STUDY - Technical - New Dacian's Medicine
Alopecia
(Classical / Allopathic Medicine)
Occurring most
commonly on the scalp, alopecia typically develops gradually
and may be diffuse or patchy. It can be classified as scarring
or nonscarring. Scarring alopecia, or permanent hair loss,
results from hair follicle destruction, which smoothes the
skin surface, erasing follicular openings. Nonscarring
alopecia, or temporary hair loss, results from hair follicle
damage that spares follicular openings, allowing future hair
growth. (See Recognizing patterns of alopecia.)
One of the most
common causes of alopecia is the use of certain
chemotherapeutic drugs. Alopecia may also result from the use
of other drugs; radiation therapy; a skin, connective tissue,
endocrine, nutritional, or psychological disorder; a neoplasm;
an infection; a burn; or the effects of toxins.
HISTORY:
Ask the patient if he's receiving chemotherapeutic drug or radiation therapy. If not, ask him when he first noticed hair loss or thinning.
Ask the patient if the hair loss is confined to the scalp or if it occurs elsewhere on the body.
Ask the patient if itching or rashes accompany the hair loss.
Ask the patient about recent weight change, anorexia, nausea, vomiting, and altered bowel habits.
Ask the patient about changes in urination habits, such as hematuria or oliguria. If the patient is female, ask about menstrual irregularities and note her pregnancy history. If the patient is male, ask about sexual dysfunction, such as decreased libido or impotence.
Ask the patient if he has been especially tired or irritable or had a cough or difficulty breathing.
Ask the patient about joint pain or stiffness and about heat or cold intolerance.
Ask the patient if he has been exposed to insecticides.
Ask the patient about hair care and hair-care products.
Check for a family history of alopecia.
Ask the patient about nervous habits, such as pulling the hair or twirling it around a finger.
Ask the patient if he's receiving chemotherapeutic drug or radiation therapy. If not, ask him when he first noticed hair loss or thinning.
Ask the patient if the hair loss is confined to the scalp or if it occurs elsewhere on the body.
Ask the patient if itching or rashes accompany the hair loss.
Ask the patient about recent weight change, anorexia, nausea, vomiting, and altered bowel habits.
Ask the patient about changes in urination habits, such as hematuria or oliguria. If the patient is female, ask about menstrual irregularities and note her pregnancy history. If the patient is male, ask about sexual dysfunction, such as decreased libido or impotence.
Ask the patient if he has been especially tired or irritable or had a cough or difficulty breathing.
Ask the patient about joint pain or stiffness and about heat or cold intolerance.
Ask the patient if he has been exposed to insecticides.
Ask the patient about hair care and hair-care products.
Check for a family history of alopecia.
Ask the patient about nervous habits, such as pulling the hair or twirling it around a finger.
Recognizing
patterns of alopecia:
Distinctive patterns of alopecia result from different causes. Alopecia areata causes expanding patches of nonscarring hair loss bordered by “exclamation point” hairs. Tinea capitis produces irregular bald patches with scaly red lesions. Trauma from habitual hair pulling or injudicious grooming habits may cause permanent peripheral alopecia. Chemotherapeutic medication produces diffuse temporary hair loss.
Distinctive patterns of alopecia result from different causes. Alopecia areata causes expanding patches of nonscarring hair loss bordered by “exclamation point” hairs. Tinea capitis produces irregular bald patches with scaly red lesions. Trauma from habitual hair pulling or injudicious grooming habits may cause permanent peripheral alopecia. Chemotherapeutic medication produces diffuse temporary hair loss.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Assess the extent and pattern of scalp hair loss.
Examine the skin. Note the size, color, texture, and location of lesions. Check for jaundice, edema, hyperpigmentation, pallor, or duskiness.
Examine the nails for vertical or horizontal pitting, thickening, brittleness, or whitening.
Observe for fine tremors in the hands, muscle weakness, and ptosis.
Palpate for lymphadenopathy, an enlarged thyroid or salivary gland, and masses in the abdomen or chest.
Take the patient's vital signs.
Assess the extent and pattern of scalp hair loss.
Examine the skin. Note the size, color, texture, and location of lesions. Check for jaundice, edema, hyperpigmentation, pallor, or duskiness.
Examine the nails for vertical or horizontal pitting, thickening, brittleness, or whitening.
Observe for fine tremors in the hands, muscle weakness, and ptosis.
Palpate for lymphadenopathy, an enlarged thyroid or salivary gland, and masses in the abdomen or chest.
SPECIAL
CONSIDERATIONS:
If the cause of hair loss is unknown, a skin biopsy may be performed to determine the cause.
If the cause of hair loss is unknown, a skin biopsy may be performed to determine the cause.
PEDIATRIC
POINTERS:
Alopecia normally occurs during the first 6 months of life, as either a sudden, diffuse hair loss or a gradual thinning that's hardly noticeable. Reassure the infant's parents that this hair loss is normal and temporary.
Common causes of alopecia in children include use of chemo-therapeutic drugs, seborrheic dermatitis (cradle cap in infancy), alopecia mucinosa, tinea capitis, and hypopituitarism. Tinea capitis may produce a kerion lesion — a boggy, raised, tender, and hairless lesion. Trichotillomania, a psychological disorder that's more common in children than adults, may produce patchy baldness with stubby hair growth due to habitual hair pulling. Other causes of alopecia include progeria and congenital hair shaft defects such as trichorrhexis nodosa.
Alopecia normally occurs during the first 6 months of life, as either a sudden, diffuse hair loss or a gradual thinning that's hardly noticeable. Reassure the infant's parents that this hair loss is normal and temporary.
Common causes of alopecia in children include use of chemo-therapeutic drugs, seborrheic dermatitis (cradle cap in infancy), alopecia mucinosa, tinea capitis, and hypopituitarism. Tinea capitis may produce a kerion lesion — a boggy, raised, tender, and hairless lesion. Trichotillomania, a psychological disorder that's more common in children than adults, may produce patchy baldness with stubby hair growth due to habitual hair pulling. Other causes of alopecia include progeria and congenital hair shaft defects such as trichorrhexis nodosa.
AGING ISSUES:
Aging, genetic predisposition, and hormonal changes may contribute to gradual hair thinning and hairline recession. This type of alopecia occurs in about 40% of adult men and may also occur in postmenopausal women.
Aging, genetic predisposition, and hormonal changes may contribute to gradual hair thinning and hairline recession. This type of alopecia occurs in about 40% of adult men and may also occur in postmenopausal women.
PATIENT
COUNSELING:
When hair loss occurs because of chemotherapeutic drug use or radiation therapy, explain that this hair loss is reversible. In patients with partial baldness or alopecia areata, topical application of minoxidil (Rogaine) for several months may stimulate localized hair growth; however, hair loss may recur if the drug is discontinued.
When hair loss occurs because of chemotherapeutic drug use or radiation therapy, explain that this hair loss is reversible. In patients with partial baldness or alopecia areata, topical application of minoxidil (Rogaine) for several months may stimulate localized hair growth; however, hair loss may recur if the drug is discontinued.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)