Alopecia: Description:ICD-9: 704.0 to 704.09 (depending on the type).Alopecia or hair loss or balding is a matter of psychological concern for both males and females. Alopecia may be of scarring and non-scarring type. It is estimated that alopecia affects several million children in the United States and that hair loss is responsible for about 3 percent of all pediatric office visits.Hair consists of the shaft and the root, which is anchored into a follicle beneath the epidermis. Hair is formed by rapid divisions of cells at the base of the follicle. Except for a few growing cells at the base of the root, hair, which is composed of keratin and other proteins, is dead tissue.Hair follicles go through cyclic phases of activity and inactivity. Each cycle comprises of three phases:Anagen: The growing phase, which lasts for 2-6yrs, average being 3 yrs.Catagen: The transitional phase, which lasts for 1-2weeks.Telogen: The resting phase, lasting for 3-4 months.In a normal scalp, 90% of the hair are in anagen phase while 10% are either in catagen or telogen phase at any given point of time. Normally 100 hair are shed everyday.Causes and Risk Factors:Alopecia can be due to a number of causes:1. Hereditary or developmental.2. Infection of the hair follicle (bacterial, fungal etc.).3. Trauma like that of burns, radiation, chemical injury or mechanical injury.4. Neoplastic (cancer) conditions such as squamous cell carcinoma, basal cell carcinoma, lymphomas or secondary metastases.5. Due to inflammation of the underlying dermis in diseases like syphilis, tuberculosis, herpes zoster, sarcoidosis, pyoderma gangrenosum, cicatrical pemphigoid, and morphea.Stress induced alopecia is due to emotional stress, starvation, crash diets, malaria, tuberculosis, hepatic or renal failure, iron or zinc deficiency, collagen vascular disease,Drug induced alopecia is due to patients on anti-cancer treatment, anti-thyroid drugs, cholesterol lowering agents and patients on anticoagulant therapy.Diagnosis:In most cases, alopecia does not require a diagnosis. The healthcare provider can usually determine the cause of hair loss after a physical examination and medical history. If there is a family history of alopecia, androgenetica alopecia is suspected. The healthcare provider will also ask questions about recent infections, new medications, diet, and hair treatments to determine if such factors are causing hair loss. If alopecia areata is suspected, a fluorescent antinuclear antibody (FANA) test may used to confirm a diagnosis. The fluorescent antinuclear antibody (FANA) test is a blood test used to detect abnormal antibodies, called autoantibodies. The autoantibodies bind to components of and individual's own cells and cause the immune system to attack the body. If autoantibodies are present, the patient has an autoimmune disorder.If the physician suspects a fungal infection of the scalp, a hair sample may be tested by microscopic examination in the laboratory. Microscopic examination of a hair plucked at the periphery of the hair loss area often reveals a characteristic disruption of the integrity of the hair shaft. The infection may be confirmed by culturing the scalp for fungal organismsTreatment:For fungal infections such as tinea capitis, treatment usually requires a systemic approach with an oral anti-fungal prescription medication such as griseofulvin (Fulvicin). This medication, which must be taken for four to eight weeks, is very effective in curing the infection and restoring the hair. Early treatment is important in preventing possible permanent hair loss.Topical creams or antifungal shampoos containing 2 percent ketoconazole are often used two to three times per week for eight weeks. Although shampoos and topical antifungal creams may decrease scaling, the infection usually returns because these products do not penetrate the hair follicle deeply enough to eradicate the infection.A wide variety of treatments are available for alopecia areata. There has been some success with use of medications that suppress the immune system, including dinitrochlorobenzene (DNCB) and diphenylcyclopropenone (DPCP). The side effects of these drugs, however, may outweigh the benefits for a disease that most often resolves on its own.In addition, topical creams or lotions such as minoxidil, cortisone (also injected into the scalp), or anthralin are sometimes used. Because such treatment triggers hair growth in bald patches but does not eradicate the disease, however, new bald patches can occur in other parts of the scalp even if new growth occurs.Hair loss resulting from telogen effluvium or drug side effects usually requires no treatment. Hair loss from poor nutrition or medical illness usually stops with the adoption of a healthy diet and treatment of the underlying medical condition. Once the stressful event is over, complete hair growth usually occurs within six months.Home Remedies Include:Aromatherapy: Aromatherapy is a safe and effective treatment for alopecia areata. Aromatherapy involves rubbing scented essential oils into the skin to treat localized and systemic disease. Massaging the essential oils of rosemary, lavender, sage, thyme, and cedar into the scalp is believed to increase circulation and reduce stress. About three to six drops of essential oil are added to 1 tablespoon of jojoba or grape seed oil and massaged into the scalp.In addition to aromatherapy, stress reduction techniques such as yoga, meditation, or creative visualization may increase blood flow to the scalp and stimulate hair growth.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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