STOP HAIR LOSS DR JOYCE LIM DERMATOLOGIST PARAGON MEDICAL CENTRE #11-16/20

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1 STOP HAIR LOSS DR JOYCE LIM DERMATOLOGIST PARAGON MEDICAL CENTRE #11-16/20

2 HAIR LOSS Types of Hair loss What causes them What are the solutions

3 HAIR LOSS

4 PATCHY HAIR LOSS

5 PATCHY HAIR LOSS Single/ Multiple Is the scalp skin normal Age of onset Other skin signs Medical problems Family history of hair loss

6 PATCHY HAIR LOSS Is the skin normal Hair loss is primary Yes : Alopecia Areata Skin not normal Hair loss because of damage to hair follicles Infection Growth Scars

7 ALOPECIA AREATA Recovers on its own after 6 months Treatment to hasten recovery Steroid Injections Creams steroids, elidel, protopic Immunotherapy Poor prognosis Ophiasis Children Nail pitting

8 TRICHOTILLOMANIA Hair pulling Children / adult Stress Patchy loss Hairs in different lengths Treatment : Psychiatric counselling

9 HAIR LOSS

10 DIFFUSE HAIR FALL All over the scalp Follows a pattern Age of onset Type of onset Duration of loss Medical problems Family history of hair loss

11 DIFFUSE HAIR FALL All over the scalp Generalised thinning Telogen Effluvium Secondary to drugs / disease Follows a pattern Male pattern / Female pattern Androgenetic Alopecia

12 TELOGEN EFFLUVIUM HAIR CYCLE Hair grows (3-5 years) Stop growing Rest (3 months) Fall and replace by new hairs 80% growing hairs 20% resting Lose up to hairs a day

13 TELOGEN EFFLUVIUM Hair stopped growing because of stress Surgery, Illness Crash diet Weight loss Hair loss seen 3 months later Hair pull + Growing hairs 20% (N: 80%) Resting hairs 80% (N: 20%) Reversible in 3 months

14 TELOGEN EFFLUVIUM Hair did not stop growing continue to grow then stop later After pregnancy Hair loss seen 3 months later Reversible

15 HAIR LOSS SECONDARY TO DISEASE OR DRUGS Commonly seen with the use of anticancer drugs or other medication Medical problems Thyroid, Anaemia Treatment Treat the underlying disease Stop the drug Need medical advice whether the drug may be related to hair loss

16 ANDROGENETIC ALOPECIA Male Pattern Hair Loss Common Affects almost everyone age related Follows a pattern Male/ Female pattern hair loss Androgen, Genetic

17 PREVALENCE (HOW COMMON) Most common form of hair loss National Skin Centre in % of all hair loss seen Bishan community (1996 study ) 63% ( 254 men in 281 households) Western population : 23 % - 87% Rising prevalence with age 32% in those aged 17 to 26 yrs to 100% in their 80 s

18 MALE PATTERN HAIR LOSS (ANDROGENETIC ALOPECIA) Androgens are requisite for male pattern hair loss Male pattern hair loss occurs anytime after puberty, usually in the 20 s 50% of men are affected by age 50

19 MALE PATTERN HAIR LOSS Effective treatment Topical Minoxidil 5 % Oral Finasteride Minoxidil : Stop further loss Finasteride : 90% stop further loss 60% regrowth (even after 5 years) Other medication /treatment not proven

20 CHANGES IN HAIR WEIGHT AND HAIR COUNT WITH FINASTERIDE Hair weight increased to a larger extent (25.6% ) compared to hair count (9.2%) after one year Implies that factors like increased growth rate (length) and thickness of hairs contribute to the beneficial effects of finasteride in treated men

21 FINASTERIDE: SAFETY Less than 2% of men experienced side effects thought to be related to the medication In most men (~60%), the side effects resolve even if they continue to take the medication In all men, the side effects resolve if they stop taking the medication

22 FEMALE PATTERN HAIR LOSS (ANDROGENETIC ALOPECIA) Equivalent in females. Pattern is of diffuse balding with no temporal recession Main treatment available is topical minoxidil Finasteride contra indicated in pre menopausal women

23 LABORATORY TESTS What about all these hair analysis, sophisticated looking machines, assessment of oily scalp or not? What is the place of tests? Appropriateness,relevance?

24 LABORATORY TESTS Not required in the majority Simple microscopy/culture for fungus, bacteria. May be relevant for hair shaft problems (microscopy) Blood tests for syphilis (patchy diffuse ) Exclude other medical disorders eg autoimmune, thyroid, iron deficiency etc

25 SEE YOUR DOCTOR FOR HAIR LOSS Hair loss can be due to many causes A correct diagnosis is essential before appropriate treatment Diagnosis involves taking good history and clinical examination. Laboratory tests where appropriate ; not always fanciful equipment Appropriate treatment costly ineffective rx and side effects of some rx prescribed

26 THANK YOU

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