DOCSLIB.ORG

Help My Hair Is Falling Out

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Help My Hair Is Falling Out Help my Hair is Falling Out Natasha Atanaskova Mesinkovska MD PhD Department of Dermatology and Dermatopathology University of California, Irvine Natasha A. Mesinkovska MD PHD www.mghcme.org Disclosures “Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest to disclose.” www.mghcme.org Human Hair Follicles • Anagen • Growing hair phase (0.37mm/day) • lasts ~3 years • 85-90% scalp hairs * Longer anagen = longer hair • Catagen • Transitional phase • 1-2 weeks • <1% scalp hairs • Telogen • Resting phase • 3-5 months • 10-15% scalp hairs Natasha A. Mesinkovska MD PHD www.mghcme.org Human Hair Follicles • Scalp hairs – Terminal – daily shed ~100 hairs per day Natasha A. Mesinkovska MD PHD www.mghcme.org Hair Embryology • First hair follicles at 9 weeks – Eyebrow, upper lip, chin • Rest of follicles at 4-5 months – Cephalad to caudal direction • First hairs are lanugo – soft non-pigmented, fine – shed between 32nd- 36th weeks Natasha A. Mesinkovska MD PHD www.mghcme.org Evaluation of the patient with hair loss • History of present illness: – How long ago? – Scalp or other areas as well? – How did the patient notice it? • eg. in the shower, hair dresser – How much hair has been lost (%)? – Any associated symptoms? • eg. itching, scaling, redness, pain – Excess hair elsewhere Natasha A. Mesinkovska MD PHD www.mghcme.org Evaluation of the patient with hair loss • Personal medical history: – Autoimmune /inflammatory – Cancer • Medications: – correlation with onset of hair loss • Hormonal milleu: – Women: oral contraceptives, replacement – Men: testosterone Natasha A. Mesinkovska MD PHD www.mghcme.org Evaluation of the patient with hair loss • Family history: – Hair loss: • Father, brothers, mother, sisters, children • Find out at what age • Did it ever regrow? – Autoimmune and inflammatory diseases: • Thyroid, Diabetis, Vitiligo, Celiac, Inflammatory Bowel, Rheumatoid Arthritis, Lupus – Neoplastic disease Natasha A. Mesinkovska MD PHD www.mghcme.org Important things to ask • Vitamins and supplements – DHEA, retinoids • Diet – vegan • Exercise – marathon Natasha A. Mesinkovska MD PHD www.mghcme.org The exam • Clinical exam of scalp • Pull test – Hair on face – On body – Axilla – Genitals – Nails • Thyroid gland • Wood’s light Natasha A. Mesinkovska MD PHD www.mghcme.org Diagnosis • Scalp biopsy – 1 or 2 – Vertical or horizontal sections – Dermatopathologist • Laboratory work up: – CBC, Ferritin levels, Thyroid, Vitamin deficiencies Natasha A. Mesinkovska MD PHD www.mghcme.org Diseases of the Hair Hair loss Non-scarring and Scarring Natasha A. Mesinkovska MD PHD www.mghcme.org Non-cicatricial Alopecia Natasha A. Mesinkovska MD PHD www.mghcme.org Non-cicatricial Alopecias 1. Androgenetic alopecia 2. Telogen effluvium 3. Anagen effluvium 4. Alopecia areata 5. Trichotillosis (trichotillomania) Natasha A. Mesinkovska MD PHD www.mghcme.org 1.Androgenetic Alopecia • Male and Female pattern hair loss – Strong genetic link (polygenic) – Family history • Progressive decrease of anagen • increase telogen and miniaturized hair follicles Natasha A. Mesinkovska MD PHD www.mghcme.org AGA Natasha A. Mesinkovska MD PHD www.mghcme.org Male pattern balding • Frontotemporal region – following puberty • Increases with age – 80% of men by age 70 • Etiology – Androgen driven • DHT greater affinity for androgen receptors • Converted to DHT by 5-alpha reductase – Type 1 in liver and sebaceous glands – Type 2 scalp, beard, and chest hair follicles Natasha A. Mesinkovska MD PHD www.mghcme.org Hamilton Norwood Classification Fronto-temporal recession with eventual involvement of vertex Natasha A. Mesinkovska MD PHD www.mghcme.org Female pattern • 30 years of age onset – as early as during puberty • apical scalp part wider • frontal hairline preserved • Work up – ferritin, TSH, free/total testosterone, DHEAS, zinc, vit D Natasha A. Mesinkovska MD PHD www.mghcme.org Female pattern Natasha A. Mesinkovska MD PHD www.mghcme.org Treatment Caution against unrealistic expectations • Primary goal is to halt progression. • COMBINATION: at least 6 months to assess response, continue treatment to maintain response. Male pattern hair loss Female pattern hair loss • 5% topical minoxidil • 5% topical minoxidil • Oral finasteride, 1mg • Oral anti-androgens (spironolactone, cyproterone • Surgery (hair acetate). transplantation)* • Surgery (hair – * selected cases transplantation) • wigs Natasha A. Mesinkovska• wigsMD PHD www.mghcme.org Androgenetic Alopecia • Minoxidil • Survival dermal papilla cells • Prolongs anagen phase • Increases shaft diameter • Finasteride (1mg daily) • Type 2 5a-reductase inhibitor • Effects after 6-12 months • Check PSA level prior to initiation • Other: • Dutasteride • Fluridil (topical antiandrogen) • ? PRP Natasha A. Mesinkovska MD PHD www.mghcme.org 2. Telogen Effluvium • Excessive shedding of telogen club hairs • Usually follows a stressful event – 3 months after event • Usually <50% scalp • Eyebrows and eyelashes usually unaffected – if they are- check thyroid levels • Resolves spontaneously Natasha A. Mesinkovska MD PHD www.mghcme.org Telogen Effluvium Several mechanisms: stress: • Illness • Fever • Surgery • labor • CT scan • Medications: amphetamines, lithium, • cimetidine, B-blockers, valproic acid • Hormonal alterations: thyroid, OCP, menopause • Drastic diet regimen • Sudden weight loss – No known cause in many cases Natasha A. Mesinkovska MD PHD www.mghcme.org Telogen effluvium • Exam: Abnormal pull test • Telogen hair • Depigmented club - shaped bulb • Lacks a sheath Natasha A. Mesinkovska MD PHD www.mghcme.org 3. Anagen Effluvium • Abrupt cessation of mitotic activity in hair matrix – Within days to weeks of stimulus – Hair shaft thins → breaks at surface (fractures) – Entirely reversible* • Associations • Chemotherapy – antimetabolites and alkylating agents • INH • Thallium • Boron Natasha A. Mesinkovska MD PHD www.mghcme.org 4. Alopecia Areata • Autoimmune –Loss of immune privilege of hair follicle –Target for activated T cells • ‘swarm of bees’ on pathology • Types: – Patchy – Totalis - loss of all scalp hair – Universalis → loss of all body hair – Ophiasis- band like pattern Natasha A. Mesinkovska MD PHD www.mghcme.org Alopecia areata- patchy Natasha A. Mesinkovska MD PHD www.mghcme.org Alopecia totalis Natasha A. Mesinkovska MD PHD www.mghcme.org Alopecia areata Natasha A. Mesinkovska MD PHD www.mghcme.org Alopecia areata- patchy Natasha A. Mesinkovska MD PHD www.mghcme.org Alopecia Areata • 10% nail pits (more uniform than psoriasis) • Exclamation point hairs - tapering hair shaft • Associated conditions • Eczema • thyroid • vitiligo • DM • Celiac • Hearing impairment • Depression and anxiety Natasha A. Mesinkovska MD PHD www.mghcme.org Tx AA • Patchy alopecia – Intralesional / topical corticosteroids – Topical anthralin – Minoxidil foam • Extensive or rapidly progressive alopecia – Contact immunotherapy (squaric acid dibutyl ester, diphenylcyclopropenone) – Systemic anti-inflammatory: tofacitinib – Wig or hairpiece Natasha A. Mesinkovska MD PHD www.mghcme.org Trichotillomania (Trichotillosis) • Compulsive desire to pull out hair • Hairs of multiple lengths – localized area – Geometric – Irregular patches – Scalp, Eyebrows and eyelashes – Even in children • Hairs of varying length – folliculitis Natasha A. Mesinkovska MD PHD www.mghcme.org Trichotillosis • Compulsive desire to pull out hair • OCD • depression • anxiety • Trichophagia – bezoars • Tx: psychotherapy + anti-depressants Natasha A. Mesinkovska MD PHD www.mghcme.org Tinea Capitis • Scale • Pustules • Broken hairs Natasha A. Mesinkovska MD PHD www.mghcme.org Tinea Capitis • Work up: – KOH scale – Culture the pustules – Biopsy only if above non-diagnostic • Trichophyton tonsurans • Microsporum canis • Treatment: – Griseofulvin – Terbinafine – Itraconazole – +/- ketoconazole or selenium sulfide wash Natasha A. Mesinkovska MD PHD www.mghcme.org Cicatricial Alopecias Alopecia accompanied by absence of follicular ostia Natasha A. Mesinkovska MD PHD www.mghcme.org Scarring alopecias • Complex • Rare conditions • Many types • Scalp Biopsy is a MUST – Dermatopathologist • Comorbidities and HPI important Natasha A. Mesinkovska MD PHD www.mghcme.org Scarring alopecias • Complex • Rare conditions, many 1. Chronic cutaneous lupus 2. Central centrifugal alopecia 3. Lichen planopilaris 4. Frontal fibrosing alopecia 5. Folliculitis decalvans Natasha A. Mesinkovska MD PHD www.mghcme.org Chronic Cutaneous Lupus Erythematosus • Clinical: – Most commonly face, ears, scalp • Erythema • Atrophy • Follicular plugging • Mottled hyper-hypopigmentation • 50% of pts with skin disease have scalp disease • ~5% develop Systemic Lupus • Difficult to distinguish from lichen planopilaris Natasha A. Mesinkovska MD PHD www.mghcme.org Chronic Cutaneous Lupus Erythematosus Natasha A. Mesinkovska MD PHD www.mghcme.org Chronic Cutaneous Lupus Erythematosus • Diagnosis: • Biopsy • Laboratory SLE work up • treatment: – Intralesional or topical steroids – Systemic (antimalarials, mycofenolate mofetil, methotrexate, retinoids, dapsone, sulfasalazine, thalidomide) Natasha A. Mesinkovska MD PHD www.mghcme.org Natasha A. Mesinkovska MD PHD www.mghcme.org 2. Central Centrifugal Cicatricial Alopecia Natasha A. Mesinkovska MD PHD www.mghcme.org 2. Central Centrifugal Cicatricial Alopecia • Overlapping entities • Hot comb alopecia/Follicular degeneration syndrome • Begins in crown → advances centrifugally • Difficult treatment –Discontinue chemical treatment –Discontinue
Load more

Recommended publications
  • Anatomy and Physiology of Hair
    Chapter 2 Provisional chapter Anatomy and Physiology of Hair Anatomy and Physiology of Hair Bilgen Erdoğan ğ AdditionalBilgen Erdo informationan is available at the end of the chapter Additional information is available at the end of the chapter http://dx.doi.org/10.5772/67269 Abstract Hair is one of the characteristic features of mammals and has various functions such as protection against external factors; producing sebum, apocrine sweat and pheromones; impact on social and sexual interactions; thermoregulation and being a resource for stem cells. Hair is a derivative of the epidermis and consists of two distinct parts: the follicle and the hair shaft. The follicle is the essential unit for the generation of hair. The hair shaft consists of a cortex and cuticle cells, and a medulla for some types of hairs. Hair follicle has a continuous growth and rest sequence named hair cycle. The duration of growth and rest cycles is coordinated by many endocrine, vascular and neural stimuli and depends not only on localization of the hair but also on various factors, like age and nutritional habits. Distinctive anatomy and physiology of hair follicle are presented in this chapter. Extensive knowledge on anatomical and physiological aspects of hair can contribute to understand and heal different hair disorders. Keywords: hair, follicle, anatomy, physiology, shaft 1. Introduction The hair follicle is one of the characteristic features of mammals serves as a unique miniorgan (Figure 1). In humans, hair has various functions such as protection against external factors, sebum, apocrine sweat and pheromones production and thermoregulation. The hair also plays important roles for the individual’s social and sexual interaction [1, 2].
    [Show full text]
  • Hair's the Question*
    Hair Transplant Forum International www.ISHRS.org March/April 2015 Hair’s the Question* Sara Wasserbauer, MD, FISHRS Walnut Creek, California, USA [email protected] *The questions presented by the author are not taken from the ABHRS item pool and accordingly will not be found on the ABHRS Certifying Examination. I got a new toy a few Christmases ago—a magnifier for my iPhone camera. I have to tell you: I LOVE this thing! For diagnositic usefulness during a consult, you cannot beat magnification (Dr. Nicole Rogers even won the poster competition in Alaska with a little device like this)! If you are not already using it for your patients, having a camera like this (or a video microscope) enables instant analysis and feedback for your patient. They will love it and you will, too. Now let’s test your skills for diagnosing some of these commonly seen photomicrographs of the scalp. 1. This patient has been: 4. The following microscopic photo is an example of: A. Shaving his hair recently A. An ingrown hair B. Plucking out his own hair B. Diffuse folliculitis C. Using keratin hair fibers (aka Toppik®, etc.) C. Donor area 6 months post FUE hair surgery D. Getting regular “Brazilian blowouts” D. Follicular plugging 2. This patient shows evidence of: 5. What recently happened to the hairs in this photo? A. Exclamation point hairs indicating trichotillomania A. They were recently backcombed as evidenced by their B. Alopecia areata ruffled cuticle. C. Loss of follicular openings B. They were recently cut as shown by their blunt (i.e., not D.
    [Show full text]
  • Pediatric and Adolescent Dermatology
    Pediatric and adolescent dermatology Management and referral guidelines ICD-10 guide • Acne: L70.0 acne vulgaris; L70.1 acne conglobata; • Molluscum contagiosum: B08.1 L70.4 infantile acne; L70.5 acne excoriae; L70.8 • Nevi (moles): Start with D22 and rest depends other acne; or L70.9 acne unspecified on site • Alopecia areata: L63 alopecia; L63.0 alopecia • Onychomycosis (nail fungus): B35.1 (capitis) totalis; L63.1 alopecia universalis; L63.8 other alopecia areata; or L63.9 alopecia areata • Psoriasis: L40.0 plaque; L40.1 generalized unspecified pustular psoriasis; L40.3 palmoplantar pustulosis; L40.4 guttate; L40.54 psoriatic juvenile • Atopic dermatitis (eczema): L20.82 flexural; arthropathy; L40.8 other psoriasis; or L40.9 L20.83 infantile; L20.89 other atopic dermatitis; or psoriasis unspecified L20.9 atopic dermatitis unspecified • Scabies: B86 • Hemangioma of infancy: D18 hemangioma and lymphangioma any site; D18.0 hemangioma; • Seborrheic dermatitis: L21.0 capitis; L21.1 infantile; D18.00 hemangioma unspecified site; D18.01 L21.8 other seborrheic dermatitis; or L21.9 hemangioma of skin and subcutaneous tissue; seborrheic dermatitis unspecified D18.02 hemangioma of intracranial structures; • Tinea capitis: B35.0 D18.03 hemangioma of intraabdominal structures; or D18.09 hemangioma of other sites • Tinea versicolor: B36.0 • Hyperhidrosis: R61 generalized hyperhidrosis; • Vitiligo: L80 L74.5 focal hyperhidrosis; L74.51 primary focal • Warts: B07.0 verruca plantaris; B07.8 verruca hyperhidrosis, rest depends on site; L74.52 vulgaris (common warts); B07.9 viral wart secondary focal hyperhidrosis unspecified; or A63.0 anogenital warts • Keratosis pilaris: L85.8 other specified epidermal thickening 1 Acne Treatment basics • Tretinoin 0.025% or 0.05% cream • Education: Medications often take weeks to work AND and the patient’s skin may get “worse” (dry and red) • Clindamycin-benzoyl peroxide 1%-5% gel in the before it gets better.
    [Show full text]
  • (In)Determinable: Race in Brazil and the United States
    Michigan Journal of Race and Law Volume 14 2009 Determining the (In)Determinable: Race in Brazil and the United States D. Wendy Greene Cumberland School fo Law at Samford University Follow this and additional works at: https://repository.law.umich.edu/mjrl Part of the Comparative and Foreign Law Commons, Education Law Commons, Law and Race Commons, and the Law and Society Commons Recommended Citation D. W. Greene, Determining the (In)Determinable: Race in Brazil and the United States, 14 MICH. J. RACE & L. 143 (2009). Available at: https://repository.law.umich.edu/mjrl/vol14/iss2/1 This Article is brought to you for free and open access by the Journals at University of Michigan Law School Scholarship Repository. It has been accepted for inclusion in Michigan Journal of Race and Law by an authorized editor of University of Michigan Law School Scholarship Repository. For more information, please contact [email protected]. DETERMINING THE (IN)DETERMINABLE: RACE IN BRAZIL AND THE UNITED STATES D. Wendy Greene* In recent years, the Brazilian states of Rio de Janeiro, So Paulo, and Mato Grasso du Sol have implemented race-conscious affirmative action programs in higher education. These states established admissions quotas in public universities '' for Afro-Brazilians or afrodescendentes. As a result, determining who is "Black has become a complex yet important undertaking in Brazil. Scholars and the general public alike have claimed that the determination of Blackness in Brazil is different than in the United States; determining Blackness in the United States is allegedly a simpler task than in Brazil. In Brazil it is widely acknowledged that most Brazilians are descendants of Aficans in light of the pervasive miscegenation that occurred during and after the Portuguese and Brazilian enslavement of * Assistant Professor of Law, Cumberland School of Law at Samford University.
    [Show full text]
  • A Case Report
    J Psychiatrists’ Association of Nepal Vol .4, No.1, 2015 CASE REPORT ARTICLE Childhood Trichotilomania with Atypical Treatment Response: A Case Report Das M1, Kaur A2 1. Assistant Professor, Department of Psychiatry, Government Medical College, Haldwani, Nainital (Uttarakhand) 2. Assistant Professor, Department of Community Medicine, Government Medical College, Haldwani, Nainital (Uttarakhand). E-mail *Corresponding author: [email protected] Abstract Trichotillomania once was considered as a rare disorder but now it is recognized as a psychiatric illness that is not as rare as previously thought. Standard treatment guideline of this disorder, especially for children is not available till the present date. In this report, a case of childhood trichotillomania, its various diagnostic possibilities and successful treatment with Risperidone in a child has been described. Keywords: Trichotillomania, Childhood Onset, Risperidone INTRODUCTION in infants though it is more often seen in the first French dermatologist, François Henri two decades of life, especially in female Hallopeau was the first to describe a case of self- adolescents. inflicted depilation of scalp and he coined the ICD 10 (International Classification of term Trichotillomania in 1989. This word is Diseases 10th revision) 5 has classified derived from Greek words: tricho- (hair), tillo trichotillomania in habit and impulse disorder (pull), and mania (madness). The term whereas DSM-V (Diagnostic and Statistical trichotillomania is misleading because the suffix Manual of Mental Disorders, Fifth Edition) 4 puts "mania" implies the presence of a serious it under obsessive compulsive and related psychiatric disorder. Even after 100 years of disorders. Meyer and Haag6 reported recognising the disease, etiology, natural history trichotillomania's association with stressful and treatment is not fully clear.
    [Show full text]
  • Rapunzel Syndrome: a Case Report and Literature Review
    Case Report Annals of Short Reports Published: 10 Jun, 2020 Rapunzel Syndrome: A Case Report and Literature Review Hemonta KD* Department of Pediatric Surgery, Assam Medical College, India Abstract Rapunzel syndrome is an extremely rare clinical condition in children. Usually affects girls of adolescent age group with history of hair ingestion (trichophagia) and trichotillomania (hair- pulling). Patients present with vague abdominal pain and bowel obstruction caused by a hairball in the stomach, with its tail extending into duodenum and beyond. We report a case of 13-year-old girl with poor general condition, who presented with recurrent abdominal pain, vomiting and a palpable mass in the abdomen. She gave history of trichophagia and trichotillomania for more than two years. On exploration, a large trichobezoar with a tail was noted in the stomach, duodenum and proximal jejunum. The bezoar was removed. The girl had uneventful recovery. She received psychiatric treatment and improved. Introduction Rapunzel syndrome is characterized by presence of hairballs or hair-like fibers in the stomach and intestine. These results from chewing and swallowing hair or any other indigestible materials (trichophagia) often associated with hair-pulling disorder (trichotillomania) in young girls [1-3]. The syndrome is named after the long-haired girl ‘Rapunzel’ in the fairy tale by the Brothers Grimm [4]. We present a case of Rapunzel syndrome in an adolescent girl, who needed surgical removal of the hairball and psychiatric treatment. Case Presentation A 13-year old girl with poor general condition presented with recurrent abdominal pain with distension, vomiting and constipation. She had a palpable mass in the epigastric region.
    [Show full text]
  • Alopecia, Particularly:  Alopecia Areata  Androgenetic Alopecia  Telogen Effluvium  Anagen Effluvium
    432 Teams Dermatology Hair disorders Color Code: Original, Team’s note, Important, Doctor’s note, Not important, Old teamwork Done by: Shaikha Aldossari Reviewer: Lama AlTawil 8 Team Leader: Basil Al Suwaine&Lama Al Tawil 432 Dermatology Team Lecture 8: Hair Disorders Objectives 1- Normal anatomy of hair follicle and hair cycle. 2- Causes, features and management of non scarring alopecia, particularly: Alopecia areata Androgenetic alopecia Telogen effluvium Anagen effluvium 3- Causes and features of scarring alopecia. 4- Causes and features of Excessive hair growth. hair disorder Excessive hair Alopecia growth non scarring Hirsutism Hypertrichosis scarring Anagen Telogen Androgenetic Alopecia effluvium effluvium Alopecia Areata P a g e | 1 432 Dermatology Team Lecture 8: Hair Disorders Anatomy of hair follicle: The Arrector piliResponsible for piloerection (goose bumps ) that happens when one is cold (produces energy and therefor warmth) . hair follicle becomes vertical instead of oblique Cuticle is the last layer here . what we can see outside . it has 7 layers of keratinocytes How many hairs in the body? 5 millions hairs in the body, 100,000 in the scalp. Growth rate: 0.3mm/day for scalp hair i.e.1cm/month Hair follicle bulge: -Very important part since it has stem cells .its the inertion of the arrector pili Hair follicle on vertical section: -So any pathological process affecting any part other Initially the shaft and the follicle are one than this, hair would still be able to regrow. organ then when you reach 1/3 the follicle -If we want to destroy a hair follicle, we’d target the bulge.
    [Show full text]
  • Trichotillomania: an Impulsion Beyond Hair Pulling (A Case Report)
    Iqbal MM, et al., J Clin Stud Med Case Rep 2019, 6: 70 DOI: 10.24966/CSMC-8801/100070 HSOA Journal of Clinical Studies and Medical Case Reports Case Report Trichotillomania: An Impulsion Introduction Trichotillomania evolves as an impulse control disorder in the lit- beyond Hair Pulling erature where hair puling ultimately leads to achievement of mental satisfaction and pleasure. Although rare, it has been reported in the (A Case Report) literature previously where adolescents and children between ages 9 -13 years have been frequently targeted by this psycho dermatologic morbidity [1]. Frequent misdiagnosis of trichotillomania with alope- Muhammad Mashood Iqbal*, Muhammad Ishaq Ghauri, Mohammad Shariq Mukarram, Mohammad Faisal Iftikhar and cia areata appears to be common according to studies and hence a Uzzam Ahmed Khawaja challenging task lies to clinically diagnose the former accurately [1- 3]. Trichotillomania repeatedly appears to be linked with depression, Department of Medicine, Jinnah Medical College Hospital, Karachi, Sindh, obsessive compulsive disorder, low self-esteem, poor social function- Pakistan ing and self-image [1,4]. Patients who clinically present with such psychiatric abnormalities should be evaluated for mental and behav- ioral disorders where they tend to carry out anomalous tasks in order Abstract to relieve anxiety. Introduction: Trichotillomania is a psycho dermatologic disorder Clinical interventions to precisely evaluate and further manage that has been identified as a common morbidity in children and ado- trichotillomanics require large scale studies with positive outcomes. lescents having a positive correlation with depression and Obsessive Most successful behavioral modifications and therapies such as habit Compulsive Disorder (OCD). Very few cases have been reported in reversal tend to outweigh the pharmacological approach where the the 20-30 age groups, therefore, we intend on reporting this case.
    [Show full text]
  • Trichotillomania in Childhood: Case Series and Review
    Trichotillomania in Childhood: Case Series and Review Yong-Kwang Tay, MD*; Moise L. Levy, MD‡§; and Denise W. Metry, MD‡§ ABSTRACT. Trichotillomania is a relatively common seen over a 2-year period and reviews the literature cause of childhood alopecia. We report our observations on TTM in children. of 10 children with trichotillomania seen over a 2-year period at Texas Children’s Hospital. Patient ages ranged PATIENTS AND METHODS from 9 to 14 years (mean: 11.3 years) with an equal gender This was a retrospective chart review of children diagnosed ratio. The duration of hair-pulling ranged from 1 month with TTM between April 1999 and March 2001 in the dermatology to 10 years (median: 4.6 months). The scalp alone was service at Texas Children’s Hospital. Demographic data and the affected in 8 cases, the scalp and eyelashes in 1 case, and following specifics were collected: duration of hair-pulling, site(s) the eyelashes alone in 1 case. The frontal scalp and vertex of hair loss, potential triggering factors and associated psychopa- were the most common sites affected. Associated find- thology, and treatment rendered. ings included nail-biting in 2 cases, “picking” of the skin in 1 case, and headaches in another case. Noted precipi- RESULTS tating factors in 3 patients included “stress” at home and A total of 10 children, ranging from 9 to 14 years school. Associated psychopathology included major de- old (mean: 11.3 years) with an equal gender ratio, pression in 1 case, attention-deficit/hyperactivity disor- der in 1 case, and an “anxious and nervous personality” were diagnosed with TTM over a 2-year period (Ta- in 1 case.
    [Show full text]
  • Gender and Hair Politics: an African Philosophical Analysis
    Gender and Hair Politics: An African Philosophical Analysis by Sharon Adetutu Omotoso, PhD [email protected] Institute of African Studies University of Ibadan, Nigeria ABSTRACT One wonders if there is anything called philosophy of hair. It may be argued in some philosophy quarters, that to endorse any philosophy of hair is to strip philosophy of its intellectual nature, relegating it into realms of trivialities. While anthropologists, sociologists, psychologists and scholars in the sciences have attempted discussing hair issues, philosophers have paid minimal attention based largely on a claim that there are more important life issues to philosophize. While ‘head’ (ori in Yoruba language) as a concept in African Philosophy has been widely theorized, very little work has been done on hair as a part of the head. Consequently, this paper argues that the importance of hair in the development of social constructs of the body puts forth the need for a gendered study of its philosophy and politics. Politics of hair in Africa is interesting and highly debatable yet overlooked by existing literatures. Using methods of critical analysis, reflective argumentation, deconstruction and reconstruction to carefully consider social, economic, cultural and religious dimensions in the politics of hair among men and women, this work draws out the implications for Africa’s holistic development. Dr Sharon Adetutu OMOTOSO is currently with the Gender Studies Program at the Institute of African Studies, University of Ibadan, Nigeria where she coordinates the Women’s Research and Documentation Centre (WORDOC). She is a a Chartered Mediator & Conciliator, Senior Research Fellow Institut Français de Recherche en Afrique (IFRA) and Research Fellow (Gender/Women Issues) of the Ibadan School of Government and Public Policy (ISGPP).
    [Show full text]
  • Hair Removal & Skin Rejuvenation Machine
    Hair Removal & Skin Rejuvenation Machine IPL Hair Removal IPL laser hair removal is a very popular method of hair removal. An IPL laser uses “intense pulsed light” to gently and safely removes hair on the face, legs, back, and bikini/pubic areas. The pulses of light focus their heat on the hair follicles, destroying them without burning or damaging the skin. IPL laser hair removal is quick and veritably painless. Side effects are few, but may include redness or swelling of the treated area; this should disappear rapidly. Good candidates for IPL laser hair removal will have lighter skin and darker hair, since IPL targets pigment in the hair follicles. Many people have experienced permanent hair removal with this method; if hair does grow back, it is often sparse and finer in texture. Laser Hair removal. Laser hair removal is a gentle and effective way to permanently reduce unwanted hair from virtually any area of the body. Locate a laser hair removal clinic in your area and acquire information on the latest laser hair removal options for men and women by reading the sections below. Laser Hair Removal Procedure Laser hair removal is most effective when hair is in the growth stage. Because hair grows in cycles, laser hair removal patients typically require a series of four to six sessions spaced approximately one month apart for maximum results. www.globalclinic.co During Laser Hair Removal Treatment Typically, the areas to be treated are shaved a few days prior to the laser hair removal treatment. On the day of the procedure, an anesthetic cream may be applied, although this step is not necessary.
    [Show full text]
  • Hair Loss in Infancy
    SCIENCE CITATIONINDEXINDEXED MEDICUS INDEX BY (MEDLINE) EXPANDED (ISI) OFFICIAL JOURNAL OF THE SOCIETÀ ITALIANA DI DERMATOLOGIA MEDICA, CHIRURGICA, ESTETICA E DELLE MALATTIE SESSUALMENTE TRASMESSE (SIDeMaST) VOLUME 149 - No. 1 - FEBRUARY 2014 Anno: 2014 Lavoro: 4731-MD Mese: Febraury titolo breve: Hair loss in infancy Volume: 149 primo autore: MORENO-ROMERO No: 1 pagine: 55-78 Rivista: GIORNALE ITALIANO DI DERMATOLOGIA E VENEREOLOGIA Cod Rivista: G ITAL DERMATOL VENEREOL G ITAL DERMATOL VENEREOL 2014;149:55-78 Hair loss in infancy J. A. MORENO-ROMERO 1, R. GRIMALT 2 Hair diseases represent a signifcant portion of cases seen 1Department of Dermatology by pediatric dermatologists although hair has always been Hospital General de Catalunya, Barcelona, Spain a secondary aspect in pediatricians and dermatologists 2Universitat de Barcelona training, on the erroneous basis that there is not much in- Universitat Internacional de Catalunya, Barcelona, Spain formation extractable from it. Dermatologists are in the enviable situation of being able to study many disorders with simple diagnostic techniques. The hair is easily ac- cessible to examination but, paradoxically, this approach is often disregarded by non-dermatologist. This paper has Embryology and normal hair development been written on the purpose of trying to serve in the diag- nostic process of daily practice, and trying to help, for ex- ample, to distinguish between certain acquired and some The full complement of hair follicles is present genetically determined hair diseases. We will focus on all at birth and no new hair follicles develop thereafter. the data that can be obtained from our patients’ hair and Each follicle is capable of producing three different try to help on using the messages given by hair for each types of hair: lanugo, vellus and terminal.
    [Show full text]