Chester Hair Clinic

Androgenetic alopecia(Male Pattern Alopecia)

Signs:

Male pattern hair loss usually starts with a recession to the temples and/or a diffuse thinning to the crown, followed in some cases by a gradual thinning, then a complete denuding of the top. Very rarely is the hair lost on the sides and back although older men of 70 plus can loose hair in the neck area,

Hamilton scale

* Bi-lateral recession to frontal​* Diffuse thinning to vertex

* Followed by gradual denuding of frontal, parietal & vertex

* Atrophy of hairs​* No scarring

Cause:

Androgenic hair loss has three causative factors: 1. Genetic predisposition, 2. The presence of the androgen testosterone and 3Age.

Male pattern baldness is more commonly inherited from the Maternal Grandfather.

 

At puberty, more of the male hormone Testosterone circulates around the body having opposite effects on hair in different places.

Under the arms and on the pubic area on men and women, and the beard chest and back and legs on men, the fine vellus hair is slowly replaced in each succeeding growth cycle by coarser terminal hairs. These hairs do not grow as long as scalp hair with the exception of some beard hair on certain races of men.

Scalp:

On the scalp, in areas that are genetically programmed to thin (the pattern areas) each new cycle of anagen growth produces finer and shorter hairs

Testosterone reaches the target organ, in this case the hair follicle, where the enzyme 5alpha – reductase changes Testosterone into the highly potent hormone Di-hydro Testosterone which causes the above affects.

The effects are progressive but not always total. Familial history can help prognosis

 

* Progressive

* More commonly inherited from maternal grandfather

 

TREATMENT:

There is no cure for MPA

 

Drugs with the side effect of hypertrichosis:

Minoxidil 2% or 5%

 

5 alpha-reductase inhibitors:

Propecia   Finasteride (Proscar)

 

Cosmetic enhancers (e.g. Mane spray, Toppik, strand thickeners, hair replacement techniques)

 

Hair transplantation

 

 

The Chester Hair Clinic

3 Castle Street, Chester

CH1 2DS

Telephone: 01244 346798

Website : www.hairmatters.co.uk

Richard Hall AIT

Androgenetic hair loss in women

 

Signs:

Androgenetic hair loss in women presents a diffuse thinning to the front and crown area of the scalp and never at the sides and back from this reason alone. Partings seem wider and the scalp seems more noticeable at the front and the top of the head

This is a slow, gradual process and rarely does it completely denude the area.

Androgenetic hair loss in women usually begins with the hormone changes after puberty, pregnancy or menopause and is fairly common in ladies over 80 years of age

There is no increased hair shedding noticed with this type of loss.

 

Associated signs:

Ladies with Androgenetic hair loss can also suffer from a greasy scalp and male type body hair growth.

 

Cause:

Androgenetic hair loss has three causative factors, age, inheritance and the presence of the hormone testosterone.

1. Age:

Androgenetic hair loss can start from puberty, childbirth, after the menopause and in old age.

2. Inheritance:

It is commonly inherited from the maternal grandmother.

3. Testosterone: F.P.A. results from the normal amount of testosterone present in a female.

Postmenopausal thinning is related to oestrogen reduction.

 

Aetiology:

The hair bulb normally grows for between three to seven years before it stops growing and enters the resting phase. The hair is then retained in the follicle for between two to four months, before a new hair grows from the base of the follicle. We normally lose (in a mosaic pattern) about 60 to 100 hairsdaily in this way often without noticing it.

With the effect of a normal increase in testosterone at puberty, each succeeding hair growth cycle is shortened, and the hair (thinner)

Sensitivity of the hair bulb to the hormone testosterone

 

Hair loss in the female area

Symptoms of F.P.A. and hirsutism can occur when there is an imbalance of sex hormones, either an excess of male hormones (androgens), or less female hormones (oestrogen/progesterone) these can occur because of ovarian cyst syndrome. Postmenopausal thinning can be related to oestrogen reduction.

 

Treatment:

There is no effective treatment for F.P.A.

Drugs with the side effect of hypertrichosis

* Minoxidil

Hair transplantation

* Systemic anti-androgen therapy (C.A.T.)(Cyproterone acetate + oestrodial)

* Dianette (Anti androgen birth control pill)

* The psychological effect of hair loss must never be underestimated

 

Prognosis:

* Assessment of final patterning is difficult to judge, but detailed questioning of family inheritance is essential.

* If no evidence of hormone imbalance = “You have pattern loss because you are programmed genetically to have it.”

* You cannot permanently change inheritance.

 

 

The Chester Hair Clinic

3 Castle Street, Chester

CH1 2DS

Telephone: 01244 346798

Website : www.hairmatters.co.uk

Richard Hall AIT

PSORIASIS

 

Signs:

Psoriasis often begins on scalp or elbows with circular, coin-shaped areas of uniform darker/ redder skin clearly differing in colour from adjacent normal coloured skin.

These areas are covered with dry white, adherent scales, which can sometimes be quite dense. These scales not easily removed but if they are, then coarse lined skin with bleeding points can be seen underneath them.

Psoriasis rarely covers the whole scalp but can overlap the hairline. It is rarely seen on children under the age of three years.

 

Symptoms:

The scalp feels rough and craggy and although not usually itchy, it can be very itchy.

 

Associated signs;

Other areas that can be affected are, the knees, elbows and shins. The fingernails and toenails can be affected with thimble pitting. Psoriasis can be accompanied by stiff and painful joints (Psoriatic arthritis)

 

Cause:

The cause of psoriasis is unknown, but there would seem to be a familial trait. Two percent of Caucasians suffer from the condition, which first appears between the ages of ten and thirty.

The condition is triggered by stress, skin damage, illness and bacterial infection. Itching to an adjacent area often denotes an extension of the condition.

 

Aetiology:

The rate of cell division in the germinating layer of the skin is increased by five times the normal. The hair growth rate not increased. Changes happen to psoriasis after childbirth and at menopause

 

Differential diagnosis

Other scalp conditions can look similar to psoriasis; Seborrhoeic dermatitis for instance which weeps, and Neurodermatitis, but treatments for these conditions are more effective.

 

Treatment:

A detailed explanation of problem is essential – Keratolytic ointment containing salicylic acid and cade oil to clean scale from lesion. Ultra violet light can help in some cases.

Treatment from doctor:  Dovonex, Psoralens, Corticosteroids,

 

Prognosis:

There is no cure for psoriasis, but it can be controlled with possible long remissions.

Individual attacks can be cleared with appropriate treatment. The commonest treatment failure is unthorough treatment. The condition doesn’t make the hair fall out unless it is scratched.

 

Psoriasis in children

Sometimes the scalp is the first site to be involved in children and it may last for years, or come and go.

 

 

The Chester Hair Clinic

3 Castle Street, Chester

CH1 2DS

Telephone: 01244 346798

Website : www.hairmatters.co.uk

Richard Hall AIT

CONTROLLING SEBORRHOEIC ECZEMA (Seborrhoeic dermatitis)

What is Seborrhoeic eczema?

Seborrhoeic eczema is an itchy, scaling condition with fine branny white flakes to greasy yellow scales over dull red moist scalp. Sometimes scratching can lead to secondary infection. It can affect the whole scalp, ears and the front hairline.

Can it affect the body elsewhere

Yes, it can sometimes affect the neck, ears, eyebrows, eyelashes, facial areas either side of nose, chest, back, pubic, under arms, flexures of knees & elbows, but mostly affects the scalp alone.

What causes Seborrhoeic eczema?

Hereditary factors (common in Celts).

Diet – Alcohol, (White wine), Milk, Cheese, Lard, Butter, Ham, Sugar, Chocolate.

Lack of Zinc in diet.

Smoking / alcohol.

Exercising (sweating)

Lowered immune system (after illness)

Psychological factors – Stress can lower the body’s immune system.

(Nervous tension can cause androgen over production, which stimulates sebum)

Yeast (Pityrosporum ovale) and Bacteria (Staphylococci) thrive in warm alkali scalp with skin scales, sebum and sweat (containing salt) causing a possible skin reaction to the mixture in this area

Scratching itchy scalp (habit factor)

Can be further aggravated and secondarily sensitised by cosmetic factors (Hair dyes etc)

Can it be cured?

No, there is no cure for Seborrhoeic eczema, but it can be controlled and go away for 6 months to a year. With treatment and avoidance of causative factors, it should go away for sometime. It always comes back, but correct management is essential.

What treatment will I need?

A keratolytic cream containing salicylic acid and sulphur will be applied to your scalp to thoroughly cleans and remove scale, yeasts and bacteria. A hypoallergenic conditioner will be applied to the hair. You will be placed under a steamer, the cream will be shampooed out and a lotion / ointment will be applied to the scalp and a radiant heat lamp will be used.

How often will I need treatment?

When the condition is scaly and itchy, then 4 to 6 weekly treatments are advised, fading off to fortnightly treatments for a few times as the condition improves.

What can I do at home?

While coming for treatment at our clinic, use the shampoo 2 at home as required applying lotion 9 (or V&E cream) daily to itchy areas.

As the condition improves and less clinic treatment is needed, continue using shampoo 2 as often as required, and once weekly, the Cetrimide shampoo as a second shampoo. Apply lotion 9  (V&E) daily until the itching and scaling subsides.

What do I do when condition subsides?

Don’t use regime as preventative measure, gradually come off it, and then use Shampoo 1 and hypoallergenic hair cosmetics. Eliminate causative factors.

Zinc and multivitamin supplements can help. Looking after your general health will help considerably.

G.P. will prescribe Betnovate scalp application, Polytar, Nizoral, Zinc omadine, Selenium sulphide

 

Primary irritant dermatitis:

Primary irritant dermatitis is caused by a substance which can create cell damage when applied for the first time in strong concentrations i.e. bleach, relaxer (sodium hydroxide). It can also occur when weak concentrations of successive applications i.e. shampoo are used. That substance is called the primary irritant. The reaction caused may be inflammatory but it is not an allergic reaction.

Primary irritants that may cause non-allergic reactions include shampoos, hair cosmetics such as conditioners, setting lotions, or perm lotions, para-dyes and relaxers on black hair. Plants and metals can also create similar problems.

Signs: 

Erythema, scaling, crusting and weeping only to the area in contact with an irritant

Associated signs:

None

Symptoms: 

There is persistent itching and burning which varies with the strength of the irritant and affects the area in contact only.

Aetiology: 

The severity of the reaction depends both on the concentration of the irritant and the duration of the exposure. Strong chemicals such as bleach, relaxers, acids and alkalis are more likely to show an immediate response, but also mild primary irritants such as shampoos and mineral oils when used repeatedly for a long time can also create an irritant dermatitis.

Treatment: 

Apply keratolytic ointment containing 2% salicylic acid and sulphur. Steam for 10 minutes, shampoo off with cade oil shampoo and then cetrimide, apply HC45 (PO pharmacy only) from chemist and avoid using the irritant. When there is secondary infection, then a mild antiseptic such as Savlon should be applied (two to three weekly treatments are normally enough). 

Prognosis:   

A scalp affected by irritant dermatitis will then be sensitised to many cosmetic hair products such as gels and oils, causing the condition to continue for as long as those sensitizers are used. Therefore removal of causative factors should resolve this problem and it will not return. Contact dermatitis, when treated properly has a very good prognosis.

Irritant dermatitis affecting Black people

Contact dermatitis can be created on environmentally dry skin (Africa and the Caribbean can have a higher humidity than in Britain). Dry skin can be itchy and scaly. Black skin needs moisture to replace the lack of humidity, but when oils and creams containing petrolatum (Vaseline), lanolin and even natural oils are rubbed in to hydrate the skin they can sometimes sensitise the skin making it itch

The most common cause of contact dermatitis on black people is hair relaxing cream (sodium/potassium hydroxide) used too strongly, too often or left on for too long. This can often sensitise the scalp to hair dressing products containing petrolatum, lanolin, oils, preservatives, perfume, colours, etc. The condition can sometimes last for as long as these products are continually used on the hair and scalp.

Constant scratching of an itching condition can create secondary infection and hair loss. 

This condition is very common.

Irritant dermatitis can occur the first time a substance is used and reacts immediately to the area in contact with the substance and nowhere else. It is not an allergic reaction. It itches and can sensitise the skin to other substances.

ALOPECIA AREATA

 

Although all Alopecia areata cases are extremely unpredictable they can be very broadly placed into short and long-term types. It can also be diffuse, sometimes leading to Totalis (lack of all scalp hair), or Universalis, (lack of all scalp and body hair). If it starts before puberty then the prognosis is not good, particularly if in the Ophiasic or marginal pattern.

Short term areata

Signs:The first signs of short term Alopecia areata are one to four circular, completely bald patches. The hair follicles are clearly visible and the earliest patch will often be regrowing vellus, often unpigmented hair from the centre of the patch, while the latest patches show extension by having short broken hairs called exclamation hairs, narrowing towards the scalp, at the margins. Short-term areata can last from between 6 months to a year. Sometimes it never returns but occasional relapses are possible.

Longer term areata:Can start the same way as the short term type but the patches soon coalesce into larger more irregularly shaped patches extending regrowing and extending into different areas. This can improve spontaneously or last for many years, coming and going with complete recovery taking place before it starts all over again, or not! Pregnancy can sometimes cause temporary regrowth of areata.

Diffuse areata:As it can mimic reflective diffuse hair loss, thorough examination of the whole scalp should be made. The patient will notice hair falling diffusely throughout the scalp, which is covered with hundreds of exclamation hairs and tiny areas of hair loss. Unlike Telogen effluvium there is no spontaneous regrowth. Diffuse areata is often the first sign of Areata Totalis or complete loss of hair all over the scalp and can fall rapidly.

 

Slight itching sometimes precedes extension of area

Brittle nails, thimble pitting and other nail malformations can co-exist with areata. Vitiligo can some times coexists with areata and is also said to be an autoimmune disease.

 

Causes:Although the actual causes and mechanism of areata are unknown, it is considered to be an autoimmune disease, where the body’s defence mechanism is destroying the hair in the same way as it would defend the body against invading pathogens. White cells in the blood (leucocytes) are more abundant in extending patches and it would seem that it attacks persons whose immunity is lowered after illnessortrauma. Where sepsis has occurred as from tooth abscess, tonsillitis, ulcerativecolitis, or other infection, then toxins circulate in the bloodstream and, it would seem that they can sometimes upset the imune system elsewhere in the body. ’High fever“cancreate a similar problem.

Areata is considered to be multi-aetiologicalandmany possible causes have been suggested. Bereavementistop of the list, as is acute stress or sudden shock. Accident, Whiplash, Displaced vertebrae, Eyestrain, Cataracts, impaired vision. Thyroiddysfunctionsand coeliac disease are said to be associated with areata.  There is often a familial traittoinherit areata and it also seems to attack those who suffer from eczema, asthma and hay fever.

Sickle cell anaemiainsome black peoplecan sometimes cause Ophiasic (marginal) areata. Sufferers of Down syndrome are more prone to areata.

 

Alopecia areata must be differentiated from other alopecias, which can look similar. When no hair follicle openings can be seen, then the hair loss is considered to be cicatricial as in autoimmune scarring alopecias as well as those of known cause. Ringworm can cause similar patchy hair loss but is usually scaly and often itchy. Traumatic alopecia of outside origin (scratching, pulling, and hairdressing) can sometimes mimic areata but questioning will reveal the real cause.  AIDS or Syphilis can cause patchy hair loss.

 

Treatment is supportive and cannot be guaranteed, but elimination of possible causative factors is essential while vitamin and mineral supplements can be of help. Electrotherapy stimulates and irritates the area giving perhaps a better chance of recovery, particularly in the shorter-term cases. Six weekly electrotherapy sessions can be performed and prolonged if regrowth is seen. Electrotherapy consists of High frequency, Infra-red and carefully timed Ultra-violet radiation with the use of Iodine tincture. ’Stress is always present“andcareful scalp massage cansometimeshelp. It is impossible to prove the treatment has worked, as areata can regrow all by itself or extend.

Doctors may prescribe corticosteroids, irritants, retinoids or Minoxidil, these may help, but none of these are cures.

The Chester Hair Clinic

3 Castle Street, Chester

CH1 2DS

Telephone: 01244 346798

Website : www.hairmatters.co.uk

Richard Hall AIT

 

DISCOID LUPUS ERYTHEMATOSUS (DLE)

Clinical features:

Discoid lupus erythematosus is a permanently scarring condition with dusky red/dark patches and tightly adherent scales.

There is no specific area of the scalp to which the lesions are found but it is more likely to affect the vertex.

There is often follicular keratosis present and telangiectasis (dilated capillaries).

The plaques spread outwards and are atrophied, shiny and depressed in the centre with follicular plugging at the peripheral.

The condition, which is rarely limited to the scalp, is more common in women.

Associated signs:

The associated signs are darker areas in a butterfly pattern on the face and peeling lips. It is rare for D.L.E. to be found only on the scalp and there may be many other lesions found on the body and the mucous membranes.

Aetiology:

The ultra-violet rays in sunlight exacerbate lupus.

Differential diagnosis:

• Pseudopelade (when burnt out)

• Excoriated psoriasis

• Alopecia areata

• Lupoid Sycosis

• Sarcoidosis

Treatment: 

There is no trichological treatment for D.L.E., but use of a sunscreen with zinc oxide is advised to screen out harmful U.V. rays.

Refer to G.P. for systemic antibiotics, steroids or anti-malarial drugs.

Prognosis:  

D.L.E. may last for many years sometimes creating extensive cicatricial damage and its course will fluctuate before it burns itself out.

Commonly the effects cease before extensive scarring is experienced.

A small percentage of cases develop into systemic lupus erythematosus.

 

ACNE NECROTICA MILIARIS

Signs:

The signs of acne necrotica miliaris are one to several very small, yellow pustules throughout the frontal and pattern area of the scalp. The pustules are often scratched away leaving small-crusted lesions. These eventually heal leaving tiny scars.

The pattern area can be afflicted by these small pinpoint scars and can be quite difficult to see without a magnifying lamp. Acne necrotica often affects people suffering from seborrhoea oleosa and pattern loss, which is why it is often missed or diagnosed as seborrhoeic eczema.

Symptoms:

Intense irritation is always present and scratching can exacerbate the situation, which can be very stressful to the sufferer. This can create an itch, scratch syndrome leading to a habit factor.

Associated signs:

Acne necrotic often occurs with excessive oiliness and is part of the seborrhoeic condition which includes seborrhoeic eczema.

Aetiology:

People, who have suffered acne vulgaris at puberty, would seem to more prone to this disorder and the scalp will have been very pruritic since their teens.

Acne vulgaris can some times progress to the pustules of acne necrotica.  

Staphylococcus aureus is present and extreme emotional pressure, poor health, a bad diet and digestive problems can be possible causative factors, as can sugar, chocolate, dairy produce and smoking.

Treatment

The treatment for acne necrotica miliaris is topical antipruritics and antiseptics but sometimes a stubborn condition will need referring to a doctor for systemic antibiotic treatment and this can be long term. If treatment has consisted of potent hydrocortisones then topical treatment is more difficult. The patient must be advised not to scratch. The systemic antibiotics prescribed are: Amoxilin or Tetracycline, and the topical antibiotic commonly used is auromycin.

Prognosis

There is no cure for acne necrotica and it can run for many years but affects the sufferer less when they get older. Systemic antibiotic treatment can send it away all the time they are being taken but will return on ceasing the medication.

Differential diagnosis

The presentation of the small scars is scattered throughout the scalp and pattern area and does not spread from central points as in folliculitis decalvans. It can present a similar situation to seborrhoeic eczema, indeed it can coexist with it but seborrhoeic eczema doesn’t scar unless it is secondarily infected. Folliculitis decalvans does not itch whereas acne necrotica miliaris is extremely pruritic. F. decalvans can form much larger coalescing scarred areas. 

 

 

RINGWORM

Clinical features:

* Small round patches of baldness with brittle, whitish dull hairs and scale

* Affects trunk as small round rings growing and healing from centre.

* Whole scalp may become involved

* Infected hairs may be buried under heaps of scales

* Hairs, brittle, dry, lustreless

* Mild itching

**Highly contagious

Aetiology: 

Fungus 

* Microsporon Audouini of human origin

* Microsporon Canis of animal origin – more inflammation present – can cure spontaneously – reinfection common

* Black dot – few scales – black dots of broken hairs at follicles

Differential diagnosis – exclamation hairs of Alopecia areata

* Pustular ringworm  (Kerion) – red boggy nodules 

Ectothrix trichophyton

Treatment:

Diagnose by Wood’s light (Potassium hydroxide fluoresces)

Refer to Doctor

* Dr. will prescribe antifungal ointment (Caneston, Daktarin) and/or systemic treatment (Griseofulvin).

* Full course of treatment essential

Ringworm is found mostly on children aged 4 – 10. (Sebum after puberty contains antifungal ingredient).

* Child should stay away from school (highly contagious).

Pets should be treated.

FAVUS

* Fungal infection of hair and scalp

* Sulphur-yellow crusts

* Thick layers of grey scales

* Pink, bald patches with a mousy smell, becoming white and cicatricial

* Affects scalp, body, nails.

Treatment – as above

FUNGI causing scalp ringworm

ANTHROPHILIC ZOOPHILIC

Normal host man Normal host animal

Most common

Differential diagnosis – exclamation hairs of Alopecia areata

* Pustular ringworm  (Kerion) – red boggy nodules 

Ectothrix trichophyton

Cicatricial Alopecia

Known Couse

• Skin Damage

Auto-immune

• Discoid Lupus Erythematosus (DLE)
• Systemic Lupus Erythematosus (SLE)
• Folliculitis Decalvans (perifollicular inflammation)
• Lichen Planus (Lichen Plano pilaris)
• Morphea (Circumscribed Scleroderma)
• Pseudopelade (Footprint in the snow)

Congenital

Genetically Inherited

Scaring Alopecia often presents itself as an irregular area of shiny bald skin, which is sometimes a darker or lighter colour that surrounding it. No hair follicles are present, and the skin can be atrophied looking like an onion skin if pressed together, or even raised and thickened (Keloid).

Aetiology:

A scar is formed when a wound heals itself after deep tissue damage. The structure of scar tissue differs from normal skin and does not support normal hair growth. There are 2 appropriate causes of scarring: infection and autoimmune disease.

1.Infection

Any bacterial infection of the skin can create scarring alopecia of the scalp. Anything that makes the scalp itch will make the sufferer scratch. The scratching can be secondary infected, and with deeper skin infection, scaring can result.

2. Auto-immune disease

There are mysterious progressive scaring diseases, which are termed auto immune. Auto-immune means that body’s defence mechanism has turned against itself.

 

What can be done about it?

Scarring is permanent and the hair will not grow on the scar tissue. Stopping the progression of the scarring is vital and the Trichologist must take a thorough history of all possible causes.

Infection must be treated with antiseptics and use of chemicals avoided in future.

If the scarring is found to be of immunological cause the there is no cure, and the condition may be progressive. The Trichologist will then refer the patient to a dermatologist.