HAIR DISORDER

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

Introduction
Hair follicle through three stages:
Anagen active growth phase of hair
follicles hair grows 1 cm every 28 days
(stays for 2 - 8 years)
Katagen a short transition stage 2
3 weeks while a club hair is formed
Telogen rest period

90% in anagen, 1014% in telogen

and 12% in catagen.
lose only 50 to 100 hairs per day
Hair on the scalp grows at a rate of
0.37 to 0.44 mm/day or approximately
1 cm/month.

Anagen

Katagen

Telogen

Hair Types :
Terminal hair Produced by large hair

follicles located in the subcutis; > 0,03 mm

in diameter

Vellus hair: Produced by very small hair

follicles located in the dermis; thin ( 0,03

mm diameter), short, often depigmented,
usually non-medullated hair shaft

Alopecia type:
Universalis on the whole body
Totalis on the whole scalp
Areata localized,

Disturbed hair follicle cycling

Effluvium
(telogen effluvium, alopecia areata,
androgenetic alopecia)

Causes of Telogen Effluvium

Endocrine
"Stressful" events
Nutritional
Intoxication
Drugs
Inflammatory scalp disease

Acute Telogen Effluvium

May occur at any age and represents a
precipitous shift of a percentage of
anagen hairs to telogen

Chronic Telogen Effluvium

A persistent form of telogen effluvium, with
loss of hair volume, lasting in excess of 6
months typically occurs in middle-aged
women

Anagen Effluvium

The daily loss of some telogen hairs is

entirely normal, but it is always abnormal
to shed anagen hairs.

ALOPECIA AREATA
Clinical Features
Presents with round patches of hair loss, may
be single or multiple, and may coalescent
Pathognomonic exclamation mark" may
present, particularly at the periphery of areas
of hair loss

Location :
Scalp
Beard
Eyebrow
Eyelash
Other location on the skin rarely

Etiology
Autoimmune disease genetic
factor
Emotional Stress

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

Differential Diagnosis
Tinea capitis.
Trichotillomania.
Early scarring alopecia.
Syphilis (alopecia areolaris).

Treatment of Alopecia Areata

Topical Corticosteroids
Intralesional Corticosteroids
Hydrocortisone acetate (25 mg/mL) and
triamcinolone acetonide (5 to 10 mg/mL)
Systemic Coticosteroids

Treatment of Alopecia Areata

Topical Minoxidil Solution
Photo(Chemo)Therapy
Psoralen and UVA light
Contact Immunotherapy

Alopecia areata

Alopecia areata multiple

Alopecia universalis

Unwanted hair follicle

transformation
Patterned hair loss (androgenetic alopecia)
Hirsutism
Hypertrichosis

Androgenetic alopecia
Male, Major features :
Recession of the frontal hair line and
balding of the scalp vertex
Women : a reduction in hair density
involving the crown and frontal scalp,
with maintenance of the frontal hair line

Treatment
Male pattern hair loss
5% topical minoxidil solution or foam
twice daily,
Oral finasteride, 1 mg daily.
Combination of the above.
Surgery (e,g., hair transplantation).

Female pattern hair loss

2%-5% topical minoxidil solution twice
daily.
TopicaI17-estradiol
Oral anti-androgens
(spironolactone,cyproterone acetate).
Maintain serum ferritin> 40 J.l9/L.
Hair transplantafion in selected cases.

Androgenetic alopecia

Androgenetic alopecia

EXCESS HAIR
Hypertrichosis
Hair density or length beyond the accepted
limits of normal for a particular age, race,
or sex.
The excess hair may be generalized or
localized and may consist of lanugo, vellus,
or terminal hair.

Hypertrichosis on face

Hirsutism
Hair growth in women in areas of the
body where hair growth is under
androgen control and in which normally
only postpubescent males have terminal
hair growth.
These areas include the moustache,
beard, chest, escutcheon, and inner
thigh.

Hirsutism on face

Hirsutism on woman chest

TRAUMATIC HAIR LOSS

Pressure Alopecia
The hair loss may be permanent and is
presumably due to ischemia from pressure
injury
Trichotillomania
a compulsive desire or habit to pull out the
hair.

Trikotilomania

TRAUMATIC HAIR LOSS

Traction Alopecia
Inadvertent prolonged traction on the scalp by the
physical pressure of hair styling (e.g.,pony tail,
tight braids, foam rollers, etc)
Tinea Capitis
It typically presents with patchy hair loss
associated with inflammation of the affected
scalp.

Traction Alopecia

Structural hair shaft defect

Monilethrix
Pili torti
Trichorrhexis nodosa

Monilethrix
Distinctive, with extremely short, brittle
hairs emerging from keratotic follicular
papules
Caused by mutations of one of three of
the genes encoding type II hair cortex
keratins

Monilethrix

Pili torti
Clinically, the patient may have patchy
alopecia with coarse stubble or longer
broken hairs
The hairs are distinguished by the multiple
irregular intervals of twisting along an
otherwise straight hair shaft

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

Trichorrhexis nodosa
Trigger by mechanical or chemical damage
Proximal breakage : appears most commonly in
African American women, usually after repetitive
chemical or hot-comb straightening
Distal : to excessive brushing, back- combing, or
sporadic use of permanent waves.

Trikoeksis nodosa

Hair Shaft Abnormalities

Associated with Unruly Hair

UNCOMBABLE HAIR SYNDROME

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

 WOOLY HAIR

The presence of kinky, wavy hair on the scalp

of persons of non-African or Negroid
background
MARIA UNNA HYPOTRICHOSIS

Scalp hair is lost in a pattern resembling

androgenetic alopecia (though both sexes
are equally affected) with a scattering of
coarse thickened hairs in the balding areas.

NON-SCARRING HAIR LOSS:

PRODUCTION DECLINE
Triangular (Temporal) Alopecia
The hair loss either may be complete or fine
vellus hairs may remain.The underlying
scalp is normal. The hair loss may be uni
or bilateral.

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

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