Androgenetic Hair loss in women

Ms.X is a middle aged lady, who had very good hair as a teenager. She even won Miss Beautiful Hair during her college days. After marriage she has put on some weight, though she cannot be called obese. Of late she has noticed that her scalp is becoming visible in the front. She has started noticing few hair strands in the bathtub as well. The length of her hair (which used to attract so much attention during younger days) has significantly reduced. She has noticed the same pattern in her mother as well, but she feels her mother started loosing hair much later in her life and it is OK for her to lose some now. She tried all the shampoos and hair loss solutions available in the market with little improvement. Her stress level has increased and it has started interfering with her day to day life. If you think I can substitute X with your name then please read the story here, otherwise search my 'Feather in the cap' series of articles for your story.

Lichen Planopilaris

Lichen Planopilaris is a type of follicular lichen planus causing hair loss, sometimes permanent. Reactions to chemicals or certain drugs can cause this type of hair loss.

Pseudopelade of Brocq

This middle aged female patient presented to me with diffuse long standing alopecia mainly involving the vertex. The hair scope revealed peri follicular scaling without significant thinning of the shaft. Clinically peri follicular erythema was also evident. My diagnosis was Lichen Plano Pilaris (LPP). Since histopathological evidence is not available, this can be categorized as pseudopelade of Brocq also.

Alopecia areata

This patient presented with an alopecia areata patch over frontal scalp. She also had unilateral loss of lateral eyebrows. An exclamation mark hair as seen through hair scope is marked with red arrows. When intralesional corticosteroids are used, low concentrations are typically injected into eyebrows or facial skin and the highest concentration is used on the scalp.

Sebo Psoriasis

This male patient presented with recent onset hair fall with itching. He also complained of boils over the scalp. On examination patient had superficial folliculitis of the scalp which is fairly common in gulf. The blue circle shows a folliculitis lesion as seen through hair scope. When it is confined to only certain regions, it could be considered a part of the spectrum of sebo-psoriasis.

Scalp Psoriasis

This patient with extensive frontal recession of pattern alopecia complained of recent onset hair loss from the vertex. On examination patient had scalp psoriasis. The hair scope examination showed characteristic follicular thinning of pattern alopecia but pictures 2 and 3 also showed characteristic scalp changes. This underlines the need to carefully look for scalp disorders even in extensive pattern alopecia.

This blog is basically for posting clinical pictures and discuss it with other trichologists.