Prostatitis and Alopecia

prostatitis

infection causing inflammation of the prostate and surrounding tissue

30

50% of men by age > _____ will end up getting prostatitis

1) gram-neg uropathogens

2) decreased zinc conc

3) alkaline pH shift

What is the patho of prostatitis?

E. coli

What is the most common pathogen causing prostatitis?

-E coli

-klebsiella pneumoniae

-proteus mirabilis

-pseudomonas aeruginosa

what are the gram neg uropathogens that can cause prostatitis?

zinc

has good bactericidal activity

> 8

In prostatitis with alkaline pH shift the pH shifts from 6.5-7 to ______

acute bacterial prostatitis (ABP)

-rapid onset (days to weeks)

-systemic illness

-requiring urgent abx

-s/s: fever and chills, pelvic pain, urinary s/s, N/V, cloudiness/blood in urine

-PE: tender, boggy, hot prostate

chronic bacterial prostatitis (CBP)/CP/CPPS

"chronic pelvic pain syndrome"

-slow onset, recurring, lasting symptoms

-symptoms persists for months (min 3-6 months); often less severe, harder to treat; can wax and wane

-s/s: pelvic pain, urinary s/s, sexual dysfunction, fatigue, NO fever/systemic s/s

-PE: prostate may be tender, boggy, or irregular; non-systemic

quantitative localization culture (Meares and Starney Method)

What is the gold standard for dx of prostatitis?

-Bactrim

-Cipro

-Levofloxacin

-Cephalosporins

-Augmentin

What are the drugs that are used to treat acute prostatitis?

10-14 days

How long is the total course of abx therapy for acute prostatitis?

rarely

Chronic prostatitis _________ achieves a cure.

achieving therapeutic concentrations in prostatic fluid

What is antimicrobial therapy directed at in chronic prostatitis?

-Trimethoprim

-Fluoroquinolones

What are the abx used for chronic prostatitis?

4-6 weeks

How long is the tx for chronic prostatitis?

3x weekly of:

-Cipro

OR

-Bactrim

OR

-Nitrogurantoin 100 mg QD

Some pts with chronic prostatitis may need suppressive therapy. What is the suppressive therapy?

lipid soluble

For chronic prostatitis you need __________ abx to treat it.

go back to the doc

If acute prostatitis doesn't go away after 14 of abx tx, then what should the pt do?

alopecia

-the partial or complete absence of hair from areas of the body

-hairs are keratinized elongated structures derived from invaginations of the epidermis and project out from most of the body surface

dead (keratinized)

The hair shaft on the outside is ____________ but on the inside it is living (bulb).

dermal papilla

-helps your hair grow and have pigmentation

-connective tissue where melanocytes are made

10-20 cycles

How many hair growth cycles do you go through in your life?

anagen

-growth phase in the hair cycle in which a new hair shaft is created

-active growth phase is 2-7 yrs

-melanocytes produce pigment (active melanogenesis)

catagen

-regression phase

-lasts 2-3 weeks

-dermal papilla detaches; lower follicle regresses

telogen

-resting phase

-3-4 months

-hair shaft is dead and eventually shed (shedding/exogen)

-follicle resets

firmly rooted

Anagen hair is _________

easily shed

Telogen hair is ________

dihydrotestosterone (DHT)

free testosterone is metablized by 5-alpha reductase to ____________

DHT

shortens the anagen phase

1) genetic association

2) maximal hair length associated with anogen phase

3) micro-inflammation and scarring

What is the patho of androgenetic alopecia (AGA)?

genetic assoc of androgenetic alopecia

mutation on the androgen receptor gene that results in an increase of DHT shortening anagen phase

max hair length associated with anagen phase

-AGA-miniturized follicle shortening maximal length (months)

-progressive shortening of anagen duration (miniaturization)

micro-inflammation and scarring in AGA

-often subclinical

-micro inflammation leading to increased lymphocyt lymphocytic infiltrate

-dermal papilla damage leading to loss of stem cells

-scarred/fibrotic dermal papilla

-subclinical micro-inflam contributes to miniaturization and eventual scarring in severe cases

male pattern of hair loss in alopecia

What is this?

pattern of hair loss for females in alopecia

What is this?

-infections

-chemo

-iron deficiency

-trauma

-autoimmune

What are identifiable causes of alopecia that should be treated?

-topical minoxidil

-oral finasteride

What are the FDA approved treatments for male pattern baldness?

vasodilator; prolongs anagen phase

MOA of topical minoxidil:

5% foam/solution

Dosage of minoxidil in male pattern baldness:

scalp irriation

AE of topical minoxidil:

5AR inhibitor; lowers scalp DHT

Finasteride MOA:

1 mg daily

Dosage of oral finasteride in male pattern baldness:

sexual dysfunction (rare)

AE of finasteride:

Rogaine

topical minoxidil

Propecia

finasteride

NOT

Dutasteride is _________ FDA approved for male pattern baldness but has been shown to be effective.

BID for 6 months

How long do you have to use topical minoxidil before saying it doesnt work in male pattern baldness?

-surgical tx: hair transplantation

-low level laster therapy (LLLT)

-platelet-rich plasma (PRP)

-topical DHT blockers (ketoconzaole shampoo)

What are the non-pharm tx options for male pattern baldness?

topical mindoxidil and systemic anti-androgens (spironolactone)

What are the topical/oral meds used for female pattern baldness?

-adjunctive and emerging therapies (low-level laser therapy, platelet rich plasma (PRP), topical ketoconazole)

-nutritional and complementary care (iron, vit D, zinc)

-hair transplantation

Non-pharm tx for female pattern baldness:

Aldactone

Spironolactone

blocks androgen receptors

MOA of Spironolactone:

hyperkalemia, menstrual irregularities (if pre-menopausal)

AEs of spironolactone:

2-5% foam/solution

Dosage of topical minoxidil for female pattern baldness:

alopecia areata

-Autoimmune disorder that causes the affected hair follicles to be mistakenly attacked by a person's own immune system; usually begins with one or more small, round, smooth bald patches on the scalp.

-typical age 20-40 yo

-intralesional corticosteroids

-systemic corticosteroids

-Jak inhibitors (Baricitinib, Ritlecitinib)

-topical steroids

-contact immunotherapy (DPCP)

-MTX

-Cyclosporine

What are the txs for alopecia areata?

Olumiant

Baricitinib

JAK1/JAK2

targets for Baricitinib:

adults and adolescents aged 12 yo + with severe AA

FDA-approved pt pop with Baricitinib:

Baricitinib (Olumiant)

The first oral medicine ever approved specifically for alopecia areata (2022). Pediatric approval was expanded in late 2026.

Litfulo

ritlecitinib

JAK3 / TEC kinase family

Specific targets for Ritlecitinib:

Adults and adolescents aged 12 years and older with severe AA.

FDA-approved pt pop for Ritlecitinib:

Ritlecitinib (Litfulo)

An irreversible, highly selective second-generation kinase blocker

designed to minimize secondary side effects associated with broader pan-JAK inhibition.

JAK1 / JAK2

Specific targets for deuruxolitinib:

Leqselvi

deuruxolitinib

Adults with severe AA

FDA approved pt pop for Deuruxolitinib:

Deuruxolitinib (Leqselvi)

Approved as a targeted systemic option for adult patients experiencing extensive hair loss.

MACE, malignancy, blood clots, death

BBW for JAK inhibitors: