10th July 2023

Hair Disorders

Hypertrichosis and Hirsutism

Excessive hair growth can be androgen-independent (hypertrichosis) or androgen-dependent (hirsutism – excess hair growth in a male pattern that occurs in women).

Table 7: Causes of hypertrichosis and hirsutism

Treatment options can include physical hair removal or medication such as the combined oral contraceptive pill (that contains anti-androgenic cyproterone acetate), spironolactone, finasteride and topical eflornithine.

Scarring alopecia

Scarring alopecia is hair loss with destruction of hair follicles. Causes include ichthyosis, tuberculosis, syphilis, burns, radiotherapy, kerion, lichen planus, discoid lupus, morphoea, sarcoidosis and cicatricial pemphigoid.

Non scarring alopecia

Non scarring alopecia is hair loss with preservation of hair follicles. Alopecia areata often presents as the classic ‘exclamation mark’ hair. It is often associated with nail dystrophy, cataracts, and other autoimmune diseases such as vitiligo, autoimmune thyroid disease, pernicious anaemia, and Addison’s disease. 50% of patients have hair growth within 1 year. First line treatment includes topical corticosteroids.

Other causes of non-scarring alopecia include male pattern (androgenic) alopecia, hypopituitary state, thyroid disease, hypoparathyroidism, pregnancy, iron deficiency anaemia, telogen effluvium, trichotillomania, and chronic illness. Medications that can lead to non-scarring alopecia include retinoids, anticoagulants, anti-mitotic agents, oral contraceptive pill, carbimazole, thiouracil and lithium.

Trichotillomania

Also known as a hair pulling disorder leading to alopecia. It affects 4% of the general population and is more commonly seen in females. It is associated with obsessive-compulsive disorder and is triggered by stress and anxiety. There have been studies that have identified a genetic linkage.