Menu Expand
Alopecia

Alopecia

Mariya I Miteva

(2018)

Additional Information

Book Details

Abstract

Get a quick, expert overview of alopecia with this concise, practical resource. Dr. Mariya Miteva covers high-interest clinical topics including hair cosmeceuticals, new medications in clinical trials, off-label treatment technologies, and much more. It’s an ideal resource for dermatologists, dermatopathologists, students, fellows, and researchers interested in hair loss.

  • Presents rich visual information combined with expert opinions from the most renowned hair experts practicing today.
  • Covers basic knowledge on healthy hair, hair pathology, and hair and scalp dermatoscopy (trichoscopy).
  • Contains focused yet complete coverage of non-scarring alopecia, primary lymphocytic cicatricial alopecia, primary neutrophilic ciatricial alopecia, hair loss management, and miscellaneous hair disorders such as hair loss in children, hair and scalp infections, hair changes due to drugs, and more.
  • Consolidates today’s available information and experience in this important area into one convenient resource.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Alopecia i
Alopecia iii
Copyright iv
List of Contributors v
Preface ix
Contents xi
1 - Healthy Hair (Anatomy, Biology, Morphogenesis, Cycling, and Function) 1
INTRODUCTION 1
EMBRYOLOGY 1
Stages of Hair Follicle Formation 1
Molecular and Genetic Basis of Hair Follicle Embryogenesis 3
ANATOMY AND CYTOLOGY OF THE PILOSEBACEOUS UNIT 3
Immunologic Components of the Hair Follicle 5
Other Constituents of the Pilosebaceous Unit 6
TYPES OF HAIR FOLLICLES 7
HAIR FOLLICLE CYCLING 7
Anagen Stage 9
Phases of anagen stage 9
Regulatory pathways/molecules 9
Hair follicle stem cells are key protagonists during anagen development 9
Catagen Stage 10
Phases of catagen stage 10
Regulatory pathways/molecules 10
Telogen Stage 11
Regulating pathways/molecules 11
Exogen 12
Kenogen 12
Differences of Hair Follicle Cycling in Various Anatomic Locations 12
Hair Follicle Metabolism During Cycling and Role of Oxidative Damage 13
HAIR SHAPE AND HAIR SHAFT COMPOSITION 13
MELANOGENESIS IN THE HAIR FOLLICLE 13
NORMAL HUMAN SCALP CHARACTERISTICS IN DIFFERENT RACES 13
HUMAN SCALP IN DIFFERENT AGES 14
DIFFERENCES BETWEEN HUMANS AND MOUSE HAIR FOLLICLES MORPHOLOGY AND CYCLING 15
NEUROENDOCRINOLOGY OF THE HAIR FOLLICLE 15
CONCLUSIONS 16
REFERENCES 16
2 - Hair Pathology: The Basics 23
SCALP BIOPSY 23
HORIZONTAL (TRANSVERSE) SECTIONS 23
HAIR FOLLICLES AND HAIR COUNTS: THE BASICS 23
LEVELS ALONG THE FOLLICULAR LENGTH 24
FOLLICULAR COUNTS 24
NONSCARRING ALOPECIA 24
Alopecia Areata 24
Alopecia Areata Incognito 28
Chronic Telogen Effluvium 29
Androgenetic Alopecia 29
Trichotillomania 29
SCARRING ALOPECIA 29
Discoid Lupus Erythematosus 30
Lichen Planopilaris and Frontal Fibrosing Alopecia 31
Central Centrifugal Cicatricial Alopecia 33
Traction Alopecia 33
Folliculitis Decalvans 33
Dissecting Cellulitis of the Scalp 35
Acne Keloidalis Nuchae 36
Erosive Pustular Dermatosis of the Scalp 36
MISCELLANEOUS 36
Seborrheic Dermatitis 36
Scalp Psoriasis 37
Lichen Simplex Chronicus 37
Tinea Capitis 38
Syphilitic Alopecia 38
Permanent Alopecia After Chemotherapy 39
REFERENCES 40
3 - Hair and Scalp Dermatoscopy (Trichoscopy) 43
INTRODUCTION 43
HOW TRICHOSCOPY HELPS THE CLINICIAN 43
TRICHOSCOPY DEVICES AND THEIR PARTICULARITIES 43
HOW TO EVALUATE THE PATIENT 44
TRICHOSCOPIC SIGNS AND PATTERNS 46
Follicular Signs 46
Yellow dots 46
Keratotic plugs 46
Black dots 47
Red dots 47
White dots 47
Loss of follicular openings 48
Perifollicular erythema 48
Scaling (perifollicular/interfollicular) 48
Hyperpigmenation 48
White-gray halo 49
Vascular Patterns 49
Hair Shafts 51
Hair shaft diameter variability 51
Short regrowing hairs 51
Broken hairs 52
Exclamation mark hairs and coudability hairs 53
Comma hairs and corkscrew hairs 54
Hair shafts in congenital syndromes 54
REFERENCES 56
4 - Alopecia Areata and Alopecia Areata Incognita 59
INTRODUCTION 59
ETIOPATHOGENESIS 59
CLINICAL FEATURES 59
DIAGNOSIS 61
DIFFERENTIAL DIAGNOSIS 62
ASSOCIATED DISEASES 63
TREATMENT 63
REFERENCES 65
5 - Androgenetic Alopecia 67
INTRODUCTION 67
CLINICAL AND HISTOLOGIC PRESENTATION 67
EPIDEMIOLOGY 69
ETIOLOGY AND PATHOGENESIS 69
MANAGEMENT: DIAGNOSIS AND DIFFERENTIAL 70
MANAGEMENT: PREVENTION, TREATMENT, MECHANISMS OF ACTION, AND PROGNOSIS 72
RESEARCH RELATED TO AGA PATHOGENESIS, MECHANISMS OF DISEASE, AND PROPOSED AREAS OF TREATMENT 74
Genetic/Genomic Targets 74
Signaling Targets 75
Cell Therapy 76
Animal Models of Human Androgenetic Alopecia 77
CONCLUSIONS 77
REFERENCES 77
6 - Telogen Effluvium 83
INTRODUCTION 83
EPIDEMIOLOGY 83
PATHOGENESIS 83
Physiology of Hair Shedding 83
Pathophysiology of Telogen Effluvium 84
Inciting Factors 84
CLINICAL FEATURES 85
Acute Telogen Effluvium 85
Chronic Telogen Effluvium 85
HISTOPATHOLOGY 86
DIAGNOSIS 88
History 88
Physical Examination 88
Hair Pull Test 89
Dermoscopy 89
Wood’s Lamp Examination 89
Investigations 89
DIFFERENTIAL DIAGNOSES 89
MANAGEMENT 89
Removal of the Inciting Factor 90
Cosmetic Treatments 90
Psychologic Support 90
Topical Minoxidil 91
Nutritional Supplementation 91
Emerging Treatments 91
PROGNOSIS 91
REFERENCES 91
7 - Trichotillomania 95
INTRODUCTION 95
Definition 95
General Concepts 95
ETIOLOGY 95
Trichoteiromania 96
Trichotemnomania 96
Trichodaganomania 96
Trichophagia and Trichobezoar 96
CLINICAL PRESENTATION 96
TRICHOSCOPY 97
PATHOLOGY 99
DIFFERENTIAL DIAGNOSIS 99
MANAGEMENT 101
REFERENCES 101
8 - Frontal Fibrosing Alopecia 103
INTRODUCTION 103
EPIDEMIOLOGY 103
PATHOGENESIS 103
Autoimmune Etiology 103
Hormonal Etiology 103
Lipid Metabolism Dysfunction 104
Neurogenic Inflammation 104
Genetics 104
Environmental Factors 104
CLINICAL FEATURES 104
DIAGNOSIS 108
TREATMENT 108
FOLLOW-UP 110
REFERENCES 111
9 - Fibrosing Alopecia in a Pattern Distribution 115
PATTERNED HAIR LOSS 115
CICATRICIAL PATTERN HAIR LOSS 115
CONCLUSION 120
REFERENCES 124
10 - Central Centrifugal Cicatricial Alopecia 127
INTRODUCTION 127
HAIR MORPHOLOGY AND PRACTICES AMONGST AFRICAN PATIENTS 127
HISTORY AND TERMINOLOGY 127
EPIDEMIOLOGY 128
ETIOPATHOGENESIS 128
CLINICAL PRESENTATION 128
DERMOSCOPY 129
HISTOLOGY 130
DIFFERENTIAL DIAGNOSIS 131
MANAGEMENT 131
GENERAL MEASURES 131
MEDICAL TREATMENT 131
SURGICAL TREATMENT 132
CONCLUSION 132
REFERENCES 132
11 - Traction Alopecia 135
INTRODUCTION 135
DEMOGRAPHIC FACTORS 135
CLINICAL PRESENTATION 135
DIFFERENTIAL DIAGNOSIS 138
DIAGNOSTIC WORKUP 139
Trichoscopy 139
Histology 139
TREATMENT, EDUCATION, AND PROGNOSIS 140
REFERENCES 141
12 - Lichen Planopilaris 143
INTRODUCTION 143
EPIDEMIOLOGY 143
ETIOLOGY 143
PATHOGENESIS 143
CLINICAL FEATURES 144
DERMOSCOPY 145
HISTOPATHOLOGY 145
MANAGEMENT 146
Topical/Intralesional Therapies 146
Systemic Therapies 147
CONCLUSION 148
REFERENCES 148
13 - Discoid Lupus Erythematosus 151
INTRODUCTION 151
EPIDEMIOLOGY 151
ETIOLOGY AND PATHOGENESIS 151
CLINICAL FINDINGS 152
DERMATOSCOPIC FINDINGS 153
HISTOPATHOLOGIC FINDINGS 154
PATIENT MANAGEMENT 155
First-Line Therapy 156
Topical/intralesional steroids and calcineurin inhibitors 156
Antimalarials 156
Second-Line Therapy 156
Biologic agents 157
CONCLUSION 157
REFERENCES 157
14 - Folliculitis Decalvans 161
HISTORY AND DEFINITION 161
History 161
Definition 161
EPIDEMIOLOGY 161
ETIOPATHOGENESIS 161
CLINICAL PRESENTATION: SIGNS AND SYMPTOMS 161
TRICHOSCOPY 162
HISTOPATHOLOGY 162
DIAGNOSIS 162
Clinical History 162
Dermatologic Examination 162
Photography 163
Bacterial Cultures 163
Skin Biopsy 163
DIFFERENTIAL DIAGNOSIS 163
TREATMENTS 164
Oral Treatment (Table 14.1) 164
PROGNOSIS 165
REFERENCES 165
15 - Dissecting Cellulitis of the Scalp 167
DEFINITION 167
EPIDEMIOLOGY 167
ETIOLOGY 167
CLINICAL FEATURES 167
TRICHOSCOPY 167
PATHOLOGY 168
ASSOCIATED CONDITIONS 169
DIFFERENTIAL DIAGNOSIS 169
TREATMENT 169
Corticosteroids 170
Oral Antibiotics 170
Oral Retinoids 170
Other Treatments 170
PROGNOSIS 170
REFERENCES 170
16 - Acne Keloidalis Nuchae 173
INTRODUCTION 173
EPIDEMIOLOGY 173
PATHOGENESIS 173
CLINICAL FINDINGS 173
TRICHOSCOPY 174
PATHOLOGY 174
DIFFERENTIAL DIAGNOSIS 174
TREATMENT 175
PROGNOSIS 176
REFERENCES 176
17 - Erosive Pustular Dermatosis of the Scalp 179
INTRODUCTION 179
EPIDEMIOLOGY 179
PATHOGENESIS 179
CLINICAL FINDINGS 180
TRICHOSCOPY 180
PATHOLOGY 180
DIFFERENTIAL DIAGNOSIS 180
TREATMENT 180
PROGNOSIS 181
REFERENCES 181
18 - Hair and Scalp Disorders Associated With Systemic Disease (Secondary Alopecia) 183
AMYLOIDOSIS 183
BULLOUS DISEASE 185
Pemphigus 185
Pemphigoid 185
Epidermolysis Bullosa 185
CONNECTIVE TISSUE DISEASE 186
Scleroderma 186
Dermatomyositis 186
Lupus Erythematosus 187
GRANULOMATOUS DERMATITIS 187
Sarcoidosis 187
Leprosy 188
MALIGNANCY 188
Lymphoproliferative Disorders 188
Alopecia Neoplastica 188
MISCELLANEOUS 189
Mastocytosis 189
Postoperative 189
Graft-Versus-Host Disease 190
REFERENCES 190
19 - Hair Loss in Children 193
INTRODUCTION 193
PATCHY ALOPECIA IN CHILDHOOD 193
Alopecia Areata 193
Age 193
Association with comorbidities 193
Clinical presentation 193
Trichoscopy 194
Pathology 194
Management 194
Trichotillomania 194
Age 194
Association with comorbidities 194
Clinical presentation 194
20 - Hair and Scalp Infections 207
INTRODUCTION 207
TINEA CAPITIS 207
Etiology 207
Clinical Presentation 207
Dermoscopy 207
Pathology 208
Culture 209
Management 209
PEDICULOSIS CAPITIS 209
Etiology 209
Clinical Presentation 209
Dermoscopy 210
Pathology 210
Treatment 210
PIEDRA 211
Etiology 211
Clinical Presentation 211
Dermoscopy 213
Culture 213
Treatment 213
SYPHILIS 213
Etiology 213
Clinical Presentation 213
Dermoscopy 214
Pathology 214
Treatment 214
DEMODEX FOLLICULITIS 215
21 - The Itchy Scalp 219
INTRODUCTION 219
DERMATOLOGIC PRURITUS 219
PRIMARY CUTANEOUS DISEASES 219
Inflammatory 219
Seborrheic dermatitis 219
Scalp psoriasis 220
Atopic dermatitis 222
Dermatomyositis 222
Scarring alopecias 222
Allergic contact dermatitis 223
Pediculosis capitis 223
Neoplastic 223
PRURITUS WITHOUT ASSOCIATED SKIN FINDINGS 224
Neuropathic 224
Diabetes mellitus 224
Postherpetic neuralgia 224
Cervical spine disease 224
Treatment for neuropathic pruritus 224
Underlying Systemic Disease 224
Pruritus in the Elderly 224
Psychiatric Conditions 224
Trichotillomania 224
Stress and scalp itch 225
REFERENCES 225
22 - Scalp Psoriasis 229
PSORIASIS OF THE SCALP AND PSORIASIFORM ALOPECIA: INTRODUCTION 229
CLINICAL PATTERNS 229
COURSE AND PROGNOSIS 229
What Are the Driving Forces Behind Such a Degree of Sebaceous Hypoplasia? 230
HISTOPATHOLOGY 231
TREATMENT 231
REFERENCES 233
23 - Hair Weathering 235
DEFINITION 235
HAIR ANATOMY 235
CAUSES OF WEATHERING 235
Sunlight 235
Blonde and red hair 235
Dark hair 235
Gray hair 236
Excessive Wetting 236
Physical Damage 237
Hair extensions 237
Chemical Damage 237
Hair dye 237
Hair straightening 238
Age 240
DIAGNOSIS 240
CLINICAL EXAMINATION 240
Trichoptilosis 241
Trichoclasis 241
Trichoschisis 242
Bubble hair 242
TREATMENT 242
REFERENCES 242
24 - Hair Changes due to Drugs 245
INTRODUCTION 245
Pathophysiology 245
HAIR AND DRUGS 245
Radiation Therapy 249
Anticoagulants 250
Antihypertensive Agents 250
Interferons 251
Trichoscopy 251
Retinol (Vitamin A) and Retinoids 251
Antiretrovirals 252
Oral Contraceptives 252
Drugs Acting on the Nervous System 252
Azathioprine 253
Minoxidil 253
Strontium Ranelate 253
Thallium 254
Cyclosporin A 254
Prostaglandin Analogs 254
Chloroquine 254
Permanent Alopecia due to Chemotherapy 255
CONCLUSIONS 255
REFERENCES 256
25 - Novel Treatment Modalities for Hair Loss 259
INTRODUCTION 259
PLATELET-RICH PLASMA 259
Possible Mechanism of Action 259
Studies 259
Conclusions and Unmet Goals 260
LOW-LEVEL LASER/LIGHT THERAPY 260
Possible Mechanism of Action 261
Studies 261
Conclusions 262
MESOTHERAPY 262
Possible Mechanism of Action 262
Studies 262
Conclusions and Caveats 262
MICRONEEDLING 262
26 - Clinical Trials and Hair Loss 267
BURDEN OF DISEASE IN ALOPECIA 267
DRUGS 267
Vasodilator: Minoxidil 268
5α-Reductase Inhibitors: Finasteride and Dutasteride 268
Immunomodulators 271
Diuretics/Antiandrogen Therapies 273
Prostaglandin Agonists 273
DEVICES 273
DIETARY SUPPLEMENTS AND NUTRACEUTICALS 273
DRUG DEVELOPMENT AND THE FDA APPROVAL PROCESS 274
Preclinical Testing 274
Clinical Testing 275
Phase 1 Clinical Studies 275
Phase 2 Clinical Studies 275
Phase 3 Clinical Studies 275
Phase 4 Clinical Studies 275
Investigational New Drug 275
Investigational Device Exemption 275
New Drug Application 276
Clinical Study Design 276
ANDROGENETIC ALOPECIA: AN ILLUSTRATIVE EXAMPLE 276
CONCLUSIONS 282
REFERENCES 282
27 - Hair Cosmeceuticals 285
SHAMPOOS 285
Surfactants 285
Anionic Surfactants 285
Cationic Surfactants 286
Amphoteric Surfactants 286
Nonionic Surfactants 286
Conditioning Shampoos 286
MINERAL AND VEGETABLE OILS 287
SHAMPOO PH AND HAIR FRIZZ 287
SHAMPOOS AND ALLERGY 288
DIFFERENT TYPES OF COSMETIC SHAMPOOS 288
Hair Care Guidelines for Different Hair Types 288
Oily hair and scalp 288
Dry virgin hair 288
Normal hair 288
Oily scalp and dry hair 289
Bleached hair 289
Seborrheic Dermatitis in Different Hair Types 289
Oily hair 289
Dry hair 289
Chemically treated hair 289
Natural African hair 289
28 - Hair Supplements 295
INTRODUCTION 295
MICRONUTRIENTS 295
Vitamins 295
Vitamin A 295
Niacin (vitamin B3) 297
Biotin (vitamin B7) 298
Vitamin D 298
Vitamin E 299
Minerals 299
Zinc 299
Iron 300
MACRONUTRIENTS 301
Amino Acids and Proteins 301
Fatty Acids 301
NONVITAMIN NONMINERAL PRODUCTS 301
Caffeine 301
Melatonin 301
Botanical Products 302
MARINE COMPLEXES 302
CONCLUSIONS 302
REFERENCES 302
29 - What Should the Hair Clinician Know About Hair Transplants? 305
OVERVIEW OF HAIR TRANSPLANTATION FOR DERMATOLOGISTS 305
THE PROCEDURE: EVOLUTION 305
FOLLICULAR UNIT TRANSPLANTATION 306
Strip Method Harvest 307
Follicular Unit Extraction Method Harvest 307
Recipient Site Creation and Graft Placement 308
Postoperative Course 309
SCALP REDUCTIONS, FLAPS, TISSUE EXPANDERS 310
ACHIEVING PATIENT SATISFACTION 310
PRACTICAL APPLICATIONS OF HAIR TRANSPLANTATION 311
Male Pattern Baldness 311
Female Pattern Baldness 312
Eyebrows and Eyelashes 313
Beards and Mustaches 313
Scar Tissue Caused by Physical Trauma 313
Primary Cicatricial Alopecia 314
Platelet-rich plasma 315
ACell Matristem 315
REFERENCES 315
Index 317
A 317
B 318
C 318
D 320
E 320
F 321
G 322
H 322
I 324
J 324
K 324
L 324
M 325
N 325
O 326
P 326
Q 327
R 327
S 327
T 329
U 330
V 330
W 330
Y 331
Z 331