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Cicatricial alopecia

Cicatricial alopecia. By Dr Neda Adibi Dermatologist and researcher of IUMS. Cicatricial or scaring alopecia means the replacement of the follicular epithelium by connective tissue All forms of alopecia that hair follicles are permanently lost Permanent injury to the follicular stem cell.

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Cicatricial alopecia

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  1. Cicatricial alopecia By Dr Neda Adibi Dermatologist and researcher of IUMS

  2. Cicatricial or scaring alopecia means the replacement of the follicular epithelium by connective tissue • All forms of alopecia that hair follicles are permanently lost • Permanent injury to the follicular stem cell

  3. Some hair disaeses are biphasic: • Non scaring in the early stages and permanent hair loss in the late stages • Examples like: • Androgenic alopecia ,traction alopecia ,alopecia areata

  4. subtypes • 1)primary scaring alopecia :the hair follicle is the main target of injury • 2)secondary: the hair follicle is inocent by stander like burn,radiation dermatitis,cutaneus TB ,sarcoidosis,morphea

  5. diagnosis • Biopsy:at least 4 mm,it is better to be two for horizental and vertical section • 6 main types 1)Central centrifugal cicatricial alopecia (CCCA) 2)Lichenplanopilaris 3)Chronic DLE 4)Acne keloidalis 5)Dissecting cellulitis 6)Cicatricial alopecia

  6. Slowly progressive symetric cicatricial alopecia centered on the crown or vertex • Most often in black woman of african descent • Treatable in early and mild stage

  7. 1)chronic and progressive • 2)predominant on the vertex • 3)symetric progression and the priphery is active • 4)more in women • 5)they used chemical hair relaxers frequently • 6)hair ironing and hot comb aggravate the Dx

  8. No symptom except mild pruritus • Tx:topical potent Cs +antibiotic (Doxy or mino)folliculitis decalvance :10 week oral rifampin and clindamycin(300 mg BID)

  9. Lichenplano pilaris • More in female ,caucasians • Most in 5th decade • Other types of LP In more than 50% • Course:incidious or fulminant • Scattered foci of partial hair loss and ,perifollicular erythema,follicular spine and scarring • Pruritus and tenderness often present

  10. The alopecic area smaller, irregularly shaped and interconnected, which can lead to a reticulated clinical pattern as compared to DLE

  11. Tx • First line treatment: • Intralesional triamcinolone each 4-6 week • Oral cyclosporine, retinoids, antimalarials and griseofulvin have been shown to have a positive effect • in patients with rapidly progressive LPP. Oral corticosteroids • in the first weeks of treatment

  12. DLE • Adult specially women(20-40 y) • Very few of patients may develop SLE • Erythema ,atrophy follicular pluggings • Over 50% have lesions in the other parts except scalp • Concurrent alopecia areata is frequent

  13. Central hyperpigmentation,follicular pluging ,erythema and scale

  14. Antimalarials :like hydroxychloroquin 200-400 mg daily in adults or • 4-6 mg/kg in children • In sever cases oral prednisolon 1 mg/kg for 8 weeks • and corticosteroids (topical or intralesional)

  15. Alopecia mucinosa • indurated, well-demarcated erythematosus • or skin colored patches of scarring or nonscarring alopecia • Grouped follicular papules,follicular cysts and follicular hyperkeratosis may be present in some cases.

  16. rule out an underlying malignancy • such as mycosis fungoides and Sezary syndrome • Oral corticosteroids,minocycline and isotretinoin have been shown to be • effective. Topical and intralesional corticosteroids,dapsone, indomethacin and light therapy

  17. Acne Keloidalis • Most in blackmen • small, smooth, firm papules admixed with occasional pustules on the occipital scalp and posterior neck • the papules resolve and leave • small zones of alopecia within a field of papular lesions. In many • patients, the papules coalesce and form firm, hairless, keloid-like

  18. Treat with topical corticosteroids and oral doxycyclines

  19. Disecting cellulitis • multiple, firm scalp nodules, most commonly on the mid and posterior vertex and upper occiput. • The nodules rapidly develop into interconnecting,fluctuant, oval and linear ridges abcesses • Pain and fuel smalling discharge

  20. Treat with isotretinoin 0.5-1 mg/kg and oral antibiotic and corticosteroid

  21. Folliculitis decalvance • Young and Middle aged specially male erythematous Cicatricial alopecia with inflamatory perifollicular papules and postules • Pain,itching and burning • Staphylococ areus and superantigens may be the cause

  22. CMX,erythromycin ,cephalosporin,Topical clindamycin • Rifampin plus clindamycin • Oral TC • Topical fusidic acid,erythromycin 2%,mupirocin

  23. Secondary cicatricial alopecia • 1)traumatic alopecia • 2)tractional alopecia • 3)pressure alopecia • 4)tricotillomania

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