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A. Scarring (Cicatricial) Alopecia (major causes only)navigator

  1. Inflammatory Dermatoses
    1. Cicatricial pemphigoid
    2. Lupus erythematosus - discoid and systemic
    3. Necrobiosis lipoidica diabeticorum
    4. Sarcoidosis
    5. Scleroderma
  2. Infection
    1. Bacterial - pyogenic, syphlis, tuberculosis, leprosy
    2. Viral - herpes (varicella) zoster
    3. Fungal and Protozoal infections
  3. Physical and Chemical Agents
  4. Neoplasms
    1. Basal cell carcinoma
    2. Lymphoma
    3. Nevi and Melanoma
    4. Metastatic Disease
    5. Squamous cell carcinoma
  5. Congenital Abnormalities
    1. Aplasia cutis
    2. Congenital ichthyosis
    3. Epidermolysis bullosa
    4. Hair follicle hamartoma
    5. Ichthyosiform erythroderma
    6. Keratosis pilaris atrophicans

B. Nonscarring Alopecianavigator

  1. Androgenic Alopecia
    1. Male common baldness
    2. Affects ~65% of men
    3. In women, usually associated w/ acne, facial hirsutism (chronic anovulatory syndrome)
  2. Telogen Effluvium
    1. Diverse causes with anagen arrest
    2. Hair loss (usually >50%) occurs 2-4 months after initiating event
    3. Psychologic and pathologic causes and medications are often implicated
    4. Drugs: anticoagulants, oral-contraceptive withdrawal, ß-blockers, tricyclics, ACE inhibitors, amphetamines, anti-thyroid medicines, lithium, levodopa, nicotinic acid
    5. Other: hypothyroidism, fever, infection, severe systemic disease
    6. Far more common than Anagen Effluvium
  3. Anagen Effluvium
    1. Drugs - antimitotic chemotherapy, colchicine, allopurinol, cimetidine, haloperidol
    2. Radiation therapy
    3. Heavy metal poisoning
    4. Hypervitaminosis A
  4. Traumatic Alopecia
    1. Trichotillomania - Nonscarring, patchy hair loss secondary to pulling out hair
    2. Traction alopecia - tightly wound, braided hair
  5. Alopecia areata
    1. One or more asymptomatic oval patches, usually sudden onset
    2. Often with nail pitting
    3. May respond to topical steroids
  6. Secondary syphilis
  7. Congenital disorders
  8. Many of these can eventually cause scarring

References navigator

  1. Nielsen TA and Reichel M. 1995. Am Fam Phys. 51(6):1513 abstract
  2. Paus R and Cotsarelis G. 1999. NEJM. 341(7):491 abstract