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Management of Alopecia

Management of Alopecia. Kyle Kennedy, M.D. Karen Calhoun, M.D. September 9, 1998. Introduction. alopecia affects both men and women variety of causes substantial emotional impact medical and surgical therapy available realistic treatment plan. Etiology of Alopecia. trauma burns

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Management of Alopecia

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  1. Management of Alopecia Kyle Kennedy, M.D. Karen Calhoun, M.D. September 9, 1998

  2. Introduction • alopecia affects both men and women • variety of causes • substantial emotional impact • medical and surgical therapy available • realistic treatment plan

  3. Etiology of Alopecia • trauma • burns • neoplasms • autoimmune disorders • chemotherapy • dermatologic conditions • androgenetic alopecia

  4. Androgenetic Alopecia • most common cause of alopecia • three distinct forms recognized-MPAA, FPAA, diffuse AA • caucasians most commonly affected • mode of inheritance unclear • terminal hairs to vellus hairs • presence of androgens (esp. DHT) essential • mechanism of action on follicles unclear

  5. Patient Selection • general history and physical examination • patient’s motivations and expectations • discussion of Tx options and limitations • pattern of alopecia incl. frontal hairline and donor hair • conservative approach • older patients typically better candidates

  6. Treatment Options • medical • non-surgical hair restoration • surgical hair restoration

  7. Medical Management • antiandrogens • biologic response modifiers

  8. Antiandrogens • spironolactone • cyproterone acetate • cimetidine • estrogen and progesterone • finasteride (Propecia)

  9. Biologic Response Modifiers • minoxidil (Rogaine)

  10. Surgical Management • punch-graft hair transplantation • minigrafts and micrografts • scalp reduction • extensive scalp reduction • tissue expansion • transposition flaps

  11. Punch-Graft Hair Transplantation • autografts • standard plugs 4 mm diam. • multiple sessions • adequacy of donor sites-finite number of donor hairs • technique

  12. Minigrafts and Micrografts • minigraft-3 to 8 hairs each, created from quadrisection of 4.5 mm diam. grafts • micrografts-1 to 2 hairs each, created from periphery of standard punch grafts

  13. Scalp Reduction • various patterns-midline sagittal ellipse, Y, and lateral • reduce area of alopecic scalp with elevation of temporal fringes toward midline • reduce recipient:donor ratio • ideal-older pt with stable mild to moderate area of alopecia of crown/vertex

  14. Extensive Scalp Reduction • differ from standard scalp reduction in degree of undermining required • usu. combination of bilateral occipitoparietal and bitemporal flaps • remaining frontal alopecic areas are hair transplanted • technique • increased incidence of complications

  15. Tissue Expansion • scalp reduction or advancement limited by poor scalp flexibility • scalp stretched with redistribution of donor hair over wider surface area • variety of expanders available • repeated injection and discomfort, temporary scalp deformity

  16. Transposition Flaps • relatively rapid restoration of frontal hairline • Juri flap-pedicled on superficial temporal artery • multiple stages • technique

  17. Complications • cobblestoning • divot/delling • compression • cyst formation • telogen effluvium • folliculitis • arteriovenous fistula • pyogenic granuloma

  18. Complications (cont.) • stretch back • slot defect • scalp necrosis • inappropriate shape of hairline • inappropriate hair direction • hair loss

  19. Summary • conservative approach • realistic treatment plan • long-term commitment • expect the worst • the more you need, the less you have

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