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  • Alopecia areata

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    Systemic lupus erythematosus (SLE)
    SLE is a chronic autoimmune inflammatory disease affecting collagen. It involves multiple systems of the body including hair loss

    Secondary syphilis
    Secondary syphilis usually begins 2 to 8 weeks after chancre type lesions appear. It can present with patchy hair loss, mostly on the scalp and often elsewhere on the body. This hair loss is often described as having a moth-eaten appearance. High-risk clients should also be questioned regarding past rashes, especially on the palms, soles, and any chancroid lesions or condyloma. Diagnosis is serologic (VDRL or rapid plasma regain [RPR]), and hair regrowth occurs after penicillin therapy. Penicillin remains the first choice, but if an allergy exists, intramuscular Rocephin (x 10 days), tetracycline, or doxycycline may be tried for 2 weeks.

    Side effects of medications

    Medications such as cytotoxic agents, colchicine, heparin, oral anticoagulants, hydroxyurea therapy, vitamin A, captopril, protease inhibitors such as indinavir and nelfinavir, amphetamines, anticancer agents, gout medication, isotretinoin (Accutane), lithium, male hormones, propranolol hydrochloride (Inderal), and valproic acid (Depacon, Depakene, Depakote), can all induce nonscarring hair loss.

    Birth control pills
    Women who lose hair while taking birth control pills may have an inherited tendency for hair thinning. If hair thinning occurs, a woman can consult her gynecologist about switching to another birth control pill. When a woman stops using oral contraceptives, she may notice that her hair begins shedding two or three months later. This may continue for six months when it usually stops. This is similar to hair loss after the birth of a child.


    Caustic chemicals
    Anyone who curls, straightens, colors, or dyes their hair may cause hair loss. Repeated exposure to these substances can injury hair follicles, weaken hair, or even damage the scalp. It is most often seen in African women, and inflammation is not always obvious.
    High fever or severe infection
    Acute and some chronic illnesses may cause hairs to enter a prolonged resting telogen phase (also known as telogen effluvium). It is not uncommon to experience a higher incidence of hair loss up to three months after high fever, severe illness, or infection. This resting phase typically resolves after several months and normal hair growth rebounds when the growth cycle returns.
    Other causes of hair loss
    Other causes of hair loss include anemia, hypoalbuminemia, malnutrition, Lichen planus, Staphylococcal folliculitis, scleroderma, psoriasis, seborrhoeic dermatitis, menopause, hypothyroidism, herpes zoster, and others.
    Treatment Recommendations

    The choice of therapeutic intervention for alopecia depends on several factors:

    Thyroid replacement or adjustment as indicated
    Fungal infection
    Ketoconazole, oral antifungal agents such as griseofulvin (Grifulvin), itraconazole (Sporanox), terbinafine (Lamisil), and fluconazole (Diflucan) may be used. Oral steroids may be necessary to decrease inflammation and scarring.

    Hormone imbalance

    If female androgen excess is suspected (hirsutism, acne) or menses is irregular, check DHEA-S and free testosterone levels first to rule out adrenal or ovarian cancer.
    Once ruled out, consider spironolactone, flutamide, or finasteride.

    Spironolactone competes with testosterone and dihydrotestosterone at the androgen receptor level. Spironolactone 100 mg per day can be given in divided doses; this dose may be increased to 200 mg.

    Flutamide (Eulexin), an antiandrogen that blocks androgen uptake and nuclear binding, is a very effective drug in treating hyperandrogenism. Give 250 mg daily and monitor hepatotoxicity.

    Finasteride (Propecia) blocks the conversion of testosterone to dihydrotestosterone. The plasma levels of testosterone may increase during treatment, whereas the dihydrotestosterone level decreases. Of utmost importance, the patient should be aware that she must avoid pregnancy during treatment with finasteride because of the potential for causing ambiguous genitalia in a male fetus.

    Drug-induced hair loss (effluvium)
    Drugs that induce hair loss include antihypertensive agents, anti-gout medications, etc. Consider tapering or discontinuing the medication if untoward risks are low.

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