Ch. 1, Part 2: Skin & Hair Disorders, Diseases, Medications (pg. 24-119)

A relatively uncommon cancer of the skin, occurs as a dark brown, small mole like growth. This becomes larger and may bleed or become an ulcerated sore

Malignant Melanoma

True or False: Warts are growths caused by a virus that affects the skin. They are not contagious.

False, they ARE contagious, as well as caused by a virus.

Herpes infections are usually recognizable by

Their typical group of water blisters or pus pimples in a single area.

What can bring on a herpes attack?

1. Emotional stress

2. Fatigue

3. High fevers/colds

4. Menstrual cycle

5. Gastrointestinal upset

6. Even sunburn and windburn

True or False: Herpes is extremely contagious, especially Type 2 (blisters in groin area)

True

What is the other name for Accutane?

Isotretinoin - part of the retinoid family

During the use of Accutane and for up to how many months after is there an increased concern for scarring when performing chemical peels and dermabrasion?

6 months

How does Accutane affect electrolysis?

1. The client skin will usually be more red and the skin appears thinner/more transparent.

2. There is no definite contraindication for the use of any electrolysis modality, but expect even more redness and sensitivity as compared to Retin A.

3. Postponing electrolysis on the face until one month after the client stops Accutane is advised.

How does low concentration, alpha hydroxy acids (AHAs) affect electrolysis?

Slight increased redness, may be noted during and after treatment

How does dermabrasion affect electrolysis?

It is recommended that a period of three months elapse before electrolysis is performed on previously dermabraded skin. If the skin is still red, electrolysis should be postponed until all redness has disappeared.

What are the 3 frequently used tretracyclines?

1. Tetracycline hydrochloride

2. Doxycycline

3. Minocycline - acne treatment

What diseases are frequently treated with tetracycline?

1. Acne

2. Lyme disease

3. Rosacea (acne rosacea)

Brownish/Gray pigmentation of the skin can occasionally occur in areas of injury when taking which antibiotic?

Minocycline

How can skin grafts affect electrolysis treatment?

Distorted follicles in scars are likely to be present.

When receiving laser resurfacing on facial units, such as the upper lip or chin, how long should you wait before attempting electrolysis?

At least two months or until the skin is no longer red or tender; if in doubt check with physician

What are the main characteristics of Type 1 Diabetes?

Juvenile diabetes; insulin dependent, this form usually develops prior to early childhood

What are the main characteristics of Type 2 diabetes?

Non-insulin-dependent. This form usually develops later on in life, and the patient may or may not be on insulin.

Peripheral vascular disease is quite common in diabetic patients and is usually manifested by poor circulation, especially where?

The lower legs

Guidelines for performing electrolysis on diabetic clients:

1. The main area you need to be concerned with is the lower legs from the knee down. If there are open sores on the legs or feet do not work on the area.

2. Also do not work on any skin that does not appear healthy.

Guidelines for performing electrolysis on pregnant clients:

Do not perform electrolysis on the abdomen or breast during the last trimester (last 3m) of the pregnancy using any modality.

Guidelines for performing electrolysis on patients with pacemakers or defibrillator:

Always have the client check with physician, or you check, with the clients cardiologist regarding the safety of electrolysis and the specific device.

It seems that that optimal results in permanent hair removal would be achieved by destruction of:

Cells beginning at the bulge region and following on down along the hair shaft to the bulb.

True or False: The bulb is the thickest or widest part of the follicle and consist of the lower third of the follicle, which is short when the bulb is formed.

True

Duration of Anagen Phase for fingers, thigh, and scalp (pg. 37)

The duration of the anagen phase varies based on the location of the body:

1. A few weeks on the fingers

2. 4-6 months on the thigh

3. 3-8 years on the scalp

What does cessation mean in relation to the Catagen Phase?

The catagen phase begins with the cessation or stopping of melanin production of the melanocytes in the upper part of the bulb.

True or False: Hair grows faster during the summer, with good health, and in the elderly.

False: Hair grows faster during the summer, with good health, and in the young.

True or False: The number of hair follicles in each individual increases after birth.

False: The total number of hair follicles in each individual does not increase after birth, but the number does gradually reduce with increasing age.

On the scalp what percentage of resting hairs are in telogen phase?

13%

On the scalp what percentage of growing hairs are in anagen phase?

85%

Is the number of hair follicles/skin area greater in Caucasians or Orientals? (pg.43)

Caucasians

Is the number of hair follicles/skin area greater in Mediterranean or Nordic individuals? (pg.43)

Mediterranean

Which two types of hormones control hair growth?

1. Thyroid hormone

2. Growth hormone

The most important hormone controlling growth are “androgens” commonly known as “male” hormones. Specifically, testosterone.

True or false: Once vellus hair has been transformed into terminal hair it cannot change back even if androgens disappear.

True

What is hypertrichosis characterized by?

This condition is characterized by excessive growth of vellus type hair, which may be darker than usual. This is very common of women of Mediterranean descent, and usually runs in families.

Hirsutism is almost always the result of what?

Hirsutism is almost always the result of excess effect of androgens on the hair follicles.

What is the different between “Iatric” and “Idiopathic”?

Iatric = medication; Idiopathic = familial (or no known cause)

What is Danazol used for and can it stimulate hair growth?

Endometriosis treatment; yes

What happens when androgen producing ovarian tumors are present?

Hirsutism progresses rapidly and left untreated leads to masculinization (loss of scalp, voice changes, male body habitus).

What can happen when someone is a hermaphrodite (mixed gonadal dysgenesis)?

It can cause hirsutism. This is a rare condition of genetic origin in which either remnants of testicular tissue are found in an ovary. Most affected individuals present marked hirsutism upon initiation of puberty.

What are the two other names for PCOS (Polycystic Ovarian Syndrome)?

1. Chronic Anovulation

2. Stein-Leventhal Syndrome

This condition is the consequence of excess production of corticosteroids in the adrenal gland.

Cushing’s Syndrome

True or False: Some of the corticosteroids in the adrenal are androgens, and therefore stimulate hair growth (Hirsutism).

True

True or False: Tweezing causes a decreased blood supply to the tweezed hairs and adjacent hairs, causing a decrease in the follicle structure.

False: Tweezing causes an increased blood supply to the tweezed hairs and adjacent hairs, causing an increase in the follicle structure.

How can birth control pills stop excessive hair growth?

By decreasing the Pituitary hormones: LH and FSH.

Do corticosteroids such as prednisone and dexamethasone stimulate excess hair growth?

Yes

What are corticosteroids used to treat?

Corticosteroids are used when the adrenal is thought to be overactive or to treat autoimmune diseases, such as lupus.

What is Decadron?

Also known as Dexamethasone, a synthetic man-made corticosteroid medication

What is the most common of all disorders associated with excess hair growth (inappropriate hairiness)?

Idiopathic hirsutism; aka genetic or familial hirsutism

True or False: The skin of both males and females contains similar numbers of hair follicles or pilot sebaceous units.

True

During the growing phase, the follicle consists of what three major structures:

1. follicular sheath (upper and lower)

2. follicular bulb

3. hair shaft

What does anovulatory mean?

Can’t ovulate

What is virilism?

The appearance of male secondary sex characteristics (such as facial hair) in the female.

What are signs of virilism?

1. Amenorrhea (absence of menstrual cycle)

2. Marked hirsutism

3. Enlargement of the clitoris

4. Lowering of the voice

5. Increased muscle mass.

Excess hair growth in females (hirsutism) can be caused by:

Increased sensitivity to her own androgens.

What causes PCOS?

The cause of PCOS is unknown. A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.

What symptoms can high levels of androgens from PCOS cause?

High androgen levels can lead to:

1. Acne

2. Excessive hair growth

3. Weight gain

4. Problems with ovulation.

Name some symptoms of PCOS (There are 9 included):

1. Infertility

2. In frequent, absent, and or irregular menstrual period

3. Hirsutism - Increased hair growth on the face, chest, stomach, back, thumbs, or toes

4. Cysts on the ovaries

5. Acne, oily skin, or dandruff

6. Weight gain or obesity

7. Male pattern, baldness, or thinning hair

8. Acanthosis Nigracans (exclusively related to diabetes): Patches of skin on the neck, arms, breasts, or thighs that are thick and dark, brown or black.

9. Skin tags, excess flaps of skin in the armpits or neck area (Arochordan)

What is acanthosis nigracans?

Exclusively related to diabetes: Patches of skin on the neck, arms, breasts, or thighs that are thick and dark, brown or black.

What is Spironolactone (Aldactone) used to treat?

First used to treat high blood pressure, has been shown work as an androgen suppressant reducing the impact of male hormones on hair growth in women.

What is Finasteride used to treat?

Taken by women for hair loss, has an anti-androgen effect and is often combined with birth control pills.

An evaluation for PCOS is recommended if some of the following symptoms are present:

• Very only skin

• Persistent acne

• Facial or body hair that requires more than occasional removal

• Loss of scalp hair. This is common with PCOS

• Darkening of the skin on the back of the neck or under arms - acanthosis nigracans

• Irregular periods, periods usually more than five weeks apart, or prolonged heavy bleeding

• Difficulty controlling weight, especially if the extra weight is on the upper part of the body or the abdomen

Hair loss without any other health changes is known as?

Alopecia (female alopecia = alopecia areata) or androgenic alopecia.

In PCOS treatment, when the testosterone comes from the adrenal, a cortisone-like medication called what can be used?

Dexamethasone can be used in low doses to partially suppress the adrenal so that it makes less testosterone. This medication is used only in special circumstances and in very low doses.

How long after starting treatment for hirsutism can one expect to observe a difference?

The improvement of hirsutism occurs slowly, often requiring 6 to 8 months of therapy prior to observing a difference.

Approximately what percentage of PCOS patients demonstrate insulin resistance?

50% or 1/2

What is one of the greatest risks with untreated PCOS or chronic anovulation (lack of period)?

Endometrial Carcinoma

What are patients with PCOS at higher risk for developing?

1. Type two diabetes

2. Colitis

3. Hypertension

4. Lipid abnormalities

5. CAD or coronary artery disease

6. Endometrial carcinoma.

What are preventative care measures that someone with PCOS or androgen excess can take?

1. Stress management

2. Weight loss

3. Smoking cessation

4. Regular exercise

5. Reduction in high fat dietary intake

True or False: Each terminal hair follicle (not vellus hair) has a special attachment, called the arrector pili.

True

The difference between males and females in regard to sexual hair patterns is due mainly to:

The concentration of circulating androgens.

What glands do androgens derive from?

Adrenals, testes, and ovaries

What are minoxidil and finasteride used for?

Minoxidil, which is used for kidney failure patients, and the treatment of severe high blood pressure, and finasteride for the treatment of alopecia.

Are minoxidil and finasteride known for being hair growth stimulators?

Yes

What are the 3 main classes of sex hormones?

1. Androgens, the male hormones, i.e. testosterone

2. Two groups of female hormones:

   1. Estrogens

   2. Progesterones

These “male hormones” stimulate the hair follicles, and the sebaceous glands, and are responsible for changing fine, vellus hairs into thick terminal hairs:

Androgens

What is the escutcheon?

Scrotum in Latin; triangle public region

What will help when the androgen receptors in the skin of hirsute women are more sensitive to normal amounts of androgens and they have normal hormonal test results?

These women will be helped by taking anti-androgens.