A Simple Guide to Entropion

A Simple Guide to Entropion
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What is Entropion?
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Entropion is an inversion(rolling inwards) of the eyelid

Who is affected by Entropion?
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Entropion is more common in women than in men.


What is the Cause of Entropion?
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The causes of Entropion can divided into 2 type:

Spasm of Orbicularis muscle:

1. Degeneration of the peripheral connective tissue of the eye

2. Occurs in old age

3. Occurs also after removal of eyeball

4. Primarily affects the lower eyelid.

Cicatricial:

1. Scarring of the eyelid muscle to connective tissue as a result of injury, trauma, burns

2.retraction of the connective tissue of eyelid from infections such as trachoma, chronic infections

3.Congenital disease

4. May affect either upper or lower eyelid

What are the Symptoms and signs of Entropion?
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Symptoms varies from mild to severe due to rubbing of eyelashes against the cornea or conjunctiva:

1.Irritation of the conjunctiva

2.Conjunctival congestion - increased blood flow through irritated eye shows up the blood vessels

3.Tearing -excess tears from irritation

Signs:

1.Erosions, opacities and vasculisation of the cornea

2.increased dilated blood vessels of conjunctiva present due to irritation

3.The presence of inward turning eyelids and eyelashes


How do you make the Diagnosis of Entropion?
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The presence of inward direction of the eyelashes and eyelid can be seen using a slit lamp microscope.

What are the complications of Entropion?
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1.Recurrent corneal ulcers

2.Recurrent irritation and conjunctivitis of eyes.

3.Severe infection of the eye - rare

What is the treatment of Entropion?
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Treatment depends on the type of Entropion:

Spastic:

1.Eversion of eyelid especially lower eyelid with adhesive plaster or tape for temporary relief together with lubricating eye
drops

2.Surgery - by removal of inturning eyelashes using laser
- eversion of eyelid by surgery as below

Cicatricial:

Surgery to tighten the eyelid muscle is usually required:

1.Quickert procedure: 2 to 3 strategically placed stitches are used under local anesthesia to evert the eyelid.

Recurrence is common.

This is useful for patients who are not suitable for surgery and can be followed the full repair surgery later on when the patient is better.

2.Repair of inverted eyelid is done by incision above and below the eyelids and removal of connective tissue or scarred tissue and tightening of the eyelid muscle.

This is usually done on an outpatient basis and under local anesthesia.

Post-operatively the wounds are protected by antibiotic creams and dressings.

Healing usually occurs within 1 week.

Antibiotics are also given for any infections of the conjunctiva and cornea.



What is the prognosis of Entropion?
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The prognosis is usually good.

Recurrence is rare but do occur especially due to weakening of eye muscles from age.

A Simple guide to Anal Fistula

A Simple guide to Anal Fistula
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What is Anal Fistula?
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Anal Fistula (or fistula-in-ano) is a chronic granulous track which communicate between the anorectal canal and the perianal skin.

There may be several external openings but only one internal opening

What is the cause of Anal Fistula?
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Anal Fistula usually result from :
1.breakdown of anorectal abscesses

2.follows surgery for anal fissure

3.Less common causes are:
lymphogranuloma

carcinoma of rectum

ulcerative colitis,

regional ileitis

tuberculosis

What are the symptoms of Anal Fistula?
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1.pain especially on sitting down

2.purulent painless discharge(pus) near the anus

3.Recurrent perianal abscesses(pockets of pus around the anus)

4.pruritis ani(itch in anus)

How are Anal Fistula diagnosed?
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1.thorough examination of the perianal region

2.Rectal examination and palpation of the fistula track

3.Pass a probe through the perianal opening to determine the length of the track

4.Sigmoidoscopy and colonoscopy to detect internal opening and other lesions in the rectum and large intestine

5.Barium enema to exclude any ulcerative colitis and regional ileitis


What is the treatment of Anal Fistula?
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There are 2 types of anal fistula:
1.High level fistulas penetrate the levator ani-muscle of the anal sphlinter

2.Low level fistulas are below the levator ani and are more common.

Treatment of lowlevel fistula:
1.lay open the track and curette(scrape the lining and debris in the track out)

Treatment of high level fistula:
1.open the track from within the ischiorectal fossa

2.colostomy may be necessary for multiple fistulas or very high internal opening

General treatment:
1.Treatment of associated diseases like diabetes, ulcerative colitis, regional ilitis, carcinoma

2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed

3.toilet and dressing of the wounds, with application of antibiotic creams

4.tub baths of the anal region several times a day in plain, warm water for about 10 minutes

What is the prognosis of Anal Fistula?
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Good with surgery.

Rarely there may undesirable complication like rectal incontinence.

A Simple Guide to Pancreatitis

A Simple Guide to Pancreatitis
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What is Pancreatitis?
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Pancreatitis is an acute or chronic inflammation of the pancreas.

What are the causes of Pancreatitis?
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Pancreatitis is usually caused by the following:

1. Alcoholism and diseases of the biliary tract

2. bacterial infections from salmonella typhi and streptococcus

3. viral infection especially mumps, coxsackie virus, cytomegalovirus

4. trauma

Chronic disease follows attacks of acute infection.

What are the symptoms and signs of Pancreatitis?
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Persons who has Acute Pancreatitis has the following symptoms:

1.acute onset of abdominal pain starting from the epigastrium, radiating to the back in 50% of cases.

2.Pain usually very severe occuring a large meal or drinking bout

3.Pain is worse lying supine, therefore patients sit or lean forward

4.mild fever and bodyaches

5.nausea and vomitting

6.hypotension followed by clinical shock

Signs:

1.Tenderness at the epigastrium with muscle spasm

2.Distension and diminished bowel sounds

3.Pleural effusion 10%,abdominal mass 20%, ascites 20%

4. Acute renal failure, respiratory failure following shock.

Chronic Pancreatitis
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Symptoms:

1.repeated attacks of epigastric abdominal pain

2.Pain worse after eating, radiates to the back

3.weight loss

4.Fever

Signs:

1.abdominal tenderness

2.abdominal mass may suggest swelling and pseudocysts

3.tender subcutaneous masses seen indicating fat necrosis

How do you diagnose Pancreatitis?
--------------------------------

Diagnosis can usually be made by :

1.Physical examination with tenderness in the epigastrium

2.Serum and urine amylase very high after 6 hours

3.White blood cell count high

4.Serum lipase high in 50% patients

5.Blood calcium may be low

6.Blood glucose tolerance test for diabetes

7.Ultrasound may show up the presence of pseudocyst in pancreas

8.CAT scan and MRI may show swelling and pseudocysts in pancreas

What is the complications of Pancreatitis?
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1.Pseudocysts from damage to pancreatic tissues

2.Hemorrhage - bleeding due to damage to the blood vessels in pancreas

3.peritonitis from rupture of pseudocysts and bleeding

4.diabetes mellitus from damage to the glands in the pancreas producing insulin

What is the treatment of Pancreatitis?
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Acute Pancreatitis:
----------------------
Admission to hospital

Gastric suction and fluid replacement

Analgesic or antispasmodic medicine usually by injection

Antibiotics for infections

Treat biliary tract diseases and alcoholism

surgical drainage of pseudocysts after acute episode.

Chronic Pancreatitis:
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Pancreatic extracts and enzymes together with meals

Sodium bicarbonate and cimetidine to prevent enzymes breakdown

Analgesic or antispasmodic medicine usually by injection

Surgical procedures usually unsuccessful

What is the prognosis of Pancreatitis?
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Prognosis is usually good after treatment of acute pancreatitis with recovery in 5-7 days.

Hemorhagic Pancreatitis has high mortality of 50-90%

Most trauma cases has complete resolution

Some alcoholic pancreatitis may go on to chronic pancreatitis.

Chronic pancreatitis relapses frequently

Rupture of pseudocysts may result in death

How do you prevent Pancreatitis?
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Avoid alcohol and oily food

Take precautions during mumps and other viral infection

Avoid injury to the abdomen especially the mid section below the sternum

A Simple Guide to Coughing

A Simple Guide to Coughing
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What is Coughing?
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Coughing is the reflex mechanism in which the body tries to get rid of excessive mucus and phlegm accumulated in the lining membranes of the respiratory tract.

The secretions from the lining of the respiratory tract trap and then flush out the viruses, bacteria and other particles like smoke, haze particles.

It prevents serious infections from entering the lungs and bronchial tubes.

What are the common causes of cough?
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Coughing is usually caused by the following:

Infections:
1.bacterial or viral infection of the nose and throat such as the common cold or influenza.(yellow or green phlegm)

2.anaerobic infections of the mouth,

3.Infection of the tonsils, nose and sinuses(postnasal drip)

4.Bacterial infection of the bronchial tubes and lungs(bronchiectasis, bronchitis, pneumonia, sinusitis, or tracheitis).
This often comes with rusty or green mucus.

Dry mouth:
1.Insufficient drinking of water

2.medications especially ACE inhibitors(eg. enapril) can cause dry persistent coughs

Allergies:
1.Certain plants, pollens, chemicals, cosmetics can cause allergic reactions in the throat and bronchial causing cough. (white clear phlegm)

2.Asthma - narrowing of the bronchial tubes due to allergic and other causes usually results in white sticky clear productive phlegm

Smoking:
Cigarettes smokes contains 40 over chemicals which irritates the cells in the lining of the bronchial tubes causing a chronic cough

Stress:
Stress can cause cough due to dryness of mouth during stress or anxiety, causing the saliva to dry up and producing dry unproductive cough.
The cough in stress usually disappears during sleep.

Gastric problems or indigetions
1. Indigestion of food in the stomach can cause the undigested food in the stomach to produce gas in the stomach which goes upwards to the throat drying saliva which then become irritating phlegm in the throat.

2.gastroesophageal reflux of food can also cause the acid and undigested food to travel to the mouth and produce mucus secretions.

Systemic diseases:
1.Congestive heart failure

2.Lower respiratory tract infections

3.Chronic Obstructive Lung Disease

4.Carcinoma lung.

What investigations are needed for cough?
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1.chest X-ray

2.sputum culture

3.pulmonary function tests

What is the treatment of Coughing?
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Medications
1.Approprate Antibiotics, antifungal for infections of throat and bonchial tubes

2.Antihistamines for allregic cough

3.Bronchodilators for asthma and Chronic Obstructive Lung Disease

4.cough mixtures - expectorants helps to expel out the phlegm
- suppresant suppress the cough -especially for dry cough and at night to stop the cough

5.Antacids and antiflatulent agents to get rid of gas in stomach and prevent reflux

6.Diuretics for treatment of congestive heart failure especially in the elderly

Healthy Lifestyle:
1.drinking several glasses of water a day prevents dryness of mouth

2.Avoid cold, acidic, spicy and oily food which irritates the throat

3.Proper oral hygience after eating: brushing of teeth and flossing.

4.Gargle mouth after every meal.

4.Avoid smoking

6.Avoid frequent usage of the voice and throat - do not talk too much

6.Treat underlying condition such as asthma, diabetes, liver, kidney and other conditions.

A Simple Guide to Urinary Stones

A Simple Guide to Urinary Stones
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What are Urinary Stones?
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Urinary Stones are small, solid stones which occur when salts or minerals in the urine become solid crystals inside the kidney.

How are Urinary Stones formed?
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Urinary Stones are formed usually because of the accumulation of salts and minerals especially calcium in the urine.

Usually the stones may be so small that they pass out through the urine without the knowledge of the patient.

Some however become bigger due to accumulation of the salts and minerals and the concentration of the urine.

The bigger stones may remain in the tubes of the kidney and are called renal stones.

Some smaller stones may move out of the kidney and passes through the ureters which are the the tubes bringing urine from the kidney to your bladder.
These are called ureteric stones.

If a ureteric stone gets stuck in the ureter, this can cause blockage of the urine and severe pain.(ureteric colic)

What are the types of Urinary Stones?
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Different kinds of Urinary stones form from different salts in the urine.

1.Calcium stones forms about 80% of the urinary stones.
50% are made up of calcium oxalate and the rest are calcium phosphate.
They are spiky or large and smooth


2.Uric acid stones are caused by accumulation of excess amounts of uric acid which can be due to eating a lot of meat.
They are smooth, brown and soft

3.Struvite stones (infection stones) are produced when there is too much ammonia in the urine occuring especially in urinary tract infection.
The bacteria that cause these urinary infections can generate ammonia.
They are usually large and have a horn-like shape
This kind of kidney stone is most often found in women.

4.Cystine stones occurs when there is high levels of cystine in the urine. A hereditary disorder called cystinuria is the source of high cystine in the urine.
They are yellow and crystalline

Who is at risk of Urinary stones formation?
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Risk factors include:

1.Men get urinary stone more commonly than women

2.a previous history of kidney stone - 50% will develop another one within five years.

3.a family history of kidney stones

4.Age between 20 and 40

5.Not drinking enough water

6.eating a diet high in protein

7.taking certain medicines such as diuretics (water tablets), antacids and thyroid medications

8.having only one kidney, or an abnormally shaped kidney

What causes Urinary Stones?
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Urinary Stones are caused by 4 main factors:

1.Insuffient water in the urine leading to concentration and stagnation of urine flow:
a.insufficient intake of water
b.intake of alcohol causing concentration of the blood volume

2.Excess Urinary Constituents:
a. Calcium:
High calcium intake (includes calcium tablets and high calcium milk)

Primary Hyperparathyroidism leading to high blood calcium

high Vitamin D intake cause high adsorption of calcium

medical conditions such as cancer, some kidney diseases, or sarcoidosis are more likely to develop calcium stones.


b. Oxalates:
high oxalate intake (cabbage,spinach,tomatoes, chocolates) in diet leads to high concentration of oxalates in urine

c. Uric Acid:
Gout or High Uric Acid can form crystals which may lead to stones

Treatments such as chemotherapy can also increase the risk of getting uric acid stones.

d: Cystine:
Hereditary cystinuria leads to high cystine in the urine and formation of cystine stones

About one in a hundred urinary stones is due to this illness.

Cystine stones tend to appear earlier in life between the ages of 10 and 30 years.

3. Infection of urine:
clumps of bacteria can form the nucleus of the stone.

Bacteria also produce ammonia which can promote formation of stones

4. Congenital deformity of the kidney and urinary tract:

these block the passage of concentrated urine and causes formation of stones.

What are the symptoms of Urinary Stones?
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Many Urinary stones do not cause any symptoms.
Once an urinary stone enters the ureter and blocks the passage of urine flow, it may cause the following symptoms:

1.severe pain or aching in the back on one or both sides

2.sudden spasms of excruciating pain which usually starts in the upper back below the ribs, radiates around the flanks of the abdomen, down to the pubes, groin and genitalia.

3.Urine is bloody, cloudy or smelly

4.frequent urge to urinate, or a burning sensation during urination

5.fever and chills

6.nausea and vomiting

Urinary stones can be passed out of the body within 48 hours.

Sometimes attacks of pain from urinary stones may last for over 30 days.

How are Urinary Stones diagnosed?
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1.History of ureteric colic symptoms and physical examination showing tenderness of abdomen and flanks

Other tests may be done to confirm the diagnosis and to reveal the size, location and type of stone:

2.blood tests - to identify excess amounts of certain chemicals (calcium, uric acid, oxalates, cystines) related to the formation of stones

3.urine analysis - to look for signs of infection and presence of crystals

4.X-ray of abdomen - stones that contain calcium (80%) usually appears white on X-rays

5.Intravenous urogram (IVU) - an injection of a special dye that shows up the whole urinary system on X-ray images, revealing stones that can't usually be seen

6.ultrasound scan - can detect stones in kidneys and solid internal organs

7.non-contrast helical computerised tomography - X-ray images taken at different angles - can diagnose kidney stones, and is probable the most accurate diagnostic test

How are Urinary Stones treated?
---------------------------------

Treatment depends on the
1.type and
2.cause of the stone.

Most stones can be treated without surgery:
1.Drinking lots of water (two and a half to three litres per day)

2.staying physically active are often enough to move stones smaller than about 5mm out of the urinary tract.

3.paracetamol or codeine may be given to reduce the pain.

4.Infections can be treated with antibiotics.

Stones that are stuck can be removed in several ways:

1.Extracorporeal shock wave lithotripsy (ESWL)
Location of the urinary stone is dtermined using X-ray imaging or ultrasound scanning.
The patient lies in a side position while a machine called a lithotriptor sends targeted shock waves to break up the kidney stone.
There may be some pain as the stone breaks up, so the procedure is usually performed under local anaesthesia.

2.Ureteroscopic stone removal
A narrow, flexible instrument called a cystoscope can be passed up through the urethra and bladder and up the ureter where the stone is stuck. The stone is captured and removed.It can also be broken up with a laser beam or shock waves generated by a device attached at the end of the cytoscope. This procedure is usually done under general anaesthesia.

3.Percutaneous nephrolithotomy (PCNL)
Large stones can be surgically removed from the kidney.
The surgeon makes a small opening at the back and uses a telescopic instrument called a nephroscope to pull the stone out or break it up with shock waves or a laser.
This procedure is performed under general anesthesia.

How to prevent Urinary Stones?
---------------------------------

1.drink more fluid at least three litres every 24 hours.

2.reducing the amount of calcium in the diet to a normal level(not excessively high)

3.For calcium oxalate stones, reduce intake of high levels of oxalate - chocolate, tea, cooked spinach and asparagus.

4.For uric acid stones, less meat, fish, poultry, organs, peanuts and soya beans should be taken. Daily intake of allopurinol medicine can help reduce the level of uric acid in the urine.

5.For cystine stones, medicines can be given to reduce formation of the stones.

6.For struvite or "infection" stones,long term antibiotics may prevent chronic urinary infection.


Added 4th October 2008
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Urinary stone:
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Melamine a chemical used for hardening plastic has found illegally in milk products in China in September 2008.

This causes urinary stones in babies.

A Simple Guide to Cerebral aneurysm

A Simple Guide to Cerebral aneurysm

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What is Cerebral aneurysm?

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A cerebral aneurysm is an abnormal ballooning of a section of a blood vessel in the brain.

What is the causes of cerebral aneurysm?

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Cerebral aneurysms occur when there is a weakened area in the wall of a blood vessel in the brain.

1.They may occur as a congenital (before birth) defect or may develop later in life.

About 5% of the population has some form of aneurysm in the brain.

2.Trauma and infection, which can injure the blood vessel wall, can cause such aneurysms.

What are the Symptoms of cerebral aneurysm?

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Cerebral aneurysm usually cause no symptoms until they rupture and cause bleeding into the brain.

Often, an aneurysm is found when a CT scan or MRI is performed for another reason. If the unruptured swollen aneurysm presses on the brain , it can cause the following symptoms:
1.Headaches

2.Eye pain

3.Neck pain

4.Double vision

5.Loss of vision

Symptoms of an aneurysm that have ruptured are:
1.Sudden occurrence of a severe headache (often described as "worst headache of my life")

2.Headaches with nausea or vomiting

3.Stiff neck

4.Muscle weakness, difficulty moving any part of the body

5.Numbness or decreased sensation in any part of the body

6.Vision changes like blurring of vision,double vision

7.Eyelid drooping

8.Confusion,

9. Sudden onset of irritability, impulsivity, or poor temper control

10.Slow, sluggish movement

11.Speech impairment

12.Seizures

A ruptured aneurysm is a medical emergency.

What are the investigations done in cerebral aneurysm?

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The following tests may be used to diagnose cerebral aneurysm:

1.CT scan of the head can identify bleeding and usually locate the aneurysm.

2.MRI of the head may be an alternative to a CT scan but may be as good at showing bleeding in the brain.

3.Cerebral angiography or spiral CT scan angiography of the head is used to pinpoint the location and size of the aneurysm.

4.cerebrospinal fluid examination via a spinal tap may confirm bleeding.

5.EEG (electroencephalogram) should be performed if there are seizures.

What is the Treatment of cerebral aneurysm?

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Symptoms often do not appear until bleeding of a cerebral aneurysm occurs.

A ruptured cerebral aneurysm is an emergency condition.

The goal of treatment is to prevent further bleeding.

Lowering of blood pressure can decrease the risk of further bleeding.

Neurosurgery is the primary treatment for cerebral aneurysm.

The base of the aneurysm is closed off with clamps or sutures.

Special coils or stents can be placed into the aneurysm through the arteries to prevent rupture.
A blood clot then forms in the aneurysm and prevents further bleeding. This is considered a less invasive approach than brain surgery. It is regarded as the best form of treatment.

If surgery is not feasible because of the location or size of the aneurysm or the condition of the person, medical treatment is:

1.restricting activity (often complete bedrest is advised),

2.treating symptoms such as headache,

3.controlling blood pressure, and

4.prescribing of antiseizure medications.

After the aneurysm is repaired, prevention of stroke due to blood vessel spasm is necessary. This may include intravenous fluids, certain medications, and controlling the blood pressure.

What is the Prognosis of cerebral aneurysm?

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The prognosis depends on the severity of the condition.
Ruptured cerebral aneurysms are often serious.

In severe cases, about 25% of people die within 1 day, and another 25% die within about 3 months. Of those who survive, more than half will have some sort of permanent disability.

In small leaks of ruptured cerebral aneurysm, early treatment of the condition can be very effective with little loss of neurological deficit.

Unruptured aneurysms can be treated very effectively before causing problems.

The decision to repair an unruptured cerebral aneurysm is based on the size and location of the aneurysm, and the patient's age and general health.

What are the Possible Complications of cerebral aneurysm?

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1.Subarachnoid hemorrhage

2.Stroke

3.Seizures, epilepsy

4.Paralysis of any part of the body

5.Permanent loss of sensation of any part of the face or body

6.Other neurologic deficits (such as vision changes, loss of speech ability, cognitive decline)

What is the Prevention of cerebral aneurysm?

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There is no known way to prevent the formation of a cerebral aneurysm because most of them are congenital.

If sudden or severe headache occurs, particularly if you also have nausea, vomiting, seizures, or any other neurological symptoms, early admission to hospital and appropriate investigation can detect an unruptured aneurym or one which has just started to bleed.

Treatment can be initiated and prognosis is good.

A Simple Guide to Alopecia(Hair Loss)

A Simple Guide to Alopecia(Hair Loss)
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What is Alopecia(Hair Loss)?
-----------------------------------

Alopecia or Hair Loss is the partial or complete loss of hair in the scalp, armpit or other areas of the body to the extent that skin is evident and sparse amount of hair is present or completely absent. Hair loss usually develops gradually and may be patchy or diffuse (all over)

Who get Alopecia?
-----------------------

Hair loss is experienced by both men and women, young or old.

The most common type of hair loss is called

1.male pattern baldness or androgenetic alopecia.

Its causes have been linked to genes, hormones and age.

Other types of hair loss are:

2. an auto-immune condition known as patchy hair loss (alopecia areata),

3.temporary hair loss (telogen effluvium),

4.compulsive hair pulling (trichotillomania) and

5.traction alopecia.

What is the cause of Alopecia?
-------------------------------------

The hair is made up of keratin, the same protein that is found in nails and the outer layer of our skin. The average adult has more than 100,000 strands of hair on his scalp.

It is normal to lose about 50 to 100 strands every day.

Old strands of hair are shed so that new ones can grow out of the hair follicles.

However, various factors can lead to sudden or excessive shedding such as:
1.genes(Male pattern baldness, Congenital),

Genetic baldness is caused by the body's failure to produce new hairs and not by excessive hair loss.

Some women also develop a particular pattern of hair loss due to genetics, age, and male hormones that tend to increase in women after menopause.

The pattern is different from that of men. Female pattern baldness involves a thinning throughout the scalp while the frontal hairline generally remains intact.

Congenital Alopecia occurs in a new born who does not develop any more hairs.

2.hormones(excessive DHT or dihydrotestosterone)

Androgens appear to play a role in male pattern baldness. These very same hormones trigger the growth of hair in the pubic, underarm and facial areas at puberty. People with male pattern baldness may have the same male hormone levels as normal people, but these hormones seem to accumulate in certain areas of their scalp and cause the hair follicles there to regress.
Women are protected from male pattern baldness because they produce less androgens, and because their female hormones, estrogen can counter the effect of their male hormones. However, women who produce excess androgens may have male pattern baldness.

Other hormones, such as those from your thyroid glands, can also affect your hair.

Too much or too little hormones from your thyroid gland can cause hair loss.

3.stress,

Sudden emotional stress can also trigger patchy baldness (alopecia areata) or temporary hair loss (telogen effluvium). Temporary hair loss may also be triggered by the stress of giving birth or losing a loved one.

4. Medical conditions

Some medicines, such as blood thinners (anti-coagulants), birth control pills, anti-depressants, anti-thyroid drugs or drugs used in chemotherapy, may cause hair loss.

5.Improper hair care

Having a hairstyle that exerts too much pull(traction) on the scalp can cause your hair to turn brittle and break. Hair breakage can also be caused by over-shampooing and the excessive use of chemical treatments such as dyes, tints, bleaches, and permanent waves.

6.Burns - Excessive heat damages the cells of the skin including the hair roots.

7.Infectious diseases such as syphilis and fungal infection can cause damage to the hair roots.

What are the Signs and Symptoms of Alopecia?
-------------------------------------------------------

Male pattern baldness (or androgenetic alopecia) accounts for the majority of all hair losses. This is the most common type of baldness in men, especially older men.

It can also occur in some women, though the instances are rare.

Hair loss is usually gradual.

The hair loss pattern differs between the sexes.

In men, the hair loss usually starts with a receding hairline.

In women, there is a diffuse thinning of the crown.

Male pattern baldness in women is usually not as severe.

Besides male pattern baldness, there are various other types of hair loss.

Patchy baldness (alopecia areata): Here a few bald patches suddenly appear.

Emotional stress(eg examinations) appears to be a triggering factor.

This condition can progress to more serious forms in which all the scalp and body hair may be lost (alopecia totalis).

Temporary hair loss (telogen effluvium): Here clumps of hair begin to fall out suddenly over a few days. It can be caused by severe stress, childbirth, severe illnesses, surgery and some medications. As its name implies, its effect is usually temporary.

Recovery though may take a year or longer depending on the cause.

Compulsive hair pulling (trichotillomania): This causes hair breakage and usually leaves the scalp undamaged. It usually affects children and women and has been linked to a psychological cause.

Traction alopecia: This is hair loss caused by certain hairstyles such as ponytails, buns or braids that pull excessively on the hair.

What tests can be done in Alopecia?
-------------------------------------------

1.Microscopic examination of a plucked hair

2.Skin biopsy (if skin changes are present)

Ringworm on the scalp may require the use of an oral drug, such as griseofulvin, because creams and lotions applied to the affected area may not get into the hair follicles to kill the fungus.

What is the Treatment and Prevention of Alopecia?
--------------------------------------------------------------

It is important to determine the underlying cause before treatment.

Most of the conditions are temporary and can be resolved once the underlying cause such as stress is removed.

However, male pattern baldness may have a permanent effect.

There has been some medical progress in helping these people regain their hair.

Two medications Finasteride and Minoxidil work by stimulating the regrowth of hair in hair follicles.

1.Finasteride counteracts the effects of the male hormone testosterone. It is available only by prescription and is taken orally. It is approved for use only in men and is not recommended in women because of its link to birth defects. Finasteride takes a few months to show its effect.
2.Minoxidil is available over the counter. . It is applied on the scalp and works by reversing the regression of hair follicles caused by hormones.It takes a few months before any effect can be seen.

Alopecia areata is sometimes treated by steroid injections into the affected scalp areas while any underlying scalp problems such as tinea capitis (fungal infection) should be treated accordingly.

Causes of telogen effluvium should be addressed and given professional guidance by psychiatrist if necessary. Those due to childbirth should recover spontaneously within a year.
Hair loss from menopause or childbirth often returns to normal 6 months to 2 years later.

For hair loss caused by illness (such as fever), radiation therapy, or medication use, no treatment is necessary. The hair will usually grow back when the illness has ended or the therapy is finished. A wig, hat, or other covering may be desired until the hair grows back.

For hair loss due to heredity, age, and hormones, the topical medication minoxidil can be helpful for both male and female pattern baldness. You may need to wait 6 months before you see results.

The oral medication Propecia (finasteride) is effective in some men. This medicine can decrease sex drive.

When either medication is stopped, the former baldness pattern returns.

Hair transplants performed by a physician is a surgical approach to transferring growing hair from one part of the head to another. It is somewhat painful and expensive, but usually permanent.

Hair weaves, hair pieces, or changes of hair style may disguise hair loss. This is generally the least expensive and safest approach to hair loss. Hair pieces should not be sutured to the scalp because of the risk of scars and infection.