Hair Disorders: Current Concepts in Pathophysiology, Diagnosis and Management

Contents

Preface xiii

Jerry Shapiro

The Basic Science of Hair Biology:What Are the Causal Mechanisms for the DisorderedHair Follicle? 1

Trisia Breitkopf, Gigi Leung,MeiYu, EddyWang, andKevinJ. McElwee

A hair disorder can be difficult to define, but patients are typically motivated to seektreatment when their hair growth patterns are significantly different from their culturalgroup or when growth patterns change significantly. The causes of hair disorders aremany and varied, but fundamentally the disorder is a consequence of aberrant alter-ations of normal hair biology. The potential trigger factors for hair disorders can beattributed to inflammation, genetics, the environment, or hormones, of which therelative contributions vary for different diagnoses, between individuals, and overtime. This article discusses the causal mechanisms for the disordered hair follicle.

How to Diagnose Hair Loss 21

AdriannaJ. Jackson andVera H. Price

This review presents a systematic approach to the diagnosis of hair loss. An accu-rate diagnosis is based on history, clinical examination, laboratory tests, and scalpbiopsy. Whether the hair loss is a cicatricial or noncicatricial alopecia guides one’shistory taking. After assessing the patient’s global appearance, the hair and scalpare evaluated, aided by a hair pull, hair tug, Hair Card, and hair mount. Scalp biop-sies can confirm a diagnosis and are essential in all cases of cicatricial alopecia. In allpatients with hair loss a complete blood count, ferritin, thyroid stimulating hormone,and vitamin D 25OH should be ordered.

Trichoscopy: How It May Help the Clinician 29

Lidia Rudnicka, Adriana Rakowska, andMalgorzata Olszewska

Trichoscopy (or dermoscopy of hair and scalp) is an easy in-office technique thatmay be performed with a handheld dermoscope or a digital videodermoscopysystem. This method is gaining increasing popularity, because it may be appliedin differential diagnosis of multiple hair and scalp diseases. The focus of this articleis application of trichoscopy in differential diagnosis of the most frequent hair andscalp diseases in dermatologic practice. Trichoscopy of genetic hair shaft abnormal-ities are briefly addressed. A new classification of perifollicular and interfollicular skinsurface abnormalities is proposed.

Histopathology of Scarring and Nonscarring Hair Loss 43

JohnM. Childs and Leonard C. Sperling

This article reviews the histologic findings of alopecia, preceded by a brief discus-sion of biopsy and processing techniques, the normal follicular anatomy and cycle,and expected findings in transverse sections. Subtle histologic abnormalities will bemissed unless the normal follicular anatomy and follicular cycle, when viewed intransverse sections, are understood.

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How to Diagnose andTreat MedicallyWomenwith Excessive Hair 57

Ulrike Blume-Peytavi

Excessive hair growth in women is common and due to a broad spectrum of causes.Management options comprise different pharmaceuticals, epilation methods, andaesthetic approaches. Because excessive hair growth in women may cause psy-chological and psychosocial problems, a holistic treatment approach, includingsupport and emotional coping strategies, should be recommended. In this article,diagnostic procedures and treatment options for excessive hair growth in femalepatients are discussed.

Drugs and Hair Loss 67

Mansi Patel, Shannon Harrison, and Rodney Sinclair

Hair loss is a common complaint, both in men and women, and use of prescriptionmedications is widespread. When there is a temporal association between the onsetof hair loss and commencement of a medication, the medication is commonlythought to have caused the hair loss. However, hair loss and in particular telogeneffluvium may occur in response to a number of triggers including fever, hemor-rhage, severe illness, stress, and childbirth, and a thorough exclusion of thesepotential confounders is necessary before the hair loss can be blamed on the med-ication. Certain medications are known to cause hair loss by a variety of mecha-nisms including anagen arrest, telogen effluvium, or accentuation of androgeneticalopecia by androgens.

Autoimmune Disease and Hair Loss 75

SiamakMoghadam-KiaandAndrewG. FranksJr

Once systemic disease is in remission, it is prudent to recognize the importance ofalopecia in the patient’s overall sense of well-being and quality-of-life clinical out-come. Scarring alopecia (scalp discoid lupus erythematosus) can be the presentingmanifestation of lupus in more than half of affected individuals. Diffuse nonscarringalopecia in lupus is usually responsive to treatment of the systemic disease. Severe,often intractable burning pruritus of the scalp is a frequent complaint in dermato-myositis. Lichen planopilaris may mimic other autoimmune forms of scarring alope-cia. Alopecia can also be caused bymedications used to treat systemic autoimmunedisease and fibromyalgia.

Alopecia Areata Update 93

AbdullahAlkhalifah

Alopecia areata (AA) is a common nonscarring alopecia. It affects 1.7% of the pop-ulation at some point in their lives. AA is an autoimmune condition characterized bydense peribulbar lymphocytic infiltrate. The exact cause and triggering factors arestill unknown. The scalp is the most commonly affected area but any hair-bearingarea can be involved. All available treatment options are neither curative nor preven-tive. This article will discuss updates in AA with focus on etiopathogenesis, clinicalpresentation, and treatment options and suggest treatment plans based on theage of the patient and extent of the disease.

Genetic Basis of Alopecia Areata: A Roadmap forTranslational Research 109

AliJabbari, Lynn Petukhova, RitaM. Cabral, Raphael Clynes, andAngelaM. Christiano

Alopecia areata (AA) is a recurrent autoimmune type of hair loss that affects about5.3 million people in the United States alone. Despite being the most prevalent

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autoimmune disease, the molecular and cellular mechanisms underlying this com-plex disease are still poorly understood, and rational treatments are lacking. Furtherefforts are necessary to clearly pinpoint the causes and molecular pathways leadingto this disease and to find evidence-based treatments for AA. The authors focus onthe central role of genetics for gaining insight into disease pathogenesis and settingthe stage for the rational development of novel effective therapeutic approaches.

Hair:What is New in Diagnosis and Management?: Female Pattern Hair Loss Update:Diagnosis andTreatment 119

Natasha AtanaskovaMesinkovskaandWilma F. Bergfeld

Female pattern hair loss (FPHL) is the most common cause of alopecia in women.FPHL is characterized histologically with increased numbers of miniaturized, vel-luslike hair follicles. The goal of treatment of FPHL is to arrest hair loss progressionand stimulate hair regrowth. The treatments for FPHL can be divided into andro-gen-dependent and androgen-independent. There is an important adjuvant rolefor nutritional supplements, light therapy, and hair transplants. All treatmentswork best when initiated early. Combinations of treatments tend to be moreefficacious.

Pattern Hair Loss in Men: Diagnosis and MedicalTreatment 129

Nusrat Banka,M.J. Kristine Bunagan, andJerry Shapiro

Androgenetic alopecia is a common cause of hair loss in both men and women. Theexact pathogenesis of androgenetic alopecia is not well understood. As the nameimplies, the role of androgens and genetic susceptibility predisposes to patternhair loss due to gradual conversion of terminal hair into vellus hair. Male and femalepattern hair loss are clinically distinct entities but histologically indistinguishable. Therole of sex hormones in females is less understood. This article discusses currentunderstanding of the etiopathogenesis of hair loss in men, diagnostic tests available,and its medical management.

HairTransplantation Update: ProceduralTechniques, Innovations, and Applications 141

M.J. Kristine Bunagan, Nusrat Banka, andJerry Shapiro

The advances in hair transplantation, particularly the advent of follicular unit trans-plantation, have greatly elevated the outcome of this procedure. Various modifica-tions to the basic technique as well as innovations focused on the differentaspects of the hair transplantation procedure have further enhanced this type ofhair restoration surgery. In addition, there is ongoing expansion of the indicationsand applications of this procedure beyond the usual male pattern hair loss.

Primary Cicatricial Alopecias 155

Nina Otberg

Primary cicatricial alopecias refer to a group of rare, idiopathic, inflammatory scalpdisorders that result in permanent hair loss. Primary cicatricial alopecias comprisea diverse group of inflammatory diseases and can be classified via differentapproaches, such as clinical presentation, histopathologic findings, or both. Primarycicatricial alopecias are rare scalp disorders. Whiting found a prevalence of 7.3% inall patients who sought advice for hair and scalp problems at the Baylor HairResearch and Treatment Center in Dallas between 1989 and 1999.

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Nutrition and Hair: Deficiencies and Supplements 167

AndreasM. Finner

Hair follicle cells have a high turnover. A caloric deprivation or deficiency of severalcomponents, such as proteins, minerals, essential fatty acids, and vitamins, causedby inborn errors or reduced uptake, can lead to structural abnormalities, pigmenta-tion changes, or hair loss, although exact data are often lacking. The diagnosis isestablished through a careful history, clinical examination of hair loss activity, andhair quality and confirmed through targeted laboratory tests. Examples of genetichair disorders caused by reduced nutritional components are zinc deficiency in acro-dermatitis enteropathica and copper deficiency in Menkes kinky hair syndrome.

Shampoos, Conditioners, and CamouflageTechniques 173

ZoeDiana Draelos

This article examines hair care in persons with hair loss. The use of shampoos, con-ditioners, and hair styling products to camouflage hair loss is discussed. Becausehair is nonliving, medical treatments are limited to only inducing change in the folli-cles within the scalp skin and do not improve the hair loss actually witnessed by thepatient. There is therefore a need to accompany medical treatment of hair loss withcosmetic hair treatment to optimize patient satisfaction.

Long-Term Removal of Unwanted Hair Using Light 179

Soodabeh Zandi andHarvey Lui

Laser (or light) hair removal, also referred to as photoepilation, is the most commonlyused laser or light-based cosmetic medical procedure. The extended theory ofselective photothermolysis is the basic principle for destruction of hair follicles usinglight. In this type of laser application the chromophore is follicular melanin. Severaltypes of lasers and light sources have been effective for hair reduction, includingthe ruby, alexandrite, diode, and neodymium:yttrium-aluminum-garnet lasers andbroadband, intense pulsed light sources. This article provides a broad overview ofhow hair can be removed using light, with an emphasis on practical considerations.

Utilizing Electromagnetic Radiation for Hair Growth: A Critical Review ofPhototrichogenesis 193

Sunil KaliaandHarvey Lui

Hair loss has a high prevalence in the general population and can have significantmedical and psychological sequelae. Pattern hair loss and alopecia areata representthe major reasons patients present to dermatologists in relation to hair loss. Becauseconventional treatment options are generally incompletely effective, novel methodsfor hair grown induction are being developed. The role of using electromagneticradiation, including low-level laser therapy for the management of hair loss throughphototrichogenesis, is reviewed in this article.

Index 201