Sie sind auf Seite 1von 3

OBJECTIVE : DIFFERENTIAL DIAGNOSIS OF ALOPECIA

DEFINITION : Absent of hair from a normal hairy area


CLASSIFICATIONS :
Cicatricial (scarring)
1. Congenital Scarred area present since
birth
2. Acquired
Trauma: Burn, wound
Infection : Kerion, favus
Diseases : SLE, malignancy

Non-Cicatricial (non-scarring)
1. Congenital Fail to grow/regrow hair
after shedding
2. Acquired
Circumscribed : Alopecia areata,
androgenetic alopecia, traumatic, tinea
capitis
Diffuse : Telogen effluvium, anemia,
SLE, hypo & hyperthyroidism, DM

ALOPECIA AREATA
Etiology
T-cell mediated autoimmune disease.
Clinical Pictures
1. Site : Hairly area (common : scalp)
2. Onset : Sudden 1/> localized, well-circumscribed,
round to oval alopecia
3. Character : Exclamation mark hair (thin prox thick
distally)
4. Pattern
Ophiasis : Alopecia on occipital area
Total : All scalp hair is lost
Universal : Scalp and body hair are absent
5. Associated with :
Nails pitting
Patient s family Atopic disorders, vitiligo, DM,
autoimmune dis.

ANDROGENETIC ALOPECIA
Etiology
Women : Genetic & hormonal factors
Men : Genetic factor of absent 5 a
reductase enzyme
Clinical Pictures
Women : Diffuse thinning on the crown area
and maintain the frontal hairline
Men : Gradual thinning in temporal area
and reshaping of ant hairline Triangular
temporal alopecia

Treatment
TELOGEN EFFLUVIUM
Definition : Hair shredding > normal
Etiology :
1. Acute illness: Febrile illness, severe infection, severe trauma
2. Chronic illness: Malignancy, SLE
3. Hormonal : Hypothyroidism
4. Anorexia, heavy metals
5. Medication : Anticoagulants, propranolol, retinoid (excess vit A)
OBJECTIVE : SCALY SCALP
Cradle Cap (Infantile)

Tinea Capitis

Scalp Psoriasis

Etiology: Unknown
C/p:
Pinky, scaly, greasy yellow
crusts. May spread to face, ears,
groin. Not itchy.
Disappear after 3-4 weeks
Treatment: Shampoo, salicylic acid
cream

Etiology: Dermatophyte infections of


the scalp
C/p: Patches of redness, scaling and
hair loss. Slightly itchy. Can be single
or multiple lesions.
Diagnosis: Woods light, skin
scrapping
Treatment: Ketoconazole shampoo
Topical: Tolnaftate cream
Systemic therapy : Griseofulvin

Etiology: Autoimmune disease


C/p: Well-defined erythematous
plaque with silvery white scales. No
hair loss. Itchy
Diagnosis: Skin biopsy. Examine
any similar lesion in other area
Treatment
Local & systemic: Phototherapy
PUVA, Corticosteroid, calcipotriol (Vit
D), tar, salicyclic acid 5%

Seborrheic Dermatitis
C/p:

Start at puberty
Scalp covered by dry/greasy white or yellow scales. Patches scales or thick crust on scalp. Itchy
OBJECTIVE: NAIL PITTING
ANATOMY
Nail plate: Clear, translucent (hard
keratin). Created by nail matrix
Nail matrix : Below cuticle. Contain blood
vesels, nerves
Lunula: Crescent whitish area of nail bed
Nail fold: Hard skin overlapping the base
and side of the nail
Nail bed : Continuation of matrix
DEFINITION : Superficial depression of the nail plate
PATHOGENESIS : Due to abnormal keratinization of proximal nail matrix result in cluster of
parakeratonic cells in the dorsal nail plate
CAUSES OF PITTING : Psoriasis, Lichen Planus, Alopecia areata, Eczematous Dermatitis
TYPES OF PITTING:
TYPES
1. Irregular pitting
2. Geometric pitting
3. Coarse pitting/ ridging

CHARACTERISTICS
Psoriasis
Multiple small superficial pits. Alopecia areata
Very irregular pits. Eczematous dermatitis

OBJECTIVE : NAIL DYSMORPHIC


OBJECTIVE : CIRCINATE LESIONS
Scaly
1. Tinea corporis
Well defined plaque +
active raised border. Cover
with
scales/papules/vesicle/pust
ules
Centre +/= clear
2. Pityriasis rosea

Crusted

Erythematous

Indurated

OBJECTIVE : ERYTHEMATOUS PLAQUE WITH REMISSION AND EXACERBATION


OBJECTIVE ; WOODS LIGHT
OBJECTIVE : TOPICAL OITMENT GIVEN. WHY WASNT EFFECTIVE?
OBJECTIVE : SYSTEMIC & TOPICAL MOTHER AND CHILDREN