Alopecia Signs and Symptoms

Signs and Symptoms

Introduction

May be localized (patchy) or generalized
Scarring or non-scarring
- Scarring alopecia from severe inflammation of the hair follicle result in irreversible damage
- Non-scarring alopecias are reversible

Abrupt or gradual onset
Most common causes include androgenic/androgenetic alopecia (male and female pattern baldness) and alopecia areata
History should be reviewed for medications, severe diet restriction, vitamin A supplementation, thyroid symptoms, concomitant illness and stress factor

Definition

Alopecia areata

Autoimmune hair follicle disease characterized by patches of significant hair loss

Androgenic alopecia

A chronic follicular disorder characterized by progressive hair loss with a patterned distribution
Alopecia totalis mimics androgenic alopecia

Signs and Symptoms

Androgenic alopecia in males/females
Patterned hair loss

Hamilton-Norwood staging [male pattern hair loss (MPHL)]
- The higher the stage, the more severe the hair loss
- Usually starts with bitemporal recession of frontal hairline and continuing with thinning over the vertex, eventually complete hair loss on the vertex; bald hair
- The bald patch enlarges and joins the receding frontal hairline
- Other patterns may develop, but it is the androgenic-independent hair (on the sides and back of scalp) that do not thin

Ludwig staging [(female pattern hair loss (FPHL)]
- Marked presence of miniaturized, vellus-like hair follicles
- The higher the stage, the more severe the hair loss
- Thinning usually diffuse, but more marked on the frontal and parietal regions; “monk’s haircut” in severe cases

Christmas Tree Pattern
- Another female hair loss pattern with centroparietal thinning and frontal accentuation

Age of onset

Thinning of the hair begins between 12-40 years for MPHL
Chronic progressive diffuse hair loss in their 20’s and 30’s for FPHL

Alopeica areata
Clinical presentation

Non-scarring with hairs located at the periphery of the patch extending a few millimeters above the scalp (“exclamation mark”) hair
Nail dystrophy occurs in 10%
- Pitting with irregular pattern or organized transverse or longitudinal rows, concave dorsal nail plate, etc

100% loss of scalp hair (alopecia totalis), 100% loss of hair on scalp and body (alopecia universalis)

Age of onset

Most patients are <40 years of age

Spotlight on multidrug-resistant gram-negative infections: New developments for an old problem

Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021

Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.