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DIAGNOSIS AND TREATMENT OF HAIR DISORDERS An Evidence Based Atlas Antonella Tosti Bianca Maria Piraccini Diagnosis and Treatment of Hair Disorders Diagnosis and Treatment of Hair Disorders An Evidence Based Atlas Antonella Tosti MD Department of Dermatology University of Bologna Bologna Italy Bianca Maria Piraccini Department of Dermatology University of Bologna Bologna Italy MD © 2006 Taylor & Francis, an imprint of the Taylor & Francis Group First published in the United Kingdom in 2006 by Taylor & Francis, an imprint of the Taylor & Francis Group, 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN Tel: Fax: E-mail: Website: +44 (0)20 7017 6000 +44 (0)20 7017 6699 info.medicine@tandf.co.uk http://www.tandf.co.uk/medicine All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. A CIP record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data Data available on application ISBN 1 84184 340 7 ISBN 978-1-84184-340-7 Distributed in North and South America by Taylor & Francis 2000 NW Corporate Blvd Boca Raton, FL 33431, USA Within Continental USA Tel: 800 272 7737; Fax: 800 374 3401 Outside Continental USA Tel: 561 994 0555; Fax: 561 361 6018 E-mail: orders@crcpress.com Distributed in the rest of the world by Thomson Publishing Services Cheriton House North Way Andover, Hampshire SP10 5BE, UK Tel: +44 (0)1264 332424 E-mail: salesorder.tandf@thomsonpublishingservices.co.uk Composition by Scribe Design Ltd, Ashford, Kent, UK Printed and bound in Great Britain by CPI, Bath Contents Preface Evidence levels in therapy vii viii 12 Hair diseases in the elderly 101 13 Traction alopecia 103 1 The normal hair 1 14 Scarring alopecia 109 2 Evaulation of hair loss 5 15 Infections and infestations 121 3 Disorders of hair pigmentation 15 16 Seborrheic dermatitis 131 4 Hair shaft disorders 23 17 Scalp psoriasis 137 5 Alopecia areata 37 18 Scalp contact dermatitis 143 6 Androgenetic alopecia 45 19 Papulo-pustular disorders 149 7 Telogen effluvium 57 20 Beard disorders 155 8 Drug-induced hair abnormalities 63 21 Ethnic hair disorders 159 9 Hirsutism 73 22 Hair cosmetics 165 10 Hypertrichosis 79 23 The hair in systemic disorders 171 11 Hair diseases in children 89 24 Body hair disorders 177 Index 180 Preface Hair science is one of the most captivating topics of dermatology that goes on evolving over the years. Hair disorders are numerous and the genetic aid has permitted to classify most of the hereditary hair defects. Thanks to molecular biology, current understanding of hair follicle science is improving. Although hair is not essential for health and survival in humans, changes in hair growth density, pattern or alterations in its color and texture can often lead to distress. In addition, these types of changes can indicate underlying systemic disease, including endocrine, genetic, metabolic and psychiatric disorders. This book is a practical atlas, complete with color pictures and tables, to present the reader with the broad spectrum of hair and scalp disorders and to help in the differential diagnosis and treatment strategies. Several hair disorders are very difficult to diagnose and, for this reason, it is necessary to have a practical guide helping the clinician to avoid the most common mistakes. In this book the authors describe hair anatomy and physiology, hair and scalp disorders and methods useful to perform a correct diagnosis. One chapter is also dedicated to abnormalities induced by cosmetics and styling, another to the specific hair and scalp disorders of African-Americans, as well as to hypertrichosis and hirsutism together with their management. Evidence levels in therapy A: B: C: D: E: Double blind study Clinical trial > 20 subjects Clinical trial < 20 subjects or very large numbers of case reports Series ≤ 5 subjects (5 cases in literature) Anedoctical < 5 cases in literature 1 The normal hair Introduction Table 1.1 Follicular density in the different body regions There are three types of hair: • • • Lanugo hairs are long and non-medullated (Figure 1.1). They are present in utero and shed after birth. Vellus hairs are short and non-pigmented (Figure 1.2). They constitute 6–25% of the hair population even in the areas considered to have only terminal hair. Terminal hairs are long, pigmented and medullated (Figure 1.3). The terminal hair shaft is wider than the inner root sheath of the follicle. Scalp Face Nasal fold Anterior forehead Lateral forehead Preauricolar area Trunk Lower limbs *Hair density decreases with aging. Hair density considerably varies in the different areas of the body with 1/5 (1 000 000) of the hair follicles (5 000 000) being on the head (Table 1.1). The scalp by itself contains about 100 000 follicles. Maximum length and growth rate of terminal hair varies in the different body regions (Table 1.2). Scalp hair grow about 0.4 mm/day and may reach a length of more than 1 meter. Maximum hair length decreases with age. Thickness of scalp hair ranges from 50–90 µm. Figure 1.2 Vellus hair. Figure 1.1 Figure 1.3 Lanugo hair in a newborn. Terminal hair. 200–400/cm2* 1600/cm2 800/cm2 455/cm2 466/cm2 50–100/cm2 50/cm2