1. ALOPECIA & VITILIGO GHADA BINSAIF, MD ASSISTANT PROFESSOR & CONSULTANT DERMATOLOGIST KSU & KKUH

2. ALOPECIA

5. Hair Types Vellous Vellous Terminal Terminal Androgen dependant terminal Androgen dependant terminal

6. Hair Cycle Hair growth is very dynamic

7. How many hairs in the body? 5 millions hairs; 100,000 in the scalp Growth rate? 0.3mm/day for scalp hair

8. Alopecia Scaring (Irreversible) None Scaring (Reversible)

10. Alopecia Areata

11. Sudden hair loss ( localized or generalized) Alopecia Areata affects up to 2% 75% : Self recovery, 2-6 m Causes : 30%: +ve Family history autoimmune

12. Clinical findings Well demarcated Well demarcated Exclamation point Exclamation point Normal scalp Normal scalp Nail: pitting, ridges Nail: pitting, ridges

15. Types of alopecia areata - Localized partial - Localized partial - Localized extensive - Localized extensive - Alopecia ophiasis - Alopecia ophiasis - Alopecia totalis - Alopecia totalis - Alopecia universalis - Alopecia universalis

18. Bad prognostic factors Young age Young age Atopy Atopy Alopecia totalis, universalis, ophiasis Alopecia totalis, universalis, ophiasis Nail changes Nail changes

20. Diagnosis Clinically Clinically H/E: sworm bees H/E: sworm bees

21. Treatment 1. Observation 2. Intralesional Corticosteroids 3. 3. Skin Sensitizers Anthraline Diphencyclopropenone (DPCP) others

22. Others Topical steroids Systemic Steroids Cytotoxic Rx Phototherapy Minoxidil Hair Transplant – ( NO)

23. Androgenetic Alopecia (Male and Female Pattern Hair Loss)

24. Androgen dependent loss of scalp hair Androgen dependent loss of scalp hair Androgenetic Alopecia affects up to 50% of males and 40% of females Androgenetic Alopecia affects up to 50% of males and 40% of females Autosomal dominant with variable penetrance Autosomal dominant with variable penetrance 85% : +ve family history 85% : +ve family history

25. 5 ALPHA Reductase Testosterone DihydorTestosterone (Active) Miniaturization of Terminal Hairs

26. Male Pattern Hair Loss

28. Female Pattern Hair Loss

30. Treatment Topical: Neoxidil 2%- 5% solution Topical: Neoxidil 2%- 5% solution Systemic: Systemic: Fenastride Fenastride Spironolactone Spironolactone

31. Anagen effluvium Telogen effluvium Telogen effluvium

32. Telogen effluvium Chronic alopecia Reversible (but may be become chronic) 3-4 months

33. Causes

34. Drugs associated with telogen Effluvium

35. Treatment Remove or treat the cause Remove or treat the cause Minoxidil 2% Solution Minoxidil 2% Solution

36. Anagen effluvium Always related to cytotoxic chemotherapy Always related to cytotoxic chemotherapy Acute and severe alopecia Acute and severe alopecia Mostly reversible but not always Mostly reversible but not always

37. Scaring Alopecia SLE — DLE SLE — DLE LP LP Sarcoidosis Sarcoidosis Leprosy Leprosy Kerion - Favus Kerion - Favus Trauma Trauma

41. Vitiligo

42. -Acquired cut. depigmentation -Kobner phenomena Causes - Genetic - Autoimmune dis. - Neural Natural coarse? Varied Varied

46. Why? Loss of normal melanocytes Dopa stain

47. Special studies T4, TSH, FBS ANA/Ro/La (prior to PUVA)

48. TREATMENT Sunscreen (sunburn, koebnerization, tanning) Limited: Class 3 topical GC Topical Tacrolimus Topical PUVA Excimer laser Resistant, Stable of 2 years : Surgical GeneralizedPhototherapyUniversal: Bleaching agent