CM I- Dermatology Module
Tory Davis, PA-C

 Normal = 100 hairs/day
– Not noticeable among the 100,000 we have
– Grows 1 cm/month
 Permanent loss
– Androgenic alopecia
– Scarring alopecia
 Temporary loss
– Telogen effluvium
– Traction alopecia
– Alopecia areata

 Autoimmune disease, cause unknown
 Possibly trigger (viral, other) in predisposed people
 Usually temporary hair loss
 Can be recurrent loss

 A physiologic reaction induced by androgen in genetically predisposed men
 Gradual recession of hair on central scalp and frontotemporal region

 Central scalp hair loss with retention of normal hair line
 Studies suggest adrenal dysfunction as one possible cause

 TREATMENT
– Minoxidil (Rogaine) solution
– Ideal in men under 30 who have been losing hair for less than 5 years
– Approx. 1/3 of these pts will regrow hair long enough to be cut or combed
– May stop or retard progression
– Effective in female pattern as well

 Rare condition
 Inflammation damages and scars the hair follicle, causing permanent hair loss.
 Patchy hair loss can be associated with slight itching or pain.
 Cause unknown, can be assoc with lupus or lichen planus


Telogen stage of hair growth is “resting stage.” 15% of hair is in telogen at any given time
 85% of follicles are in anagen (growth phase)
 Telogen effluvium is a loss of a larger than normal percent of hair in telogen phase

 Caused by change in normal hair cycle
 Event causes more hair to be moved from anagen to telogen at one time, followed by a larger-than-normal loss of hair about 2-4 months later
 Like a reset button has been hit
 Lost hair appears normal

 Childbirth
 Severe illness
 Crash diets
 Drugs
 High fever
 Acute blood loss
 Thyroid disease
 Physiologic stress
 Physical stress
 Psychologic stress

 Less common
 Caused by
– Chemotherapy
– Poisoning
– Radiation therapy

 Rapid onset of total hair loss in sharply defined (usually round) area
 Dx by observation
 Most pts under 40
 Regrowth in 1-4 months, usually
 Cause unknown
 Whole scalp = alopecia totalis
 Whole body = alopecia universalis

 Observation
 Intralesional injection of steroid
 Systemic steroids
 PUVA: Psoralen (a photosensitizing agent) plus UVA
 Minoxidil



The act of manually removing hair
Defined in the DSM IV as “an irresistible urge to pull the hair and a sense of relief after the hair has been plucked”
 Thinned in irregular pattern
 Cases may resolve spontaneously
 Treatment aimed at behavior

 HISTORY
– Drugs, diet restriction, vitamin A, illness, recent childbirth
– Thyroid symptoms
– Time of onset and duration
 Abrupt = telogen
 Gradual = anagen or localized

 PHYSICAL EXAM
– Examine scalp surface and hair shafts
– Observe pattern, thinning,
– Microscopic examination of hair
– Hair pull
– Daily counts
– Part width

 Appearance of excessive coarse hair in pattern not normal in females
 May be sign of endocrine disorder
– Most cases mediated by androgens, which originate in adrenals or ovaries in women
 Many pts have no physiologic cause

 Polycystic Ovarian Syndrome
– Endocrine disorder involving abnl hormone levels, irregular menses, infertility and ovarian cysts

Cushing’s Disease
– Overproduction of cortisol from pituitary gland
 Ovarian or adrenal gland tumors

 PHYSICAL EXAM
– Look for signs of virilization
 Like what?
– Pelvic exam for ovarian tumors
– Abdomen for adrenal tumors
– Lab evaluation of hormonal levels
– Ovarian ultrasound
 Tx aimed at underlying cause

 PSORIASIS
– 10-50%
– Pitting (ice pick-like depressions)
 LICHEN PLANUS
– Longitudinal grooving and ridging
– Severe, early destruction of nail matrix
– with scarring
 ALOPECIA AREATA
– Shallow pitting or stippling

 Paronychia
– Usually Staph infection
– Rapid onset of painful, bright red swelling of the proximal and lateral nailfold.
– Relieved by draining
– May require antibiotics

 A.k.a. tinea unguium
– Fungal infection of nail (toe more common than finger) Some, but not all nails- if all nails, seek other dx
– 6-8% of population affected
 Increases with age
– Thickened, yellow, cloudy nails
– Difficult to treat
 Topical vs systemic

 Transverse depressions of the nails
 Appear weeks after a stressful event
 Caused by temporary interruption of nail growth
 Stressors may include syphilis, uncontrolled DM, myocarditis, high fever, PVD, zinc deficiency

 YELLOW NAIL SYNDROME
– Response to respiratory disease
– Nail growth slows to half normal rate
 SPOON NAILS- koilonychia
– Lateral elevation and central depression
– Can be seen in normal children
– May be caused by iron-deficiency anemia

 Distal phalanges become enlarged and bulbous
 Angle of proximal nail fold increases
 Associated with lung ds, CVD, cirrhosis, colitis, and thyroid disease

White or light pink nails with no lunula
 Associated with liver failure, CHF, diabetes, malnutrition
 Decrease in vascularity and increase in connective tissue in nail bed