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Adnexal Disorders (Hair (Alopecia (Subtypes (Areata = patchy on scalp…

- - - - ABX: oral, topical (mupirocin), soap
      - Avoid trauma to area
      - Apply products in direction of hair growth
      - Laser hair removal
  - - - Percentage of hairs in telogen phase increases from 10% (normal) to 40-50% -- "hair in handfuls"
      - Reaction of scalp to internal trauma delayed 2-3 mos after event
      - Temporary for isolated events. Chronic if chronic disease or meds.
    - - Arrest of hairs in active growth cycle (anagen)
      - Typically from chemo
      - Loss of hair from scalp, eyebrows, eyelashes, body
  - - - Totalis = all of scalp
      - Universalis = full scalp and body
      - Areata = patchy on scalp
        
        Treatment = Steroids, anthralin, corticosteroid injections or oral, MTX, phototherapy (focused UVB xtrac laser, PUVA)
  - - - Topical corticosteroids
      - Topical antifungals
      - Medicated shampoo
  - - - Itchy, scaly, round patches w/ broken hairs
      - Due to trichophyton tonsurans, microsporum canis
      - Kerion = boggy erythematous plaque w/ severe inflammation and loss of hair on scalp
      - Treatment
        
        Oral terbinafine or griseofulvin
        
        Treat fomites (combs, brushes, pets)
      - More common in children, AAs, hx of eczema
      - Dermatophyte infection of scalp hair
    - - Fungal infxn of beard area. Well demarcated border beyond hair
      - Folliculitis mimic
      - Treatment = oral antifungals
- - - - Decrease oil production: topical/oral retinoids, benzoyl peroxide, salicylic acid, OCPs
      - Decrease bacterial colonization: ABX topical/oral, benzoyl peroxide
      - Decrease inflammatory response: ABX topical/oral, UV light
  - - - Fair skin
      - Adult onset
    - - Ocular involvement
      - Minimal bacterial component
    - - Papulopustular
        
        Topical ABX (metronidazole)
        
        Topical anti-inflamm (azelaic acid, sulfur)
        
        Oral ABX, sub-antimicrobial dose for anti-inflamm
      - Erythematotelangiectatic
        
        Vascular laser
        
        Topical brimonidine (Mirvaso)
      - Ocular
        
        Oral ABX
      - Rhinophyma
        
        Ablative laser
        
        Systemic retinoids
      - Avoid Triggers!
    - - Alcohol
      - Sun
      - Heat
- - - - Oral terbinafine
      - Laser
- - - - Topical AlCl3
      - Oral glycopyrrolate
      - Botox
      - Iontophoresis
      - Mira-Dry
      - Sympathectomy
  - - - Painful nodules
      - Scarring
      - Sinus tracts
      - Draining lesions
    - - Female
      - Obese
      - Smoking
    - - ABX
      - Retinoids
      - Adalimumab
      - Surgery
      - Laser hair removal