Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

Alopecia 99

Physical/Environmental

■Injury – burns, chemical hair treatments

➣More common in African-Americans with hair relaxers

■Traction alopecia – chronic tension on hair with various hairstyles

(corn rows, ponytails)

■Trichotillomania-repeated manual extraction of hair; often fron-

toparietal region of the scalp or occipital

management

■Treat underlying cause of hair loss – medical, infectious, psychoso-

cial.

■Consider referral to dermatologist.

■Scarring is irreversible – the follicle is gone.

specific therapy

■Androgenic alopecia

➣Topical minoxidil can be applied twice daily.

➣Propecia – effective for men, limited data for use in women

➣Wigs

➣Surgical procedures include hair transplants, scalp reduction and

flaps.

■Alopecia areata

➣No curative treatment available; some cases resolve sponta-

neously

➣Corticosteroids

Topical – class 1 or 2 strength – penetration of Rx is the limiting

factor

Intralesional injection of triamcinolone acetonide

Systemic corticosteroids should be avoided

pulsed methylprednisolone has been used

➣Refer to a dermatologist for anthralin, PUVA, squaric acid, dy-

phencyprone, or cyclosporin

➣Hair weaves and wigs

■Tinea capitis/Kerion – see Tinea chapter

follow-up

■Dependent on underlying cause or management modality

complications and prognosis

■Dependent upon the disease/condition