Hair disorders Antonella Tosti

Transcription

1 Hair disorders Antonella Tosti Fredric Brandt Endowed Professor of Dermatology&Cutaneous Surgery Miller School of Medicine, University of Miami

2 DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY Antonella Tosti, MD F073 Hair Disorders DISCLOSURES Fotofinder :Consultant. CRC Press /Trichoscopyonline :Author-Royalties, Karger : Editor in chief

3 Diagnosis :Monilethrix Notice regular beading of the hair shaft at dermoscopy

4 Monilethrix Autosomal dominant Mutations in the human basic hair keratins hhb6 and hhb1 Hair shaft breakage with alopecia more severe in areas of friction.

5 Monilethrix Hair beading : elliptical nodes and intermittent constrictions at regular distance Medulla absent at internode level

6 Hair breakage occurs at internode level Monilethrix

7 Affected hair bend in different directions Monilethrix

8 Thickness and length of the internodes can vary Monilethrix

9 Monilethrix Severity varies even among members of same family

10 Monilethrix Eyebrows and eyelashes can be affected

11 Monilethrix Mild forms can be misdiagnosed de Lencastre A, Tosti A. Monilethrix. J Pediatr Dec;161(6):1176.

12 13 year old boy Progressive alopecia and loss of the eyelashes since the age of 9

13 Diagnosis: Scarring alopecia Absence of follicular openings Peripilar casts Hair tufting

14 Keratosis follicularis spinulosa decalvans Rare genetic disorder with X- linked or autosomal dominant pattern of inheritance Scarring alopecia of scalp and eyebrows.

15 8 year old girl History of hair thinning and unruly hair Deafness

16 Diagnosis :Pili torti

17 Pili torti Pili torti are flattened and present irregular twisting and flattening of the hair shaft

18 Pili torti Thinning and trichorrexis with hair breakage are common

19 Pili torti Hair appears curly, brittle, thin and opaque because of the light reflection loss in the twisted hair surface

20 Pili torti May be an isolated finding or could represent an hallmark of several congenital multisystemic disorders involving skin, cutaneous annexes, skeletal and neurological systems Genetic syndromes Bazex Dupré syndrome Beare syndrome Björnstad syndrome Citrullinemia Conradi-Hünnermann syndrome Crandall s syndrome Familial acnes conglobata Hypohidrotic ectodermal dysplasia Menkes syndrome Rapp-Hodgkin syndrome Salti-Salem syndrome Trichothiodystrophy

21 Björnstad syndrome Pili torti and neurosensorial deafness Autosomal recessive

22 Bazex -Duprè Syndrome Pili torti Congenital hypotrichosis Follicular atrophoderma Trichorrexis nodosa Hypohidrosis Multiple milia Basal cell carcinomas of early onset

23 15 year old girl Hair that does not grow long and is frizzy

24 Loose anagen hair syndrome Rectangular black granular structures Rakowska et al Trichoscopy findings in loose anagen hair syndrome:rectangular granular structures and solitary yellow dots. J Dermatol Case Rep.2015 Mar 31;9(1):1-5.

25 Loose anagen hair syndrome Can use the dermatoscope to look at the roots Anagen hairs devoid of sheaths Ruffled cuticle

26 16 year old girl Severe hair breakage She can only wear a shaved hairstyle

27 Severe hair breakage with trichorrhexis nodosa

28 Pili annulati The hair shaft presents alternating light and dark bands

29 Pili annulati White bands correspond to air filled cavities

30 Pili annulati They appear dark under the microscope

31 Pili annulati Hair shaft more seusceptible to weathering Usually not associated with breakage Donati A, Andriolo AC, Barletta M, Valente N, Romiti R. Pili Annulati and Trichorrhexis Nodosa in the Same Patient: Cause or Coincidence? Skin Appendage Disord Mar;1(1):25-7.

32 9 year old boy Patchy alopecia Just recently noticed by hairdresser

33 Congenital triangular alopecia Carpet of vellus hair Lacarrubba F, Micali G. Congenital triangular alopecia. BMJ Case Rep Jan 8;2014.

34 Congenital triangular alopecia Usually noticed in childhood The patch contains vellus hairs.

35 7 year old boy Erythematous plaque with alopecia Present since a few years but recently enlarged

36 Sebaceous nevus Bright yellow dots not associated to the hair follicles

37 Sebaceous nevus Commonly present at birth Well demarcated yellowish plaque of alopecia Becomes verrucoid at puberty.

38 Sebaceous nevus Presence of bright yellow dots at dermoscopy is characteristic and distinguish sebaceous nevus from other causes of patchy alopecia in children Neri et al. Usefulness of dermatoscopy for the early diagnosis of sebaceous naevus and differentiation from aplasia cutis congenita. Clin Exp Dermatol Jul;34(5):e50-2.

39 15 year old boy Patchy alopecia since a few days Recent history of complicated surgery because of multiple gun shots with liver and stomac lacerations

40 Pressure alopecia Black dots Broken hairs

41 Pressure alopecia Prolonged pressure can cause ulceration and permanent alopecia

42 2 year old girl 1 month history of increased hair shedding no evident patches

43 Tinea capitis Comma and corkscrew hairs Slowinska M, Rudnicka L, Schwartz RA, et al Comma hairs: a dermatoscopic marker for tinea capitis: a rapid diagnostic method. J Am Acad Dermatol Nov;59(5 Suppl):S77-9 Hughes R, Chiaverini C, Bahadoran P, Lacour JP. Corkscrew hair: a new dermoscopic sign for diagnosis of tinea capitis in black children Arch Dermatol Mar;147(3):355-6.

44 Tinea Capitis Comma hair Short broken hair that bends like a comma

45 Tinea Capitis Comma hair Seen both in ectothrix and endothrix infection More numerous in recent infections

46 Tinea Capitis Corckscrew hair Short broken coiled hair Usually seen together with comma hair

47 Tinea Capitis Broken hair with casts Short broken hair surrounded by a peripilar cast

48 Tinea Capitis Black dots Hair broken at scalp emergency (endothrix infections)

49 Tinea Capitis Zigzag hair Morse hair Broken hair with horizontal white bands

50 Tinea Capitis Tranlucent hair Empty bands due to massive fungal invasion

51 Tinea Capitis Corckscrew hair Seen in patients of African descent Depends on shape of African hair

52 16 year old girl Severe dandruff and itching

53 Pediculosis Nits Ovoidal shape attached to the shaft

54 Allows to distinguish viable from empty nits Pediculosis

55 Pediculosis Nits Viable nit : distal estremity rounded brown in color

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