by a corynebacterium. The hair shaft becomes coated with the adherent yellow firm secretion. It may be red or black occcasionally. Hyperhidrosis is often present. Hair is shaved and hyperhidrosis is controlled with antiperspirant.

Conclusion

The psychological aspect of hair disorders have to be well managed through adequate counselling and artificial aids used in very severe cases of hair loss.

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