ALOPECIA
DiagnĆ³stico de los subtipos de pĆ©rdida de cabello
La pĆ©rdida de cabello (alopecia) puede ser temporal o permanente en el cuero cabelludo o en el cuerpo. En Clinic Dermatology, estamos capacitados para tratar varios tipos de alopecia, como CCCA, alopecia frontal fibrosante, alopecia areata y pĆ©rdida de cabello de patrĆ³n masculino o femenino.
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Central Centrifugal Cicatricial Alopecia
Richardson, who is nurse practitioner (NP), medical dermatology, at the Ruth & Raymond Perelman Center for Advanced Medicine at the University of Pennsylvania in Philadelphia, outlined the key features of central centrifugal cicatricial alopecia (CCCA). She noted it is almost exclusively seen in Black women and has a prevalence rate that varies from 2.7% to 16%.2
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Premature loss of inner root sheath, follicular rupture, and follicular degeneration are some of the proposed causes of this hair loss. Other causes include fibroproliferative disorder and persistent low-grade inflammation that results in end stage fibrosis of the follicular unit. Hair care practices also can contribute to the pathogenesis of the disease, according to Richardson.
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CCCA manifests as scarring patches or loss of follicular openings beginning on the crown of the head and spreading outward. Additionally, it is characterized by early stage hair breakage, follicular papules, pustules, erythema, scaling, and possibly an absence of overt inflammation, Richardson said.
Female Pattern Hair Loss
Discussing female pattern hair loss (FPHL), Richardson emphasized looking for gradual, increased scalp visibility, widening midline part, decreased ponytail size, and preservation of frontal hairline. Other symptom to watch include increased miniaturized follicles (T:V ratio < 4:1), a shorter anagen phase, and a longer telogen phase.
She recommended a patient work-up checking:
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CBC
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Micronutrients: Vitamin D, ferritin, ESR, zinc
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Hormones or hormonal levels/: Thyroid-stimulating hormone (TSH), testosterone free/total, dehydroepiandrosterone sulfate (DHEAS)
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Richardson suggested a biopsy only if there are concerns for concomitant scarring alopecia
Frontal Fibrosing Alopecia
For frontal fibrosing alopecia (FFA), look for a band-like recession of the frontal hairline, loss of eyebrows, lonely hairs, forehead vein prominence, and perifollicular papules and pustules. Additionally, facial papules and occipital scalp may be involved. Itching may be absent in FFA, according to Richardson.
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Histological features of FFA include lymphocyte predominant inflammatory infiltrate, and scarring. She recommended biopsy of the affected area, along with testing TSH to determinewhether the patient is prothrombin time (PT) dependent.
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Alopecia Areata
Finally, Richardson described the characteristics of alopecia areata (AA). These characteristics are single or multiple round/oval hairless patches with visible follicular ostia, hairpull, exclamation point hairs, and possible nail dystrophy.
For acute AA, histological features of disease include peribulbar inflammation, melanin incontinence, increased catagen and telogen, miniaturization, and residual inflammatory cells in follicular stalae. Chronic disease features include having most follicles in the telogen phase and miniaturization.
For diagnosing AA, Richardson recommended checking:
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TSH
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Vitamin D, Ferritin, ESR, zinc
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If anemia is suspected, check CBC. If there is a celiac/gluten sensitivity, check TTG Ab (transglutaminase IgA).
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Baseline labs if systemic therapy is planned.
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