A 50 yr old man came with these lesions on his scalp. Total duration was 2 years. Initially started as few papules but later spread to invoke a larger area and also to the dorsum of the right hand. Usually asymptomatic but rarely itchy. No similar lesions elsewhere. Diagnosis and management?

75 year old man with recurrent episode of eryhthematous, itchy , plaque lesions... subsides with betnovate ointment which a GP gave him....but recurence after few weeks.....diagnosis...

Friends today I am discussing about a problem known as Alopecia Areata. What is alopecia areata? Alopecia areata is a disease that causes hair to fall out in small patches, which can remain unnoticeable. These patches may eventually connect and then become noticeable, however. This disease develops when the immune system attacks the hair follicles, resulting in hair loss. Sudden hair loss may occur on the scalp, and in some cases the eyebrows, eyelashes, and face, as well as other parts of the body. It can also develop slowly, and recur after years between instances. The condition can result in total hair loss, called alopecia universalis, and it can prevent hair from growing back. When hair does grow back, it’s possible for the hair to fall out again. The extent of hair loss and regrowth varies from person to person. There’s currently no cure for alopecia areata. However, there are treatments that may help hair grow back more quickly and that can prevent future hair loss, as well as unique ways to cover up the hair loss. Resources are also available to help people cope with the stress of the disease. What are the symptoms of alopecia areata? The main symptom of alopecia areata is hair loss. Hair usually falls out in small patches on the scalp. These patches are often several centimeters or less. Hair loss might also occur on other parts of the face, like the eyebrows, eyelashes, and beard, as well as other parts of the body. Some people lose hair in a few places. Others lose it in a lot of spots. You may first notice clumps of hair on your pillow or in the shower. If the spots are on the back of your head, someone may bring it to your attention. However, other types of diseases can also cause hair to fall out in a similar pattern. Hair loss alone isn’t used to diagnose alopecia areata. In rare cases, some people may experience more extensive hair loss. This is usually an indication of another type of alopecia, such as: alopecia totalis, which is the loss of all hair on the scalp alopecia universalis, which is the loss of all hair on the entire body Doctors might avoid using the terms “totalis” and “universalis” because some people may experience something between the two. It’s possible to lose all hair on the arms, legs and scalp, but not the chest, for example. The hair loss associated with alopecia areata is unpredictable and, as far as doctors and researchers can tell, appears to be spontaneous. The hair may grow back at any time and then may fall out again. The extent of hair loss and regrowth varies greatly from person to person. What causes alopecia areata? Alopecia areata is an autoimmune disease. An autoimmune disease develops when the immune system mistakes healthy cells for foreign substances. Normally, the immune system defends your body against foreign invaders, such as viruses and bacteria. If you have alopecia areata, however, your immune system mistakenly attacks your hair follicles. Hair follicles are the structures from which hairs grow. The follicles become smaller and stop producing hair, leading to hair loss. Researchers don’t know what triggers the immune system to attack hair follicles, so the exact cause of this condition isn’t known. However, it most often occurs in people who have a family history of other autoimmune diseases, such as type 1 diabetes or rheumatoid arthritis. This is why some scientists suspect that genetics may contribute to the development of alopecia areata. They also believe that certain factors in the environment are needed to trigger alopecia areata in people who are genetically predisposed to the disease. Alopecia alongside other skin conditions People with an autoimmune disease, like alopecia areata, are also more prone to having another autoimmune disease, including those that also affect the skin and hair. If you’ve been diagnosed with alopecia areata and another skin condition, you may find that treating one helps the other. In other cases, however, treating one may make the other worse. Psoriasis Psoriasis causes a rapid buildup of skin cells. It happens when the immune system mistakenly attacks the skin cells and causes the skin cell production process to go into overdrive. This results in thick patches of skin called plaques, as well as red, inflamed areas of skin. Treating psoriasis with alopecia can be tricky. The scaling associated with psoriasis can make the skin itchy, and scratching can make hair loss worse. In addition, biologic treatments often used for psoriasis, called TNF inhibiters, have been associated with hair loss in some people. For others, treating the psoriasis may help regrow hair. In one small study, over two-thirds of participants with alopecia areata who took a common psoriasis treatment called methotrexate had hair regrowth greater than 50 percent. Another case study found that a new psoriasis treatment called apremilast (Otezla) helped one woman with both psoriasis and alopecia regrow the hair on her scalp in 12 weeks. Atopic dermatitis (eczema) Researchers have established a link between alopecia and atopic dermatitis, a condition in which inflammation on the skin causes itchy, red rashes. Atopic dermatitis is more commonly known as eczema. Many treatment options for atopic dermatitis, like steroid creams and phototherapy, overlap with alopecia treatments, so it’s possible that treating one condition will help treat the other. One area of interest for treating both atopic dermatitis and alopecia is a class of drugs called JAK inhibitors. They’re currently used to treat rheumatoid arthritis and other conditions. One oral JAK inhibitor known as tofacinitib has already shown promise in small clinical trials for both atopic dermatitis and alopecia areata. Another biologic treatment called dupilumab (Dupixent), which has recently been approved by the FDA to treat atopic dermatitis, is also a drug of interest for treating alopecia. A clinical study evaluating dupliumab in people with alopecia — both with and without atopic dermatitis — is currently underway. How is alopecia areata diagnosed? A doctor will review your symptoms to determine if you have alopecia areata. They may be able to diagnose alopecia areata simply by looking at the extent of your hair loss and by examining a few hair samples under a microscope. Your doctor may also perform a scalp biopsy to rule out other conditions that cause hair loss, including fungal infections like tinea capitis. During a scalp biopsy, your doctor will remove a small piece of skin on your scalp for analysis. Blood tests might be done if other autoimmune conditions are suspected. The specific blood test performed depends on the particular disorder the doctor suspects. However, a doctor will likely test for the presence of one or more abnormal antibodies. If these antibodies are found in your blood, it usually means that you have an autoimmune disorder. Other blood tests that can help rule out other conditions include the following: C-reactive protein and erythrocyte sedimentation rate iron levels antinuclear antibody test thyroid hormones free and total testosterone follicle stimulating and luteinizing hormone How is alopecia areata treated? There’s no known cure for alopecia areata, but there are treatments that you can try that might be able to slow down future hair loss or help hair grow back more quickly. The condition is difficult to predict, which means it may require a large amount of trial and error until you find something that works for you. For some people, hair loss may still worsen despite treatment. Medical treatments Topical agents You can rub medications into your scalp to help stimulate hair growth. A number of medications are available, both over-the-counter (OTC) and by prescription: Minoxidil (Rogaine) is available OTC and applied twice daily to the scalp, eyebrows, and beard. It’s relatively safe, but it can take a year to see results. Anthralin (Dritho-Scalp) is a drug that irritates the skin in order to spur hair regrowth. Corticosteroid creams such as clobetasol (Impoyz), foams, lotions, and ointments are thought to work by decreasing inflammation in the hair follicle. Topical immunotherapy is a technique in which a chemical like diphencyprone is applied to the skin to spark an allergic rash. The rash, which resembles poison oak, may induce new hair growth within six months, but you’ll have to continue the treatment to maintain the regrowth. Injections Steroid injections are a common option for mild, patchy alopecia to help hair grow back on bald spots. Tiny needles inject the steroid into the bare skin of the affected areas. The treatment has to be repeated once every one to two months to regrow hair. It doesn’t prevent new hair loss from occurring. Oral treatments Cortisone tablets are sometimes used for extensive alopecia, but due to the possibility of side effects, this option should be discussed with a doctor. Oral immunosuppressants, like methotrexate and cyclosporine, are another option you can try. They work by blocking the immune system’s response, but they can’t be used for a long period of time due to the risk of side effects, such as high blood pressure, liver and kidney damage, and an increased risk of serious infections and a type of cancer called lymphoma. Light therapy Light therapy is also called photochemotherapy or just phototherapy. It’s a type of radiation treatment that uses a combination of an oral medication called psoralens and UV light. Alternative therapies Some people with alopecia areata choose alternative therapies to treat the condition. These may include: aromatherapy acupuncture microneedling probiotics low-level laser therapy (LLLT) vitamins, like zinc and biotin aloe vera drinks and topical gels onion juice rubbed onto the scalp essential oils like tea tree, rosemary, lavender, and peppermint other oils, like coconut, castor, olive, and jojoba an “anti-inflammatory” diet, also called the “autoimmune protocol,” which is a restrictive diet that mainly includes meats and vegetables scalp massage herbal supplements, such as ginseng, green tea, Chinese hibiscus, and saw palmetto Most alternative therapies haven’t been tested in clinical trials, so their effectiveness in treating hair loss isn’t known. The effectiveness of each treatment will vary from person to person. Some people don’t even need treatment since their hair grows back on its own. In other cases, however, people never see improvement despite trying every treatment option. You might need to try more than one treatment to see a difference. Keep in mind that hair regrowth may only be temporary. It’s possible for the hair to grow back and then fall out again. Homeopathic Medicines for Alopecia Areata 1. Arsenic Album – Homeopathic Medicine for Alopecia Areata Accompanied by Itching and Burning on the Scalp Arsenic Album is a recommended homeopathic treatment for alopecia areata which appears as circular bald patches along with itching and burning on the scalp. These symptoms aggravate at night. In some cases, the scalp is also sensitive. 2. Vinca Minor – Another Useful Homeopathic Medicine for Alopecia Areata Vinca Minor is another useful homeopathic medicine for alopecia areata. It works well in cases where there is a tendency for hair to fall in spots which are then replaced by white hair. Along with this, itching and violent scratching over the scalp may also be present. 3. Baryta Carb, Lycopodium, and Silicea – Homeopathic Medicines for Alopecia Areata in Young People The most prominently indicated homeopathic medicines for alopecia areata in young people are Baryta Carb, Lycopodium, and Silicea. Baryta Carb helps in recovering from bald patches that occur on the top of the scalp. Lycopodium works well for bald patches on the temples. Silicea is a good homeopathic treatment for alopecia areata occuring on the back of the scalp. 4. Fluoric Acid – Excellent Homeopathic Medicine for Alopecia Areata Fluoric Acid is among the top grade homeopathic remedies for alopecia areata. Fluoric Acid helps in the regrowth of hair in the bald patches. Fluoric Acid is also a highly suitable homeopathic medicine for hair fall after fever. 5. Phosphorus – A Wonderful Homeopathic Medicine for Alopecia Areata Another homeopathic medicine that has shown its effectiveness in alopecia areata cases is Phosphorus. Phosphorus works well in cases where a person suffers from the loss of hair in patches. Along with hair loss, dandruff on the scalp is also present. In some cases, there is itching on the scalp along with hair fall. Phosphorus also seems to help cases of traction alopecia. In such situations, there is a receding hair line. Hair fall from the forehead is prominent. A person needing Phosphorus may crave cold drinks and ice creams.

Diagnosis and differential DIAGNOSIS PLZ. .source. INTERNATE.

#HolisticMedicine #CCAUpdates All you need to know about Alopecia (hairloss) Most people normally shed 50 to 100 hairs a day. This usually doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair loss, baldness or alopecia occurs when this cycle of hair growth and shedding is disrupted or when the hair follicle is destroyed and replaced with scar tissue. The exact cause of hair loss may not be fully understood, but it's usually related to one or more of the following factors: Family history (heredity), especially for male-pattern baldness Hormonal changes (e.g. pregnancy, childbirth or the onset of menopause) Certain medical conditions (e.g. thyroid disorders, diabetes, anemia, Systemic Lupus Erythematosus (SLE), sarcoidosis with skin involvement, and some local conditions such as tinea infection of scalp, lichen planus, and Trichotillomania (a disorder causes people to repeatedly pull out their own hair)) Certain treatment (e.g. cancer treatment (chemotherapy and radiation therapy), blood thinners, high dose vitamin A, drug for arthritis, depression, heart problems and high blood pressure, birth control pills and anabolic steroids (steroids taken to build muscle and improve athletic performance)) Severe emotional and physical stress Nutritional deficiencies (not enough protein or iron, eating disorder such as anorexia and bulimia, and weigh lost) Androgenetic alopecia: Androgenetic alopecia is the most common type of progressive hair loss. It is also known as male-pattern baldness, female-pattern baldness, or just common baldness. Androgenetic alopecia is caused by a combination of genetic and hormonal factors. Dihydrotestosterone (DHT) is the main hormone responsible for androgenetic alopecia in genetically susceptible individuals. DHT causes scalp hair loss by inducing a change in the hair follicles on the scalp. The hairs produced by the affected follicles become progressively smaller in diameter, shorter in length and lighter in colour until eventually the follicles shrink completely and stop producing hair. Male-pattern baldness can begin as early as puberty, and affects around half of all men by 50 years of age. It generally follows a pattern of a receding hairline, followed by thinning of the hair on the crown and temples, resulting in partial or complete baldness. In female-pattern baldness, hair usually only thins on top of the head. It tends to be more noticeable in women who have been through the menopause. Besides Androgenetic alopecia, there are other forms of hair loss such as Alopecia Areata (AA), Telogen Effluvium (TE). Alopecia areata: Alopecia areata most frequently presents as a single round patch (about the size of a large coin) or multiple patches of hair loss that may coalesce into larger areas of alopecia. They usually appear on the scalp but can occur anywhere on the body. It can occur at any age, but mostly affects teenagers and young adults. In alopecia areata, hair is lost because it is affected by inflammation. The cause of this inflammation is unknown but it is thought that the immune system, the natural defence which normally protects the body from infections and other diseases, may attack the growing hair. Why this might happen is not fully understood, nor is it known why only localised areas are affected and why the hair usually regrows again. Telogen effluvium In telogen effluvium (TE), hair density decreases resulting in reduced volume of hair. The decrease of hair density is due to marked increase in hairs shed each day, an increased proportion of hairs shift from the growing phase (anagen) to the shedding phase (telogen). Normally only 10% of the scalp hair is in the telogen phase, but in telogen effluvium this increases to 30% or more. The cause of TE is due to a disturbance of the normal hair cycle. Common triggers of telogen effluvium include childbirth, severe trauma or illness, a stressful or major life event (such as losing a loved one), marked weight loss and extreme dieting, a severe skin problem affecting the scalp, a new medication or withdrawal of a hormone treatment Many cases of hair loss are temporary; while some hair loss is permanent. Some are natural part of ageing and do not need treatment; some are part of the process of medical conditions which will resolve as the medical conditions are treated; whereas for some conditions, treatment are available. Hair loss can have an emotional impact, so you may want to look at treatment if you're uncomfortable with your appearance. The goals of treatment are to promote hair growth, slow hair loss or hide hair loss. Drug treatments for some types of hair loss are available. For telogen effluvium it usually resolves completely without any intervention, as the normal length of telogen is approximately 100 days (3 to 6 months) after which period the hair starts growing again (anagen phase). For alopecia areata hair may regrow without treatment within a year. There is drug for treating alopecia areata e.g. corticosteroid, it is used for reducing inflammation and suppress immune system. For androgenic alopecia, drugs treatments are available. In addition to drug treatment there are other available treatments such as surgery, laser therapy, and wigs. Your doctor may suggest a combination of these approaches in order to get the best results. *Drugs for Androgenetic Alopecia: Two medicines, namely finasteride and minoxidil, are used in the treatment of male-pattern baldness. Minoxidil is currently the only medicine available to treat female-pattern baldness. Finasteride is available as oral tablets which are only used for men. It works by preventing the hormone testosterone being converted to the hormone dihydrotestosterone (DHT). DHT causes the hair follicles to shrink, so blocking its production allows the hair follicles to regain their normal size. It usually takes three to six months of continuously using finasteride before any effect is seen. The balding process usually resumes within six to twelve months if treatment is stopped. Minoxidil is available as topical preparations (e.g. topical solution/lotion, and foam) which may be used for men and women. It is applied directly to the scalp. It's not clear how minoxidil works. It usually needs to be used for several months before any effect is seen. The balding process will usually resume if treatment with minoxidil is stopped. The re-grown hair may fall out three to four months after treatment is stopped. Finasteride tablets are prescription only medicines, whereas topical preparations containing not more than 5% of minoxidil are pharmacy only medicines. It is important to seek dermatologist's opinion or medical advice to identify any underlying causes before starting any treatment. *Drugs for Alopecia Areata: Although there is neither a cure for alopecia areata nor drugs approved for its treatment, some people find that medications approved for other purposes can help hair grow back, at least temporarily. Intralesional corticosteroids stimulate hair regrowth at the site of injection and may be of benefit for limited patchy hair loss. Side effect of intralesional corticosteroid injection includes increased risk of infection, headache, joint pain and injection site reaction. Oral pulsed or continuous corticosteroids may be used in severe progressive cases. Both intralesional and oral corticosteroid are prescription only medicines. *Drugs for Alopecia, common side effects and precautions 1. Finasteride (oral) side effects: impotence decreased libido ejaculation disorders breast tenderness and enlargement testicular pain Precautions: Use with caution in hepatic impairment. Patients should be evaluated for prostatic carcinoma before and during therapy. Contra-indicated in women who are or may become pregnant. Women who are or may become pregnant should avoid handling crushed or broken tablets of finasteride. Use of a condom is recommended if sexual partner is pregnant or likely to become pregnant. Cases of male breast cancer have been reported. May increase the risk of high-grade prostate cancer. 2. Minoxidil (topical) side effects: contact dermatitis itching local burning flushing changes in hair colour or texture headache Precautions: Should be restricted to the scalp. Do not apply on other parts of the body. Avoid contact with eyes, mouth and mucous membranes, broken, infected, shaved, or inflamed skin. Avoid inhalation of spray mist when spray applicator is used. Avoid occlusive dressings and topical drugs which enhance absorption. Discontinue if increased hair loss persists for more than 2 weeks. Users should discontinue treatment if there is no improvement after one year. Avoid in pregnancy and lactation. Contraindicated in user with treated or untreated hypertension. General advice: * Eat a nutritionally balanced diet. If you are otherwise well-nourished, taking nutritional supplements has not been shown to be helpful. * Avoid tight hairstyles, such as braids, buns or ponytails. * Avoid compulsively twisting, rubbing or pulling your hair. * Treat your hair gently when washing and brushing. A wide-toothed comb may help prevent pulling out hair. * Avoid harsh treatments such as hot rollers, curling irons, hot oil treatments and permanents.