alopecia
ALOPECIA

Alopecia is an involuntary loss of hair usually in the scalp that may occur anywhere over the body.
Scarring alopecia is severe inflammation of the hair follicle result in irreversible damage.
Non-scarring alopecias are reversible.
Alopecia may  be abrupt or gradual in onset.
Most common causes include androgenic alopecia (male & female pattern baldness) & alopecia areata.
History should be reviewed for medications, severe diet restriction, vitamin A supplementation, thyroid symptoms, concomitant illness & stress factor.

Alopecia 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
Editor's Recommendations
Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
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.
Jairia Dela Cruz, 6 days ago
For inflammatory bowel disease (IBD) patients, smoking cigarettes or just being exposed to secondhand smoke raises the risk of developing colorectal neoplasia, a study has found.
Jairia Dela Cruz, 2 days ago
Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.