| What are the characteristics of alopecia areata? | Asymptomatic, single/ multiple smooth bald patches; can progress to involve whole scalp (alopecia totalis) or all body hairs (alopecia universalis) | • Asymptomatic, single/ multiple smooth bald patches; can progress to involve whole scalp (alopecia totalis) or all body hairs (alopecia universalis) • H/o atopy, examine for nail pitting • <50% of scalp: Topical 0.05% Betamethasone lotion OD, intralesional Triamcinolone once in 2-4 weeks ( 5 mg/ml for scalp and 2.5 mg/ml for beard or eyebrows) only for limited involvement, topical Minoxidil 5% OD • >50% of scalp or involvement of facial and body hairs or margin of occipital area: refer to tertiary centre to be worked up for immunosuppressants such as oral steroids mini pulse, Methotrexate or Cyclosporine • Children with patches of hair loss with scaling and/ or signs of inflammation (erythema, pustulation, boggy swelling). | 2 | definition | 0.980 | • Asymptomatic, single/ multiple smooth bald patches; can progress to involve whole scalp (alopecia totalis) or all body hairs (alopecia universalis) • H/o atopy, examine for nail pitting • <50% of scalp: Topical 0.05% Betamethasone lotion OD, intralesional Triamcinolone once in 2-4 weeks ( 5 mg/ml for scalp and 2.5 mg/ml for beard or eyebrows) only for limited involvement, topical Minoxidil 5% OD • >50% of scalp or involvement of facial and body hairs or margin of occipital area: refer to tertiary centre to be worked up for immunosuppressants such as oral steroids mini pulse, Methotrexate or | 1 | page=1,block=32 | 0.700 | valid |
| What are the characteristics of alopecia with asymptomatic smooth bald patches? | single/ multiple smooth bald patches; can progress to involve whole scalp (alopecia totalis) or all body hairs (alopecia universalis) | • Asymptomatic, single/ multiple smooth bald patches; can progress to involve whole scalp (alopecia totalis) or all body hairs (alopecia universalis) • H/o atopy, examine for nail pitting • <50% of scalp: Topical 0.05% Betamethasone lotion OD, intralesional Triamcinolone once in 2-4 weeks ( 5 mg/ml for scalp and 2.5 mg/ml for beard or eyebrows) only for limited involvement, topical Minoxidil 5% OD • >50% of scalp or involvement of facial and body hairs or margin of occipital area: refer to tertiary centre to be worked up for immunosuppressants such as oral steroids mini pulse, Methotrexate or Cyclosporine • Children with patches of hair loss with scaling and/ or signs of inflammation (erythema, pustulation, boggy swelling). | 16 | summary | 0.970 | • Asymptomatic, single/ multiple smooth bald patches; can progress to involve whole scalp (alopecia totalis) or all body hairs (alopecia universalis) • H/o atopy, examine for nail pitting • <50% of scalp: Topical 0.05% Betamethasone lotion OD, intralesional Triamcinolone once in 2-4 weeks ( 5 mg/ml for scalp and 2.5 mg/ml for beard or eyebrows) only for limited involvement, topical Minoxidil 5% OD • >50% of scalp or involvement of facial and body hairs or margin of occipital area: refer to tertiary centre to be worked up for immunosuppressants such as oral steroids mini pulse, Methotrexate or |
| What are the typical features of discoid lupus erythematosus? | Erythematous to depigmented plaques with atrophy, scaling and follicular plugs | Investigations: • Trichoscopy, scalp biopsy for histopathology, direct immunofluorescence, workup to rule out SLE Treatment: • Photoprotection • Topical steroids • Hydroxychloroquine 5mg/kg/day after baseline ocular examination; usually required for 6-12 months Discoid lupus erythematosus Erythematous to depigmented plaques with atrophy, scaling and follicular plugs Folliculitis decalvans Dissecting cellulitis of scalp | 290 | summary | 0.970 | Investigations: • Trichoscopy, scalp biopsy for histopathology, direct immunofluorescence, workup to rule out SLE Treatment: • Photoprotection • Topical steroids • Hydroxychloroquine 5mg/kg/day after baseline ocular examination; usually required for 6-12 months Discoid lupus erythematosus Erythematous to depigmented plaques with atrophy, scaling and follicular plugs Folliculitis decalvans Dissecting cellulitis of scalp | 1 | page=1,block=58 | 0.700 | valid |
| What investigations and treatments are recommended for non-scarring alopecia with smooth bald areas and small black intact hair follicles? | Investigations: • Trichoscopy, scalp biopsy for histopathology, direct immunofluorescence, workup to rule out SLE Treatment: • Photoprotection • Topical steroids • Hydroxychloroquine 5mg/kg/day after baseline ocular examination; usually required for 6-12 months | NON SCARRING ALOPECIA (SMOOTH BALD AREAS WITH SMALL BLACK INTACT HAIR FOLLICLES)
Investigations: • Trichoscopy, scalp biopsy for histopathology, direct immunofluorescence, workup to rule out SLE Treatment: • Photoprotection • Topical steroids • Hydroxychloroquine 5mg/kg/day after baseline ocular examination; usually required for 6-12 months | 81 | list | 0.820 | Investigations: • Trichoscopy, scalp biopsy for histopathology, direct immunofluorescence, workup to rule out SLE Treatment: • Photoprotection • Topical steroids • Hydroxychloroquine 5mg/kg/day after baseline ocular examination; usually required for 6-12 months | 1 | page=1,block=58 | 0.700 | valid |
| What are some congenital or inherited conditions that can lead to alopecia? | Congenital hypotrichosis • Monilethrix • Trichorrhexis nodosa • Loose anagen hair syndrome • Woolly hair syndrome | If present, hormonal workup to rule out PCOS or virilising tumors of ovary/ adrenal glands • 1 ml of 5% Minoxidil solution OD for local application • Treatment of underlying condition • Severe non-responsive: refer to tertiary care • Oral anti-androgens (Finasteride, Spironolactone, cyproterone acetate with oral contraceptives may be added) Alopecia due to inherited/ congenital disorders with or without easy hair breakage • Congenital hypotrichosis • Monilethrix • Trichorrhexis nodosa • Loose anagen hair syndrome • Woolly hair syndrome Refer to tertiary centre for further evaluation HIGH REGROWTH POTENTIAL WITH NON-SCARRING ALOPECIA, GUARDED REGROWTH POTENTIAL WITH SCARRING ALOPECIA Standard Treatment Workflow (STW) | 428 | list | 0.820 | If present, hormonal workup to rule out PCOS or virilising tumors of ovary/ adrenal glands • 1 ml of 5% Minoxidil solution OD for local application • Treatment of underlying condition • Severe non-responsive: refer to tertiary care • Oral anti-androgens (Finasteride, Spironolactone, cyproterone acetate with oral contraceptives may be added) Alopecia due to inherited/ congenital disorders with or without easy hair breakage • Congenital hypotrichosis • Monilethrix • Trichorrhexis nodosa • Loose anagen hair syndrome • Woolly hair syndrome Refer to tertiary centre for further evaluation HIGH |
| What features on the scalp help distinguish between scarring and non-scarring conditions? | Loss of skin markings • Loss of hair follicle ostia • Pigmentary changes | Elicit history pertaining to • Duration and age of onset of hair loss • Whether patchy or diffuse scalp involvement, and if other hair bearing areas are affected • Relevant medical history pertaining to specific entities mentioned below • Hair care practices including cosmetic hair procedures Examine scalp for scarring vs non-scarring by looking for • Loss of skin markings • Loss of hair follicle ostia • Pigmentary changes GENERAL HAIR CARE PRINCIPLES • Hair fall of upto 100 per day may be normal and need not cause alarm • Regular cleaning of scalp and hair with plain shampoo • Avoid hair oil application and damaging mechanical/ chemical hair care procedures | 354 | list | 0.820 | Elicit history pertaining to • Duration and age of onset of hair loss • Whether patchy or diffuse scalp involvement, and if other hair bearing areas are affected • Relevant medical history pertaining to specific entities mentioned below • Hair care practices including cosmetic hair procedures Examine scalp for scarring vs non-scarring by looking for • Loss of skin markings • Loss of hair follicle ostia • Pigmentary changes GENERAL HAIR CARE PRINCIPLES • Hair fall of upto 100 per day may be normal and need not cause alarm • Regular cleaning of scalp and hair with plain shampoo • Avoid hair oil |
| What oral antifungal medications are recommended for treating fungal hair infections? | Griseofulvin 10-20 mg/kg, Terbinafine 5 mg/kg; for 6-8 weeks | Easy pluckability of hair within the patch • KOH mount for confirmation, if available • Oral antifungals- Griseofulvin 10-20 mg/kg, Terbinafine 5 mg/kg; for 6-8 weeks • Topical antifungal shampoos • Avoid comb sharing • Children or young adults with bizzare shaped bald patches with broken hair of different length and focal scalp hemorrhages • Look for other signs of impulsive behaviour • Counselling and referral to psychiatrist if needed SCARRING ALOPECIA (AREAS WITH FIBROSIS AND DAMAGE TO HAIR FOLLICLES) All cases of scarring alopecia must be referred to a dermatologist for histological confirmation & further management Due to trauma/ burns/ dermatoses like morphea, pemphigus, neoplasms affecting the scalp Pustules or boggy lesions Pigmentary changes Lichen plano pilaris Violaceous plaques and follicular plugs. | 106 | list | 0.820 | Easy pluckability of hair within the patch • KOH mount for confirmation, if available • Oral antifungals- Griseofulvin 10-20 mg/kg, Terbinafine 5 mg/kg; for 6-8 weeks • Topical antifungal shampoos • Avoid comb sharing • Children or young adults with bizzare shaped bald patches with broken hair of different length and focal scalp hemorrhages • Look for other signs of impulsive behaviour • Counselling and referral to psychiatrist if needed SCARRING ALOPECIA (AREAS WITH FIBROSIS AND DAMAGE TO HAIR FOLLICLES) All cases of scarring alopecia must be referred to a dermatologist for histological |
| What methods are used to diagnose lichen planus on the scalp? | Trichoscopy, scalp biopsy for histopathology | Examine for lichen planus of other sites Investigation and treatment of underlying disorder Investigations: • Trichoscopy, scalp biopsy for histopathology Treatment: • Long term oral antibiotics: Doxycycline/ Clindamycin for 10-12 weeks • Consider low dose oral steroids • Isotretinoin Primary Secondary ACQUIRED CONGENITAL Diffuse Telogen effluvium Pattern hair loss • History to rule out underlying medical illness, drug intake, menstrual irregularities, hypo/ hyperthyroidism, anemia, physical/ mental stress • Labs- Hemogram, and if indicated serum ferritin, TSH • Reassurance and treatment of underlying disorder. | 110 | list | 0.820 | Examine for lichen planus of other sites Investigation and treatment of underlying disorder Investigations: • Trichoscopy, scalp biopsy for histopathology Treatment: • Long term oral antibiotics: Doxycycline/ Clindamycin for 10-12 weeks • Consider low dose oral steroids • Isotretinoin Primary Secondary ACQUIRED CONGENITAL Diffuse Telogen effluvium Pattern hair loss • History to rule out underlying medical illness, drug intake, menstrual irregularities, hypo/ hyperthyroidism, anemia, physical/ mental stress • Labs- Hemogram, and if indicated serum ferritin, TSH • Reassurance and treatment of |
| What are the recommended long-term oral antibiotics for treatment? | Doxycycline/ Clindamycin for 10-12 weeks | Examine for lichen planus of other sites Investigation and treatment of underlying disorder Investigations: • Trichoscopy, scalp biopsy for histopathology Treatment: • Long term oral antibiotics: Doxycycline/ Clindamycin for 10-12 weeks • Consider low dose oral steroids • Isotretinoin Primary Secondary ACQUIRED CONGENITAL Diffuse Telogen effluvium Pattern hair loss • History to rule out underlying medical illness, drug intake, menstrual irregularities, hypo/ hyperthyroidism, anemia, physical/ mental stress • Labs- Hemogram, and if indicated serum ferritin, TSH • Reassurance and treatment of underlying disorder. | 196 | list | 0.820 | Examine for lichen planus of other sites Investigation and treatment of underlying disorder Investigations: • Trichoscopy, scalp biopsy for histopathology Treatment: • Long term oral antibiotics: Doxycycline/ Clindamycin for 10-12 weeks • Consider low dose oral steroids • Isotretinoin Primary Secondary ACQUIRED CONGENITAL Diffuse Telogen effluvium Pattern hair loss • History to rule out underlying medical illness, drug intake, menstrual irregularities, hypo/ hyperthyroidism, anemia, physical/ mental stress • Labs- Hemogram, and if indicated serum ferritin, TSH • Reassurance and treatment of |
| What medical conditions should be ruled out in cases of diffuse telogen effluvium? | underlying medical illness, drug intake, menstrual irregularities, hypo/ hyperthyroidism, anemia, physical/ mental stress | Examine for lichen planus of other sites Investigation and treatment of underlying disorder Investigations: • Trichoscopy, scalp biopsy for histopathology Treatment: • Long term oral antibiotics: Doxycycline/ Clindamycin for 10-12 weeks • Consider low dose oral steroids • Isotretinoin Primary Secondary ACQUIRED CONGENITAL Diffuse Telogen effluvium Pattern hair loss • History to rule out underlying medical illness, drug intake, menstrual irregularities, hypo/ hyperthyroidism, anemia, physical/ mental stress • Labs- Hemogram, and if indicated serum ferritin, TSH • Reassurance and treatment of underlying disorder. | 390 | list | 0.820 | Examine for lichen planus of other sites Investigation and treatment of underlying disorder Investigations: • Trichoscopy, scalp biopsy for histopathology Treatment: • Long term oral antibiotics: Doxycycline/ Clindamycin for 10-12 weeks • Consider low dose oral steroids • Isotretinoin Primary Secondary ACQUIRED CONGENITAL Diffuse Telogen effluvium Pattern hair loss • History to rule out underlying medical illness, drug intake, menstrual irregularities, hypo/ hyperthyroidism, anemia, physical/ mental stress • Labs- Hemogram, and if indicated serum ferritin, TSH • Reassurance and treatment of |