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The scalp, hair & its applied anatomy

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WELL EXPLAINED, PICTORIAL PRESENTATIONS.EASY TO REMEMBER. EASY TO UNDERSTAND

The scalp, hair & its applied anatomy

  1. 1. DR.TARUN KUMAR DWIBEDI PG SCHOLAR SHALAKYA TANTRA SJG AMC & H, KOPPAL. THE SCALP, HAIR & IT’S APPLIED ANATOMY
  2. 2. THE CONTENT… THE SCALP • EXTENTEND • LAYERS • SKIN • CONNECTIVE TISSUE (DENSE) • APONEUROTIC LAYER /GLEA APONEUROTICA • LOOSE CONNECTIVE TISSUE • PERI-CRANIUM • MUSCLES • BLOOD SUPPLY • LYMPHATIC DRAINAGE • NERVE SUPPLY THE HAIR • PARTS • LAYERS • GROWING CYCLE OF HAIR • ANAGEN • CATAGEN • TELOGEN
  3. 3. APPLIED ANATOMY 1. SCALP AVULSION 2. SEBASEOUS CYST 3. TELOGEN EFFLUVIUM 4. NEVUS 5. DISCOID LUPUS ERYTHEMATOSUS (D LE) 6. DISSECTING CELLULITIS OF THE SCALP 7. NON SCARRING HAIR LOSS 8. TRICHOTILLOMANI A (TTM) 9. KERION 10. ALOPECIA UNIVERSALIS 11. ALOPECIA TOTALIS 12. ALOPECIA AREATA 13. TRACTION ALOPECIA 14. FOLLICULITIS DECALVANS 15. ACNE KELOIDALIS NUCHAE 16. ACTINIC KERATOSIS (AK) 17. DERMATITIS HERPETIFORMIS 18. TRICHORRHEXIS NODOSA 19. SCALP ECZEMA 20. LICHEN SIMPLEX CHRONICUS 21. SCALP PSORIASIS 22. HEAD LICE INFESTATION 23. MALE PATTERN HAIR LOSS 24. LICHEN PLANNUS SCALP 25. CRADLE CAP 26. PREMATURE GREYING OF HAIR 27. TRICHORRHEXIS INVAGINATA 28. INGROWN HAIR 29. MONILETHRIX 30. HAIR CASTS 31. FOLLICULITIS 32. TINEA CAPITIS 33. SEBORRHOIC DERMATITIS 34. DANDRUFF
  4. 4. THE SCALP • Extend from top of the forehead to the superior nuchal line behind. • Laterally up to the zygomatic arch and external acoustic meatus
  5. 5. LAYERS OF SCALP • 5 layers • S -skin • C –connective tissue (dense) • A –aponeurotic layer / glea aponeurotica • L –loose connective tissue • P –peri-cranium / osteum
  6. 6. THE SCALP
  7. 7. SKIN • Thick & hairy • ADHERANT TO THE EPICRANEAL APONEUROSIS / GLEA APONEUROTICA (a tough layer of dense fibrous tissue) THROUGH THE DENSE SUPERFICIAL FASCIA. • Numerous sebaceous gland.
  8. 8. CONNECTIVE TISSUE (DENSE) • More Fibrous And Dense In The Center Than Periphery Of Head • Provides Proper Medium To The Nerves And Vessels Of The Skin .
  9. 9. APONEUROTIC LAYER / GLEA APONEUROTICA • Freely Movable On Pericranium • On Each Side It Is Attached To The Superior Temporal Line • It Receives The Insertion Of Frontalis And Occipital Bellies Posteriorly.
  10. 10. LOOSE CONNECTIVE TISSUE • Extends anteriorly into the eye lids • Posteriorly to the highest and superior nuchal lines and on each side to the superior temporal lines.
  11. 11. PERI-CRANIUM • Loosely attached to the surface of the bones but firmly to the sutures .
  12. 12. MUSCLES OF SCALP OCCIPITALIS • Origin –Superior nuchal line of the occipital bone and mastoid process of the temporal bone • Insertion- glea aponeurotica • Posteriorly • Pulls scalp back, anchors aponeurosis. TEMPOROPARIETALIS • Origin –auricularis muscle • Insertion- glea aponeurotica • On both sides • Tenses scalp, moves ear. FRONTALIS • Origin- glea aponeurotica • Insertion-orbicularis oculi • Anterior part of scalp • Raises eyebrows and wrinkles forehead OCCIPITOFRONTALIS • Origin- Two occipital bellies and two frontal bellies • Insertion- glea aponeurotica • It consists of two parts or bellies: The occipital belly, near the occipital bone, and the frontal belly, near the frontal bone. • Wrinkle the forehead, widen the eyes, and • raise the ears
  13. 13. BLOOD SUPPLY Arterial supply • Branch of external carotid artery • Supratrochlear artery • Supraorbital artery • Superficial temporal artery • Posterior auricular artery • Occipital artery Venous supply • Branch of EJV AND IJV • Supratrochlear veins • Supraorbital veins • Superficial temporal vein • Posterior auricular vein • Occipital vein
  14. 14. BLOOD SUPPLY
  15. 15. LYMPHATIC DRAINAGE • The part of the scalp that is anterior to the auricles is drained to the parotid, submandibular, and deep cervical lymph nodes. • The posterior part of the scalp is drained to the posterior auricular (mastoid) and occipital lymph nodes.
  16. 16. NERVE SUPPLY TO THE SCALP • Supratrochlear nerve • Supraorbital nerve • Zygomaticotemporal n. • Auriculotemporal n. • Greater auricular n. (C2, c3) • Third occipital n. • Greater occipital nerve (c2) Posteriorly up to the vertex. • Lesser occipital nerve (c2) Behind the ear.
  17. 17. THE HAIR • It’s a protein filament grows from hair follicle in dermis of skin. • Keratin is the protein found in hair. • Pigments of hair is responsible for its color.
  18. 18. ARRECTOR PILLI MUSCLE
  19. 19. PARTS OF HAIR IT HAS 3 PARTS 1. ROOT –PART OF HAIR ELOW THE SURFACE OF SKIN, Widest Part--follicle 2. SHAFT- The body 3. TIP– The End Of Hair , The Narrowest Part.
  20. 20. HAIR BULB • Part of root • The hair bulb is the bulb-shaped structure at the base of the hair follicle Each hair bulb includes: • The area of cells that produces new hairs by mitosis is the GERMINAL MATRIX • PAPLLA is the area that contains many blood vessels which supply nutrients to nourish the growing hair
  21. 21. ROOT SHEATH Two layers :- surrounded by an outer sheath of connective tissue. • External epithelial root sheath :- Consists of several layers of cuboid epithelial cells visible when stained with H&E stain, a histology stain • Internal epithelial root sheath :- consists of three layers: 1. Henle's layer 2. Huxley's layer, and 3. Cuticle of inner sheath.
  22. 22. LAYERS OF HAIR It has 3 layers 1. Cuticle- outer covering with over lapping scales 2. Cortex – PROTEIN RICHED, ARROUND THE MEDULLA HAVING PIGMENTS (melanocytes). 3. Medulla – the central core part
  23. 23. GROWING CYCLE OF HAIR There are cycles of hair growth & loss during which the follicle presents different appearance It has 3 growing stages 1. Anagen 2. Catagen 3. Telogen
  24. 24. ANAGEN • It’s the growing phase of the follicle. • Maximum development of hair takes place • Mitosis occurs during this stage • ~90 % hairs are in this stage • Lasts for 2-6 years • Growth 1-1.5 cm / month. • Hair bulb is rounded, full and contains melanin
  25. 25. CATAGEN • It’s the transition stage ~1-2 % of hairs are at this stage • Lasts for 1-2 weeks • Mitosis stops hair =>growth ceases. • Germinal matrix shrinks away from the papilla
  26. 26. TELOGEN • The resting stage ~8-9% of hairs • Lasts for 3-4 weeks • Follicles has shrunk away from the papilla • The inferior segment of follicle is absent in this phase and this is succeeded by the next anagen phase. • Hairs fall out ~50-80 hairs / day
  27. 27. • The ‘danger area of the scalp’ is the area of loose connective tissue. As pus and blood spread easily within it, and can pass into the cranial cavity along the emissary veins. Hence infection can spread from the scalp to the meninges, which could lead to meningitis. • Scalp laceration bleeds profusely as elastic fibres of underlying glea aponeurotica prevent initial vessel retraction. • Hence significant blood loss which may lead to clinical shock
  28. 28. • So it is essential to control all bleeding points before suturing the lacerations. • Failure to control the bleeding points can leads to hematomas. • Repair of scalp require full thickness tension sutures because the glea aponeurotica will otherwise gape as the occipital and frontal bellies contract. • Scalp flaps can be used in craniofacial surgery for correction of congenital deformity,
  29. 29. SCALP AVULSION • Avulsion - body structure is forcibly detached from its normal point of insertion • The inner smooth surface of avulsed scalp is first placed on a spherical vessel or container. The long hairs is then clipped and shaving commence from front to back and side to side .The eye brows are not shaved.
  30. 30. • After the completion of shaving the scalp is washed thoroughly in running tap water. Then the scalp is taken off from the container. The scalp is prepared without any hairs in the inner part of it. • All patients has acceptable recovery of sensation of forehead and scalp by 6-9 months after replantation. • There will be satisfactory hair growth
  31. 31. SEBASEOUS CYST • Due To The Presence Of Numerous Sebaceous Gland The Scalp Is Commonest Site Of Sebaceous Cyst. • The Sebaceous Gland Produces The Oil Called Sebum That Coats Our Hair And Skin. • Cysts Can Develop If The Gland Or Its Duct, The Passage Where Oil Is Able To Leave, Becomes Damaged Or Blocked. This Usually Occurs Due To A Trauma To The Area. • Treatment:- Surgical Removal Of The Cyst.
  32. 32. TELOGEN EFFLUVIUM • Thinning or shedding of hair resulting from the early entry of hair in the telogen phase. • 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 disorder, crash diets, hypothyroidism, and drugs • Vitamin d ” levels may also play a role in normal hair cycle
  33. 33. NEVUS • Visible, Circumscribed, Chronic Lesion Of The Scalp Skin. • Can Be Either Congenital Or Acquired. Management • Chemical Peels • Cryotherapy • Dermabrasion • Electrodessication • Laser Ablation
  34. 34. DISCOID LUPUS ERYTHEMATOSUS (DLE) • It’s A Chronic Skin Condition Of Sores With Inflammation And Scarring • These Lesions Develop As A Red, Inflamed Patch With A Scaling And Crusty Appearance. • The Centre Areas May Appear Lighter In Color With A Rim Darker Than The Normal Skin.
  35. 35. DISSECTING CELLULITIS OF THE SCALP • Pus-filled Lumps Develop On The Scalp, Resulting In Scarring And Permanent Hair Loss Over The Area Affected. • Most Likely Due To Blocked And Ruptured Hair Follicles, Resulting In Significant Inflammation And Secondary Bacterial Infection. Management:- • Avoid Picking And Squeezing The Lumps As This Can Worsen The Problem • Avoid Oil-based Hair Products And Use An Antiseptic Shampoo Regularly
  36. 36. • Antiseptic Washes (Eg Chlorhexidine) And Shampoos Can Be Useful As Well As Topical Antibiotics Such As Clindamycin Lotion. • Doxycycline, Erythromycin Or Clindamycin. • A Combination Of Clindamycin And Rifampicin • Steroid - Prednisolone Can Be Used For Short Term • Large Cysts And Abscesses Can Be Incised And Drained Or Excised. • Skin Grafting May Be Required In Some Cases.
  37. 37. NON SCARRING HAIR LOSS • Loss Of Hair Without Any Scarring Causes • Alopecia Areata • Anagen Effluvium • Androgenetic Alopecia • Dermatopathia Pigmentosa Reticularis • Telogen Effluvium • Trichotillomania (Trichotillosis) Treatment :- According To Their Causes
  38. 38. TRICHOTILLOMANIA (TTM) • Hair Pulling Disorder • It Is An Impulse Control Disorder Characterized By A Long Term Urge That Results In The Pulling Out Of One's Hair. • The Head And Around The Eyes Are Most Common Site. • The Disorder May Run In Families. Women Are More Commonly Affected Than Men • It Occurs More Commonly In Those With Obsessive Compulsive Disorder. Episodes Of Pulling May Be Triggered By Anxiety. Treatment • Cognitive Behavioral Therapy With Clomipramine • Psychotherapy Is Useful In This Case
  39. 39. KERION • Raised, Spongy Lesions, And Typically Occurs In Children • Host's Response To A Fungal Ringworm Infection Of The Hair Follicles Of The Scalp That Can Be Accompanied By Secondary Bacterial Infections • Painful Inflammatory Reaction With Deep Suppurative Lesions Treatment • Antifungals:-griseofulvin Or Terbinafine For 6- 8 Weeks
  40. 40. ALOPECIA UNIVERSALIS • Loss Of Hair All Over Body Including Eyebrows And Eye Lashes. • In Any Age Group • An Autoimmune Disorder, In Which A Person's Immune System Attacks The Hair Follicles. Treatment • Immunomodulatory Agents Such As Imiquimod. • Tofacitinib Citrate May Also Have Benefits.
  41. 41. ALOPECIA TOTALIS • Loss Of All Skull And Facial Hair • Believed To Be Autoimmune TREATMENT • Methotrexate And Corticosteroids
  42. 42. ALOPECIA AREATA • Spot Baldness, • A Condition In Which Hair Is Lost From Some Or All Areas Of The Body. • Often Few Bald Spots On The Scalp, Each About The Size Of A Coin CAUSE • Autoimmune Disease • Failure By The Body To Recognize Its Own Cells With Subsequent Immune Mediated Destruction Of The Hair Follicle
  43. 43. TREATMENT • Corticosteroids Clobetasol Or Fluocinonide , Corticosteroid Injections, Or Cream. • Minoxidil, Elocon (Mometasone) Ointment (Steroid Cream), Irritants (Anthralin Or Topical Coal Tar), And Topical Immunotherapy Ciclosporin, Sometimes In Different Combinations • Alopecia Areata Is Associated To Celiac Disease , The Treatment With A Gluten- free Diet Allows Complete And Permanent Regrowth Of Scalp And Other Body Hair In Many People, But In Others There Are Remissions And Recurrences. (May Be Due To The Normalization Of The Immune Response As A Result Of Gluten Withdrawal )
  44. 44. TRACTION ALOPECIA • Gradual Hair Loss, Caused Primarily By Pulling Force Being Applied To The Hair • Results From The Sufferer Frequently Wearing Their Hair In A Particularly Tight Ponytail, Pigtails Or Braids
  45. 45. FOLLICULITIS DECALVANS • An Inflammation Of The Hair Follicle That Leads To Bogginess Or Induration Of Involved Parts Of The Scalp Along With Pustules, Erosions, Crusts, Ulcers, And Scale TREATMENT • Rifampin 300 Mg Twice Daily And Clindamycin 300 Mg Twice Daily For 3-5 Months.
  46. 46. ACNE KELOIDALIS NUCHAE • Destructive Scarring Folliculitis That Occurs Almost Exclusively On The Occipital Scalp Of People Of African Descent
  47. 47. ACTINIC KERATOSIS (AK) • A Pre-cancerous Patch Of Thick, Scaly, Or Crusty Skin. • These Growths Are More Common In Fair-skinned People And Those Who Are Frequently In The Sun. • They Usually Form When Skin Gets Damaged By Ultraviolet (UV)radiation From The Sun Or Indoor Tanning Beds. • Aks Are Considered Potentially Pre- cancerous; Left Untreated, They May Turn Into A Type Of Cancer Called Squamous Cell Skin Cancer.
  48. 48. TREATMENT SURGICAL TECHNIQUES • Dermabrasion • Laser Therapy • Chemical Peels • Shave Excision And Curettage • Surgical Excision • Fluorouracil Cream • Imiquimod Cream • Ingenol Mebutate Gel • Diclofenac Sodium Gel • Retinoids • Photodynamic Therapy
  49. 49. DERMATITIS HERPETIFORMIS • An Itchy, Blistering, Burning Skin Rash • This Rash Likely Indicates Gluten Intolerance, Which May Be Related To A More Serious Underlying Condition Known As Celiac Disease TREATMENT • Gluten-free Diet • Dapsone Is Most Effective But Have Many Side Effects.
  50. 50. TRICHORRHEXIS NODOSA • Defect In The Hair Shaft Characterized By Thickening Or Weak Points (Nodes) That Cause The Hair To Break Off Easily • Hair Loss, Lack Of Growth, And Damaged-looking Hair MANAGEMENT • Harsh Chemicals Such As Hair Straightening Compounds And Permanents Should Be Avoided. • The Hair Should Not Be Ironed. • Excessively Harsh Shampoo Should Be Avoided. • Hair Conditioners Should Be Used.
  51. 51. SCALP ECZEMA • Irritated, Red, And Itchy Skin On The Scalp, Which Causes The Flakes Known As Dandruff, Is Called Scalp Eczema. MANAGEMENT • Antidandruff Shampoo Or Medicines Which Are Made Up Of Salicylic Acid, Coal Tar,zinc,resorcinol,ketoconazole,seleniumsulfi de,corticosteroids, Ciclopirox, Sulfacetamide Sodium, Protopic (Tacrolimus) Or Elidel (Pimecrolimus)are Usefull.
  52. 52. LICHEN SIMPLEX CHRONICUS • A Skin Disorder Characterized By Chronic Itching And Scratching.The Constant Scratching Causes Thick, Leathery, Darkened, (Lichenified) Skin. • More Common Between Ages 35 And 50 And Is Seen Approximately Twice As Often In Women Compared To Men. MANAGEMENT • Steroid Cream (Suchas Triamcinolone Or Betamethasone) Applied To The Affected Area Of The Skin. • Nighttime Scratching Can Be Reduced With Sedatives And Antihistamines.
  53. 53. SCALP PSORIASIS • Red Scaling, Slightly Raised Bumps(papules) That Merge To Form Plaques • Loss Of Scalp Hair, Which Usually Will Return If The Disease Can Be Controlled MANAGEMENT • Salicylic Acid • Coal Tar • Dovonex For Scalp Psoriasis • Taclonex • Tazarotene Which Is Alternative Of Vitamin A • Calcipotriene, Which Is A Unique Form Of Vitamin D
  54. 54. HEAD LICE INFESTATION • Infection Of The Head Hair And Scalp By The Head Louse(pediculus Humanus Capitis) • Itching From Lice Bites Is Common. • During A Person's First Infection, The Itch May Not Develop For Up To Six Weeks.If A Person Is Infected Again, Symptoms May Begin Much More Quickly
  55. 55. MANAGEMENT • Combs, Shaving, Medical Creams, And Hot Air Can Be Used • Dimethicone,ivermectin ,Permethrin, Malathion, Benzyl Alcohol Are Effective In This Case
  56. 56. MALE PATTERN HAIR LOSS • Hair Loss That Primarily Affects The Top And Front Of The Scalp • Hair Loss that Primarily Affects The Top And Front Of The Scalp MANAGEMENT • Minoxidil, Finasteride • Hair Transplant Surgery
  57. 57. LICHEN PLANNUS SCALP • Inflammatory Condition That Results In Patchy Progressive Permanent Hair Loss SYMPTOMS • Itch, pain, tenderness, discomfort, burning, TREATMENT Topical Tacrolimus, hydroxychoroquine Tetracycline,doxycycline,acitretin,methotrexate,ciclosporin, mycophenolate
  58. 58. CRADLE CAP • A Yellowish, Patchy, Greasy, Scaly And Crusty Skin Rash That Occurs On The Scalp Of Recently Born Babies • The Rash Is Often Prominent Around The Ear, The Eyebrows Or The Eyelids • Massage Baby's Scalp With The Fingers Or A Soft Brush To Loosen The Scales
  59. 59. • Oil Remedies Can Be Used By Rubbing A Small Amount Of Pure, Plant-derived Oil (Coconut Oil, Pure Olive Oil, Almond Oil) On The Baby's Scalp And Leaving It On For 15 Minutes. After 15 Minutes, Gently Comb Out The Flakes With A Fine Tooth Comb Or Brush. Be Sure To Wash Out All Of The Oil To Avoid Making The Cradle Cap Worse • Clotrimazole , Miconazole Can Be Applicable
  60. 60. PREMATURE GREYING OF HAIR • Also Known As Canities • Hair Is Said To Have Greyed Prematurely If It Occurs Before The Age Of 20 Years In Whites, Before 25 Years In Asians, And Before 30 Years In Africans. • Topical Antiaging Compounds That Are Currently Under Investigation Include Photoprotectors, Such As Cinnamidopropyltrimonium Chloride And Solid Lipid Nanoparticles As Carriers For Uv Blockers, Oral Supplementation With L- cystine And L-methionine, And Topical Melatonin.[Temporary Hair Colorants Are Used Worldwide.
  61. 61. TRICHORRHEXIS INVAGINATA • Also Known As "Bamboo Hair • A Distinctive Hair Shaft Abnormality That May Occur Sporadically, Either In Normal Hair Or With Other Hair Shaft Abnormalities, Or Regularly As A Marker For Netherton's Syndrome • The Primary Defect Appears To Be Abnormal Keratinization Of The Hair Shaft In The Keratogenous Zone, Allowing For Intussusception Of The Fully Keratinized And Hard Distal Shaft Into The Incompletely Keratinized And Soft Proximal Portion Of The Shaft
  62. 62. INGROWN HAIR • A Condition Where Hair Curls Back Or Grows Sideways Into The Skin • Most Prevalent Among People Who Have Coarse Or Curly Hair MANAGEMENT • Removed With Tweezers • Electrolysis • Twice Daily Topical Application Of Diluted Glycolic Acid • Applying Salicylic Acid Solution Is Also A Common Remedy For Ingrown Hairs Caused By Waxing Or Shaving
  63. 63. MONILETHRIX • Also Termed As Beaded Hair Is A Rare Autosomal Dominant Hair Disease That Results In Short, Fragile, Broken Hair That Appears Beaded. • It Comes From The Latin Word For Necklace (Monile) And The Greek Word For Hair
  64. 64. HAIR CASTS • Also Known As "Pseudonits“ • Represent Remnants Of The Inner Root Sheath, And Often Occur In Great Numbers And May Mimic Nits In The Scalp
  65. 65. FOLLICULITIS • Hair Follicles Become Inflamed • Caused By A Bacterial Or Fungal Infection • Look Like Small Red Bumps Or White-headed Pimples Around Hair Follicles • Itchy, Sore, Permanent Hair Loss And Scarring. • Some Folliculitis Are Known As Hot Tub Rash, Razor Bumps And Barber's Itch.
  66. 66. TINEA CAPITIS • Ringworm Of The Hair Or Ringworm Of The Scalp • Is A Cutaneous Fungal Infection (Dermatophytosis) Of The Scalp • 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.
  67. 67. MANAGEMENT • Griseofulvin, Terbinafine, Itraconazole, And Fluconazole Provides Effective Results.
  68. 68. SEBORRHOIC DERMATITIS • Red, Itchy Rash On Your Scalp That Has Flaky Scales Could Be Seborrheic Dermatitis, Or Seborrhea. • It's A Common Skin Disease That Looks Similar To Psoriasis, Eczema, Or An Allergic Reaction. MANAGEMENT :- • Proper Skin Care • Antifungal Medications Provides Better Results
  69. 69. DANDRUFF • Flaking And Sometimes Mild Itchiness • It Can Result In Social Or Self- esteem Problems. TREATMENT • Ketoconazole (Nizoral) Shampoo • Zinc Pyrithione And Selenium Disulfide
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WELL EXPLAINED, PICTORIAL PRESENTATIONS.EASY TO REMEMBER. EASY TO UNDERSTAND

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