Alopecia

What is Alopecia

The two major forms ofalopeca are scarring and nonscarring. In scarring alopecia there is associated brosis,inflammation,and loss of hair follicles. A smooth scalp with a decreased number of follicular openings is usually observedclinicl but in some cases the changes are seen only in biopsy specimens from the affected areas. In nonscarring alopecia the hair shafts are gone, but the hair follicles are preserved, explaining the reversible nature of nonscarring alopecia.

Primary cutaneous disorders are the most common causes of non- scarring alopecia and they include telogen effluvium, androgenetic alopecia, alopecia areata, tinea capitis, and traumatic alopecia. In women with androgenetic alopecia, an elevationincircing levels of androgens may be seen as a result of ovarian or. gland dysfunction. When there are signs of virilization, such as deepened voice and enlarged clitoris, the possibility of an ovarian or adrenal gland tumor should be considered.

Treatment of Alopecia

Treatment routinely involves removing any predisposing factors such as antibiotic therapy or chronic wetness and the use of appropriate topical or systemic antifungal therapy. Choice of therapy for other forms of Alopecia is based on case series and anecdotal reports. In general, amphotericin B-based preparations, the azole antifungal agents, and the echinocandin antifungal agents play a role in treatment.

Effective topical agents include nystatin or topical azoles (miconazole, clotrimazole, econazole, or ketoconazole). These agents are generally effective in clearing mucous membrane or glabrous skin involvement in nonimmunosuppressed patients. The associated inflammatory response that often accompanies candidal infection on glabrous skin should be treated with a mild glucocorticoid lotion or cream (2.5% hydrocortisone).

Systemic therapy is generally reserved for immunosuppressed patients or individuals with chronic or recurrent disease who fail to respond to or tolerate appropriate topical therapy. Vulvovaginal Alopecia may respond to treatment with a single dose of fluconazole (150 mg). Chronic recurrent oral or vaginal Alopecia may be treated with weekly to monthly oral fluconazole (150 to 200 mg) in conjunction with topical therapy.