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QUESTION OF THE WEEK

Dr. Donovan's Articles

QUESTION OF HAIR BLOGS

Diagnosing Hair Loss in Darker Skin Types

Diagnosing hair loss in patients with darker skin types employs the same principles as for lighter skin types. However, a few features are unique including the the greater likelihood for scalp inflammation to create areas of hypopigmentation and hyperpigmemtation. In this picture of a male with androgenetic alopecia several findings are present. The redness and fine scale is consistent with seborrheic dermatitis. The patient also has folliculitis and a pustule can be seen in the upper portion of the picture. In the bottom left of the picture, areas of whitish hypopigmentation can be seen and in the bottom right areas of darker hyperpigmentation can be seen. The tiny white dots that are speckled al over the scalp represent the openings of the eccrine glands.

This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Partially Treated Alopecia Areata

Alopecia areata is an autoimmune condition that affects approximately 2 % of the worlds population. Many treatments are available. For patches of alopecia areata, the most effective treatment is steroid injections. When the scalp is examined a few weeks after a patient has received steroid injections a mixture of hair regrowth and hair loss is typically seen. In alopecia areata, hairs that are in the losing stage include broken hairs (arrow) and so called exclamation mark hairs (asterisk). Over time as hair growth dominates, the proportion of broken hairs and exclamation mark hairs will be reduced.

This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Partially Treated Lichen Planopilaris

 Scale Gone, Redness Remains

Lichen planopilaris (LPP) is a scarring hair loss condition. The goal of treating LPP is to stop the condition. Successful treatment is associated with a halting of hair loss but also with an improvement in the symptoms and signs of the disease. Patients will notice a reduction in itching and burning and clinically there will be an improvement in scaling and redness around hairs. Sometimes scaling is the first to improve and improvements in redness happen later. This picture shows a patient with partially treated lichen planopilaris. The disease is still active although scaling has improved. The patient's itching has also improved.

This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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Trichotillomania

Exclamation Mark Hairs

Exclamation mark hairs are short hairs that are thick at the top and thinner as they enter the scalp. These hairs are known to occur in the autoimmune condition alopecia areata but also can occur in trichotillomania (shown this picture), poisoning situations (ie thallium) and have also been reported in dissecting cellulitis.

This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.
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