| What is a characteristic feature of alopecia universalis? | all body hairs | • 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). | 112 | definition | 0.940 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_alopecia.pdf | • 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 some conditions listed under patchy hair loss? | Androgenetic alopecia: males Female pattern hair loss Tinea capitis Alopecia areata Trichotillomania | If persistent, consider 1 ml of 5% topical Minoxidil once a day Androgenetic alopecia: males Female pattern hair loss Tinea capitis Alopecia areata Trichotillomania Patchy Investigations: • Trichoscopy, scalp biopsy for histopathology Treatment: • Oral steroid mini pulse +/- Methotrexate/ Azathioprine/ Cyclosporine for halting active progression • Strict laboratory monitoring for any adverse drug events • For burnt out disease- wigs and camouflage | 64 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_alopecia.pdf | If persistent, consider 1 ml of 5% topical Minoxidil once a day Androgenetic alopecia: males Female pattern hair loss Tinea capitis Alopecia areata Trichotillomania Patchy Investigations: • Trichoscopy, scalp biopsy for histopathology Treatment: • Oral steroid mini pulse +/- Methotrexate/ Azathioprine/ Cyclosporine for halting active progression • Strict laboratory monitoring for any adverse drug events • For burnt out disease- wigs and camouflage | 1 | page=1,block=32 | 0.700 |
| What are the recommended oral antifungals for treating certain hair conditions? | 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 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_alopecia.pdf | 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 investigations are suggested for diagnosing hair conditions? | 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 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_alopecia.pdf | 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 items are listed under “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 | 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 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_alopecia.pdf | 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 laboratory tests are recommended for investigating diffuse hair loss? | Hemogram, and if indicated serum ferritin, TSH | 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. | 520 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_alopecia.pdf | 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 history should be reviewed for diffuse hair loss conditions? | 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 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_alopecia.pdf | 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 treatments are suggested for halting the active progression of certain hair conditions? | Oral steroid mini pulse +/- Methotrexate/ Azathioprine/ Cyclosporine | If persistent, consider 1 ml of 5% topical Minoxidil once a day Androgenetic alopecia: males Female pattern hair loss Tinea capitis Alopecia areata Trichotillomania Patchy Investigations: • Trichoscopy, scalp biopsy for histopathology Treatment: • Oral steroid mini pulse +/- Methotrexate/ Azathioprine/ Cyclosporine for halting active progression • Strict laboratory monitoring for any adverse drug events • For burnt out disease- wigs and camouflage | 248 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_alopecia.pdf | If persistent, consider 1 ml of 5% topical Minoxidil once a day Androgenetic alopecia: males Female pattern hair loss Tinea capitis Alopecia areata Trichotillomania Patchy Investigations: • Trichoscopy, scalp biopsy for histopathology Treatment: • Oral steroid mini pulse +/- Methotrexate/ Azathioprine/ Cyclosporine for halting active progression • Strict laboratory monitoring for any adverse drug events • For burnt out disease- wigs and camouflage | 1 | page=1,block=32 | 0.700 |
| What is a common pattern of hair thinning in postmenopausal women? | Hair thinning with widening of partition | • Adult males with fronto-temporal hairline thinning or recession, it may progressively involve vertex & parietal areas with usual sparing of occipital area • Treat with 1mL of topical 5% Minoxidil solution BD • If effective continue this treatment to maintain hair growth • Addition of oral Finasteride 1 mg/day may be considered • Can be referred to trained specialist for hair transplant, if required • Hair thinning with widening of partition usually in postmenopausal women • In premenopausal, look for signs of hyperandrogenism. | 406 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_alopecia.pdf | • Adult males with fronto-temporal hairline thinning or recession, it may progressively involve vertex & parietal areas with usual sparing of occipital area • Treat with 1mL of topical 5% Minoxidil solution BD • If effective continue this treatment to maintain hair growth • Addition of oral Finasteride 1 mg/day may be considered • Can be referred to trained specialist for hair transplant, if required • Hair thinning with widening of partition usually in postmenopausal women • In premenopausal, look for signs of hyperandrogenism. |
| What is considered a normal amount of daily hair fall? | Hair fall of upto 100 per day | 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 | 458 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_alopecia.pdf | 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 |