HAIR DISORDERHAIR DISORDER

dr. Anis Irawan Anwar, Sp.KK(K)

IntroductionIntroduction

Hair follicle through three stages:Hair follicle through three stages:

AnagenAnagen active growth phase of hair active growth phase of hair follicles follicles → → hair grows 1 cm every 28 days hair grows 1 cm every 28 days (stays for(stays for 2 - 8 years) 2 - 8 years)

KatagenKatagen a short transition stage a short transition stage 2 – 2 –3 weeks while a club hair is formed3 weeks while a club hair is formed

TelogenTelogen rest period rest period

90% in anagen, 10–14% in telogen 90% in anagen, 10–14% in telogen and 1–2% in catagen.and 1–2% in catagen.

lose only 50 to 100 hairs per daylose only 50 to 100 hairs per day

Hair on the scalp grows at a rate of Hair on the scalp grows at a rate of 0.37 to 0.44 mm/day or approximately 0.37 to 0.44 mm/day or approximately 1 cm/month.1 cm/month.

Anagen Katagen TelogenAnagen Katagen Telogen

Hair Types : Hair Types :

Terminal hair Terminal hair → → Produced by large hair Produced by large hair follicles located in the subcutis; > 0,03 follicles located in the subcutis; > 0,03 mm in diametermm in diameter

• Vellus hair: Produced by very small hair Vellus hair: Produced by very small hair follicles located in the dermis; thin (follicles located in the dermis; thin (≤≤ 0,03 0,03 mm diameter), short, often depigmented, mm diameter), short, often depigmented, usually non-medullated hair shaftusually non-medullated hair shaft

Alopecia type:Alopecia type:

Universalis Universalis on the whole body on the whole body

Totalis Totalis on the whole scalp on the whole scalp

Areata Areata localized, localized,

Disturbed hair follicle cyclingDisturbed hair follicle cycling

EffluviumEffluvium

(telogen effluvium, alopecia areata, (telogen effluvium, alopecia areata,

androgenetic alopecia)androgenetic alopecia)

Causes of Telogen Effluvium

EndocrineEndocrine

"Stressful" events"Stressful" events

NutritionalNutritional

IntoxicationIntoxication

DrugsDrugs

Inflammatory scalp diseaseInflammatory scalp disease

Acute Telogen EffluviumAcute Telogen Effluvium

May occur at any age and represents a May occur at any age and represents a

precipitous shift of a percentage of anagen precipitous shift of a percentage of anagen

hairs to telogenhairs to telogen

Chronic Telogen EffluviumChronic Telogen Effluvium

A persistent form of telogen effluvium, with A persistent form of telogen effluvium, with

loss of hair volume, lasting in excess of 6 loss of hair volume, lasting in excess of 6

months typically occurs in middle-aged months typically occurs in middle-aged

womenwomen

Anagen EffluviumAnagen Effluvium

The daily loss of some telogen hairs is The daily loss of some telogen hairs is entirely normal, but it is always abnormal entirely normal, but it is always abnormal to shed anagen hairs.to shed anagen hairs.

ALOPECIA AREATAALOPECIA AREATA

Clinical FeaturesClinical Features

Presents with round patches of hair loss, may Presents with round patches of hair loss, may be single or multiple, and may coalescent be single or multiple, and may coalescent

Pathognomonic “exclamation mark" may Pathognomonic “exclamation mark" may present, particularly at the periphery of areas present, particularly at the periphery of areas of hair lossof hair loss

Location :Location :

ScalpScalp

BeardBeard

EyebrowEyebrow

EyelashEyelash

Other location on the skin Other location on the skin rarely rarely

EtiologyEtiology

Autoimmune disease Autoimmune disease genetic genetic factorfactor

Emotional StressEmotional Stress

HistopatologiHistopatologi

alopecia areata is characterized by an alopecia areata is characterized by an inflammatory infiltrate, comprised mainly of inflammatory infiltrate, comprised mainly of T cells, in and around the bulbs of anagen T cells, in and around the bulbs of anagen hair follicleshair follicles

Differential DiagnosisDifferential Diagnosis

Tinea capitis.Tinea capitis.

Trichotillomania.Trichotillomania.

Early scarring alopecia.Early scarring alopecia.

Syphilis (alopecia areolaris).Syphilis (alopecia areolaris).

Treatment of Alopecia AreataTreatment of Alopecia Areata

Topical CorticosteroidsTopical Corticosteroids

Intralesional Corticosteroids

Hydrocortisone acetate (25 mg/mL) and Hydrocortisone acetate (25 mg/mL) and triamcinolone acetonide (5 to 10 mg/mL)triamcinolone acetonide (5 to 10 mg/mL)

Systemic Coticosteroids

Treatment of Alopecia AreataTreatment of Alopecia Areata

Topical Minoxidil Solution

Photo(Chemo)Therapy

Psoralen and UVA lightPsoralen and UVA light

Contact Immunotherapy

Alopecia areataAlopecia areata

Alopecia areata multipleAlopecia areata multiple

Alopecia universalisAlopecia universalis

Unwanted hair follicle Unwanted hair follicle transformationtransformation

Patterned hair loss (androgenetic alopecia)Patterned hair loss (androgenetic alopecia)

HirsutismHirsutism

HypertrichosisHypertrichosis

Androgenetic alopeciaAndrogenetic alopecia

Male, Major features : Male, Major features :

Recession of the frontal hair line and Recession of the frontal hair line and balding of the scalp vertexbalding of the scalp vertex

Women : a reduction in hair density Women : a reduction in hair density involving the crown and frontal scalp, involving the crown and frontal scalp, with maintenance of the frontal hair line with maintenance of the frontal hair line

TreatmentTreatment

Male pattern hair lossMale pattern hair loss

• • 5% topical minoxidil solution or foam5% topical minoxidil solution or foam

twice daily,twice daily,

• • Oral finasteride, 1 mg daily.Oral finasteride, 1 mg daily.

• • Combination of the above.Combination of the above.

• • Surgery (e,g., hair transplantation). Surgery (e,g., hair transplantation).

Female pattern hair lossFemale pattern hair loss

• • 2%-5% topical minoxidil solution twice 2%-5% topical minoxidil solution twice daily.daily.

• • TopicaI17-estradiol TopicaI17-estradiol

• • Oral anti-androgens Oral anti-androgens (spironolactone,cyproterone acetate).(spironolactone,cyproterone acetate).

• • Maintain serum ferritin> 40 J.l9/L.Maintain serum ferritin> 40 J.l9/L.

• • Hair transplantafion in selected cases.Hair transplantafion in selected cases.

Androgenetic alopeciaAndrogenetic alopecia

Androgenetic alopeciaAndrogenetic alopecia

EXCESS HAIREXCESS HAIR

HypertrichosisHypertrichosis

Hair Hair density or length beyond the accepted density or length beyond the accepted limits of normal for a particular age, race, or limits of normal for a particular age, race, or sex. sex.

The excess hair may be generalized or The excess hair may be generalized or localized and may consist of lanugo, vellus, localized and may consist of lanugo, vellus, or terminal hair.or terminal hair.

Hypertrichosis on face Hypertrichosis on face

HirsutismHirsutism

Hair growth in Hair growth in women in areas of the women in areas of the body where hair growth is under body where hair growth is under androgen control and in which normally androgen control and in which normally only postpubescent males have terminal only postpubescent males have terminal hair growth.hair growth.

These areas include the moustache, These areas include the moustache, beard, chest, escutcheon, and inner beard, chest, escutcheon, and inner thigh.thigh.

Hirsutism on faceHirsutism on face

Hirsutism on woman chestHirsutism on woman chest

TRAUMATIC HAIR LOSSTRAUMATIC HAIR LOSS

Pressure AlopeciaPressure Alopecia

The hair loss may be permanent and is The hair loss may be permanent and is presumably due to ischemia from presumably due to ischemia from pressure injurypressure injury

TrichotillomaniaTrichotillomania

a compulsive desire or habit to pull out the a compulsive desire or habit to pull out the hair.hair.

TrikotilomaniaTrikotilomania

TRAUMATIC HAIR LOSSTRAUMATIC HAIR LOSS

Traction AlopeciaTraction Alopecia

Inadvertent prolonged traction on the scalp by Inadvertent prolonged traction on the scalp by the physical pressure of hair styling the physical pressure of hair styling (e.g.,pony tail, tight braids, foam rollers, etc)(e.g.,pony tail, tight braids, foam rollers, etc)

Tinea CapitisTinea Capitis

It typically presents with patchy hair loss It typically presents with patchy hair loss associated with inflammation of the affected associated with inflammation of the affected scalp.scalp.

Traction AlopeciaTraction Alopecia

Structural hair shaft defectStructural hair shaft defect

Monilethrix Monilethrix Pili torti Pili torti Trichorrhexis nodosaTrichorrhexis nodosa

MonilethrixMonilethrix

Distinctive, with extremely short, brittle Distinctive, with extremely short, brittle hairs emerging from keratotic follicular hairs emerging from keratotic follicular papulespapules

Caused by mutations of one of three of the Caused by mutations of one of three of the genes encoding type II hair cortex keratinsgenes encoding type II hair cortex keratins

MonilethrixMonilethrix

Pili tortiPili torti

Clinically, the patient may have patchy Clinically, the patient may have patchy alopecia with coarse stubble or longer alopecia with coarse stubble or longer broken hairsbroken hairs

The hairs are distinguished by the multiple The hairs are distinguished by the multiple irregular intervals of twisting along an irregular intervals of twisting along an otherwise straight hair shaftotherwise straight hair shaft

Pili torti. A. Irregularly spaced 1800 twists in hair shaft. B. Brittle broken hair typical of congenital pili torti.

Trichorrhexis nodosaTrichorrhexis nodosa

Trigger by mechanical or chemical damageTrigger by mechanical or chemical damage

Proximal breakage : appears most commonly in Proximal breakage : appears most commonly in African American women, usually after repetitive African American women, usually after repetitive chemical or hot-comb straighteningchemical or hot-comb straightening

Distal : to excessive brushing, back- combing, or Distal : to excessive brushing, back- combing, or sporadic use of permanent waves.sporadic use of permanent waves.

Trikoeksis nodosaTrikoeksis nodosa

Hair Shaft AbnormalitiesHair Shaft AbnormalitiesAssociated with Unruly HairAssociated with Unruly Hair

UNCOMBABLE HAIR SYNDROMEUNCOMBABLE HAIR SYNDROME

The slowgrowing, silvery blonde, "spun-glass“ hair The slowgrowing, silvery blonde, "spun-glass“ hair is generally unmanageable and disorderly but is generally unmanageable and disorderly but not unduly fragile not unduly fragile

WOOLY HAIR

The presence of kinky, wavy hair on the The presence of kinky, wavy hair on the scalp of persons of non-African or Negroid scalp of persons of non-African or Negroid backgroundbackground

MARIA UNNA HYPOTRICHOSIS

Scalp hair is lost in a pattern resembling Scalp hair is lost in a pattern resembling androgenetic alopecia (though both sexes androgenetic alopecia (though both sexes are equally affected) with a scattering of are equally affected) with a scattering of coarse thickened hairs in the balding areas.coarse thickened hairs in the balding areas.

NON-SCARRING HAIR LOSS:NON-SCARRING HAIR LOSS:PRODUCTION DECLINEPRODUCTION DECLINE

Triangular (Temporal) AlopeciaTriangular (Temporal) Alopecia

The hair loss either may be complete or fine The hair loss either may be complete or fine vellus hairs may remain.The underlying vellus hairs may remain.The underlying scalp is normal. The hair loss may be uni scalp is normal. The hair loss may be uni or bilateral.or bilateral.

Hypotrichosis SimplexHypotrichosis Simplex

characterized by progressive global loss of characterized by progressive global loss of scalp hair from early/mid childhood scalp hair from early/mid childhood onward.onward.

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