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Symptoms include rash, itching skin, and hair which remains in spite of shaving. The site of the ingrown hair will form a reddish, raised bump, similar in appearance to a pimple.
Ingrown hair is a condition where hair curls back or grows sideways into the skin. The condition is most prevalent among people who have coarse or curly hair. It may or may not be accompanied by an infection of the hair follicle (folliculitis) or "razor bumps" (pseudofolliculitis barbae), which vary in size. While ingrown hair most commonly appears in areas where the skin is shaved or waxed (beard, legs, pubic region), it can appear anywhere. Anything which causes the hair to be broken off unevenly with a sharp tip can cause ingrown hairs. Ingrown hairs are also caused because of lack of natural exfoliation in the skin.
Among the symptoms(and signs) for this condition are the following:
- lack of apparent hair growth
- hair appears patchy
- hair breaks easily close to scalp
- hair may have thickenings or nodes in the shaft
- ends of hair thinned or split
- whitish discoloration of hair tips
- hair breaks easily at tips
Pseudofolliculitis barbae (PFB), also known as barber's itch, folliculitis barbae traumatica, razor bumps, scarring pseudofolliculitis of the beard, and shave bumps, is a medical term for persistent irritation caused by shaving. Pseudofolliculitis barbae was first described in 1956.
Endothrix refers to dermatophyte infections of the hair that invade the hair shaft and internalize into the hair cell. This is in contrast to exothrix (ectothrix), where a dermatophyte infection remains confined to the hair surface. Using an ultraviolet Wood's lamp, endothrix infections will not fluoresce whereas some exothrix infections may fluoresce bright green or yellow-green.
Examination of the hair shafts with a microscope may reveal changes of trichorrhexis nodosa.
Symptoms of hair loss include hair loss in patches usually in circular patterns, dandruff, skin lesions, and scarring. Alopecia areata (mild – medium level) usually shows in unusual hair loss areas e.g. eyebrows, backside of the head or above the ears where usually the male pattern baldness does not affect. In male-pattern hair loss, loss and thinning begin at the temples and the crown and either thins out or falls out. Female-pattern hair loss occurs at the frontal and parietal.
People have between 100,000 and 150,000 hairs on their head. The number of strands normally lost in a day varies, but on average is 100. In order to maintain a normal volume, hair must be replaced at the same rate at which it is lost. The first signs of hair thinning that people will often notice are more hairs than usual left in the hairbrush after brushing or in the basin after shampooing. Styling can also reveal areas of thinning, such as a wider parting or a thinning crown.
Baldness is the partial or complete lack of hair growth, and part of the wider topic of "hair thinning". The degree and pattern of baldness varies, but its most common cause is androgenic hair loss, "alopecia androgenetica", or "alopecia seborrheica", with the last term primarily used in Europe.
Keratosis pilaris results in small bumps on the skin that feel like rough sandpaper. They are skin-colored bumps the size of a grain of sand, many of which are surrounded by a slight pink color in light skinned people and dark spots in dark skinned people. Most people with keratosis pilaris do not have symptoms but the bumps in the skin can occasionally be itchy.
Though people with keratosis pilaris experience the condition year-round, the problem can become exacerbated and the bumps are likely to look and feel more pronounced in color and texture during the colder months when moisture levels in the air are lower. The symptoms may also worsen during pregnancy or after childbirth.
Exothrix refers to Dermatophyte infections of the hair that infect the hair surface. This is in contrast to Endothrix, where a Dermatophyte mainly invades the hair shaft. Using an ultraviolet Wood's lamp, endothrix infections will not fluoresce whereas exothrix infections will.
Pseudofolliculitis barbae (PFB) is most common on the face, but it can also happen on other parts of the body where hair is shaved or plucked, especially areas where hair is curly and the skin is sensitive, such as genital shaving (more properly termed "pseudofolliculitis pubis" or PFP).
After a hair has been shaved, it begins to grow back. Curly hair tends to curl into the skin instead of straight out the follicle, leading to an inflammation reaction. PFB can make the skin look itchy and red, and in some cases, it can even look like pimples. These inflamed papules or pustules can form especially if the area becomes infected.
This is especially problematic for some men who have naturally coarse or tightly curling thick hair. Curly hair increases the likelihood of PFB by a factor of 50. If left untreated over time, this can cause keloid scarring in the beard area.
Pseudofolliculitis barbae can further be divided into two types of ingrown hairs: transfollicular and extrafollicular. The "extrafollicular" hair is a hair that has exited the follicle and reentered the skin. The "transfollicular" hair never exits the follicle, but because of its naturally curly nature curls back into the follicle causing fluid build-up and irritation.
It is important to continue to watch for symptoms and signs of active disease during and after treatment to ensure that the disease is responding adequately and has not re-activated after therapy has been discontinued. Response to therapy may be indicated by the resolution of scalp symptoms such as itching, pain, tenderness, or burning, by improvement in the signs of scalp inflammation such as decreased redness, scaling or pustules, and by halting or slowing the progression of hair loss. A dermatologist can follow your cicatricial alopecia using these guidelines, and with the pull test. Photographs of the scalp may be useful in monitoring the course of the disease and response to treatment.
Keratosis pilaris (KP) (also follicular keratosis, lichen pilaris, or colloquially "chicken skin") is a common, autosomal dominant, genetic condition of the skin's hair follicles characterized by the appearance of rough, slightly red bumps on light skin and brown bumps on darker skin. It most often appears on the back, outer sides of the upper arm (though the forearm can also be affected), face, thighs, and buttocks; KP can also occur on the hands, and tops of legs, sides, or any body part except glabrous skin (like the palms or soles of feet). Often the lesions will appear on the face, which may be mistaken for acne.
Scarring hair loss, also known as cicatricial alopecia, is the loss of hair which is accompanied with scarring. This is in contrast to non scarring hair loss.
It can be caused by a diverse group of rare disorders that destroy the hair follicle, replace it with scar tissue, and cause permanent hair loss. A variety of distributions are possible. In some cases, hair loss is gradual, without symptoms, and is unnoticed for long periods. In other cases, hair loss is associated with severe itching, burning and pain and is rapidly progressive. The inflammation that destroys the follicle is below the skin surface and there is usually no "scar" seen on the scalp. Affected areas of the scalp may show little signs of inflammation, or have redness, scaling, increased or decreased pigmentation, pustules, or draining sinuses. Scarring hair loss occurs in otherwise healthy men and women of all ages and is seen worldwide.
Typical first symptoms of alopecia areata are small bald patches. The underlying skin is unscarred and looks superficially normal. Although these patches can take many shapes, they are usually round or oval. Alopecia areata most often affects the scalp and beard, but may occur on any part of the body with hair. Different areas of the skin may exhibit hair loss and regrowth at the same time. The disease may also go into remission for a time, or may be permanent. It is common in children.
The area of hair loss may tingle or be painful. The hair tends to fall out over a short period of time, with the loss commonly occurring more on one side of the scalp than the other.
Exclamation point hairs, narrower along the length of the strand closer to the base, producing a characteristic "exclamation point" appearance, are often present.
When healthy hair is pulled out, at most a few should come out, and ripped hair should not be distributed evenly across the tugged portion of the scalp. In cases of alopecia areata, hair will tend to pull out more easily along the edge of the patch where the follicles are already being attacked by the body's immune system than away from the patch where they are still healthy.
Nails may have pitting or trachyonychia.
Hair diseases are disorders primarily associated with the follicles of the hair.
A few examples are
- Alopecia
- Bubble hair deformity
- Hair casts
- Hair loss
- hypertrichosis
- Ingrown hair
- Monilethrix
- Premature greying of hair
- Pattern hair loss
- Trichorrhexis invaginata
Many hair diseases can be associated with distinct underlying disorders.
Piedra are fungal diseases.
Hair disease may refer to excessive shedding or baldness (or both). Balding can be localised or diffuse, scarring or non-scarring. Increased hair can be due to hormonal factors (hirsutism) or non-hormonal (hypertrichosis). Scalp disorders may or may not be associated with hair loss.
Most carbuncles, boils, and other cases of folliculitis develop from "Staphylococcus aureus".
Folliculitis starts with the introduction of a skin pathogen to a hair follicle. Hair follicles can also be damaged by friction from clothing, an insect bite, blockage of the follicle, shaving, or braids too tight and too close to the scalp. The damaged follicles are then infected by "Staphylococcus". Folliculitis can affect people of all ages.
Iron deficiency anemia is sometimes associated with chronic cases.
It may appear as thickened, scaly, and sometimes boggy swellings, or as expanding raised red rings (ringworm). Common symptoms are severe itching of the scalp, dandruff, and bald patches where the fungus has rooted itself in the skin. It often presents identically to dandruff or seborrheic dermatitis. The highest incidence in the United States of America is in American boys of school age.
There are three type of tinea capitis, microsporosis, trichophytosis, and favus; these are based on the causative microorganism, and the nature of the symptoms. In "microsporosis", the lesion is a small red papule around a hair shaft that later becomes scaly; eventually the hairs break off 1–3 mm above the scalp. This disease used to be caused primarily by "Microsporum audouinii", but in Europe, "M. canis" is more frequently the causative fungus. The source of this fungus is typically sick cats and kittens; it may be spread through person to person contact, or by sharing contaminated brushes and combs. In the United States, "Trichophytosis" is usually caused by "Trichophyton tonsurans", while "T. violaceum" is more common in Eastern Europe, Africa, and India. This fungus causes dry, non-inflammatory patches that tend to be angular in shape. When the hairs break off at the opening of the follicle, black dots remain. "Favus" is caused by "T. schoenleinii", and is endemic in South Africa and the Middle East. It is characterized by a number of yellowish, circular, cup-shaped crusts (scutula) grouped in patches like a piece of honeycomb, each about the size of a split pea, with a hair projecting in the center. These increase in size and become crusted over, so that the characteristic lesion can only be seen around the edge of the scab.
Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on the skin except the palms of the hands and soles of the feet. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, and head.
Telogen effluvium is a scalp disorder characterized by the thinning or shedding of hair resulting from the early entry of hair in the telogen phase (the resting phase of the hair follicle). Emotional or physiological stress may result in an alteration of the normal hair cycle and cause the disorder, with potential causes including eating disorders, fever, childbirth, chronic illness, major surgery, anemia, severe emotional disorders, crash diets, hypothyroidism, and drugs.
Diagnostic tests, which may be performed to verify the diagnosis, include a trichogram, trichoscopy and biopsy. Effluvium can present with similar appearance to alopecia totalis, with further distinction by clinical course, microscopic examination of plucked follicles, or biopsy of the scalp. Histology would show telogen hair follicles in the dermis with minimal inflammation in effluvium, and dense peribulbar lymphocytic infiltrate in alopecia totalis.
Vitamin D levels may also play a role in normal hair cycle.
Tinea capitis (also known as "herpes tonsurans", "ringworm of the hair", "ringworm of the scalp", "scalp ringworm", and "tinea tonsurans") is a cutaneous fungal infection (dermatophytosis) of the scalp. The disease is primarily caused by dermatophytes in the "Trichophyton" and "Microsporum" genera that invade the hair shaft. The clinical presentation is typically single or multiple patches of hair loss, sometimes with a 'black dot' pattern (often with broken-off hairs), that may be accompanied by inflammation, scaling, pustules, and itching. Uncommon in adults, tinea capitis is predominantly seen in pre-pubertal children, more often boys than girls.
At least eight species of dermatophytes are associated with tinea capitis. Cases of "Trichophyton" infection predominate from Central America to the United States and in parts of Western Europe. Infections from "Microsporum" species are mainly in South America, Southern and Central Europe, Africa and the Middle East. The disease is infectious and can be transmitted by humans, animals, or objects that harbor the fungus. The fungus can also exist in a carrier state on the scalp, without clinical symptomatology. Treatment of tinea capitis requires an oral antifungal agent; griseofulvin is the most commonly used drug, but other newer antimycotic drugs, such as terbinafine, itraconazole, and fluconazole have started to gain acceptance.
Infections on the body may give rise to typical enlarging raised red rings of ringworm. Infection on the skin of the feet may cause athlete's foot and in the groin, jock itch. Involvement of the nails is termed onychomycosis, and they may thicken, discolour, and finally crumble and fall off. They are common in most adult people, with up to 20% of the population having one of these infections at any given moment.
Animals such as dogs and cats can also be affected by ringworm, and the disease can be transmitted between animals and humans, making it a zoonotic disease.
Specific signs can be:
- red, scaly, itchy or raised patches
- patches may be redder on outside edges or resemble a ring
- patches that begin to ooze or develop blister
- bald patches may develop, when the scalp is affected
- nails may thicken, discolour or begin to crack
It is commonly seen with certain hair styles or braiding patterns that pull the hairline forcefully towards the vertex of the scalp, and has been reported more often in African American women (as some wear their hair tightly pulled back), in whom it can cause scarring. It has also been seen in female ballerinas, and in cultural traditions where the hair is voluntarily not cut in religious obeisance, the latter caused by progressively increasing weight of the hair itself. Traction alopecia is mechanical in cause, rather than androgenic, and treatment is typically not pharmaceutical. Management includes cessation of the chronic traction, cosmeses, with surgical restoration reserved for more severe cases.
Traction alopecia is a substantial risk in hair weaves, which can be worn either to conceal hair loss, or purely for cosmetic purposes. The former involves creating a braid around the head below the existing hairline, to which an extended-wear hairpiece, or wig, is attached. Since the hair of the braid is still growing, it requires frequent maintenance, which involves the hairpiece being removed, the natural hair braided again, and the piece snugly reattached. The tight braiding and snug hairpiece cause tension on the hair that is already at risk for falling out. Traction Alopecia is one of the most common causes of hair loss in African American women.
Sikh men are also susceptible to traction alopecia if the hair under the turban is tied too tightly for many years.
Other causes include:
- Hairstyle. Although the aforementioned style is one of the culprits, hairstyles such as dreadlocks and single (extension) braids can also have the same effect. Men and women who have suffered from traction alopecia have found that the hair loss occurs most at the hair line—primarily around the temples and the sides of their heads.
- Headgear. Compressive safety helmets worn tightly and closely to the scalp are a cause of traction alopecia. The lining of tightly fitted safety helmets like those worn for activities such as motorcycling, cycling, skiing and snowboarding are responsible for the constant rubbing and tugging of localised areas of the hair and scalp. Frequent wearers or those who use such helmets for prolonged periods seem more likely to suffer traction alopecia.
- Chemicals. A condition known as CCCA (central cicatricial centrifugal alopecia), seen almost exclusively in African American women, can cause extensive hair loss. It is caused by a combination of too much stress (traction) on the hair and the use of harsh relaxers and dyes.
In most cases which begin with a small number of patches of hair loss, hair grows back after a few months to a year. In cases with a greater number of patches, hair can either grow back or progress to alopecia areata totalis or, in rare cases, alopecia areata universalis.
There is no loss of body function, and effects of alopecial areata are mainly psychological (loss of self-image due to hair loss), although these can be severe. Loss of hair also means the scalp burns more easily in the sun. Patients may also have aberrant nail formation because keratin forms both hair and nails.
Hair may grow back and then fall out again later. This may not indicate a recurrence of the condition, but rather a natural cycle of growth-and-shedding from a relatively synchronised start; such a pattern will fade over time. Episodes of alopecia areata before puberty predispose to chronic recurrence of the condition.
Alopecia can be the cause of psychological stress. Because hair loss can lead to significant changes in appearance, individuals with it may experience social phobia, anxiety, and depression.
Causes of noncicatricial alopecia include:
- Alopecia areata
- Anagen effluvium
- Androgenetic alopecia
- Dermatopathia pigmentosa reticularis
- Telogen effluvium
- Trichotillomania (Trichotillosis)