Skip to main content
  1. Right Decisions
  2. Back
  3. Dermatology pathways
  4. Alopecia
Announcements and latest updates

Polyfill.io vulnerability

28 june 2024

Our eHealth team advised us yesterday of an international vulnerability relating to polyfill.io . This domain has become compromised and is  spreading malware through a widespread supply chain attack, estimated to affect over 110,000 websites including major websites such as the BBC. The Polyfill site offered widely used bits of code for older browsers that allowed the use of modern Javascript features. Such code makes the work for web developers easier and allows compatibility with a broader range of browsers. 

Websites that have used the Javascript code from Polyfill have been urged to remove such code immediately. The change occurred after a suspected Chinese firm purchased the domain in early 2024.

Tactuum have identified and are now testing a fix to remove all Polyfill code from the RDS site.. They will be deploying the fix on Monday 1 July along with other planned fixes and amendments. I will notify you of the timing  of the deployment as soon as possible.

In the meantime, please ensure that you have up-to-date anti-virus software installed on your machines and personal devices.

 

Alopecia

Not all treatment options may be listed in this guidance. Please refer to local formulary for a complete list.

Treatment/ therapy

Alopecia may be scarring or non-scarring, localised or diffuse, inflamed or non-inflamed 

Diffuse non-scarring 

  • Physiological: normal ageing process 
  • Female pattern hair loss (FPHL)- thinning over crown 
  • Telogen effluvium/ excessive shedding occurs three–four months after pregnancy/ other major event 
  • May be component of polycystic ovarian disease in young women 
  • Consider any new medications 

 

Diffuse non-scarring

Localised non-scarring 

  • Alopecia areata 
  • Patchy hair loss with exclamation mark hair 

Localised non-scarring

Diffuse inflamed non-scarring 

  • Consider seborrhoeic dermatitis or psoriasis (may also rarely cause scarring) 

 

Localised inflamed non-scarring 

  • Consider tinea infection (may also cause scarring) 
  • Consider psoriasis or seborrhoeic dermatitis 

Local inflamed non-scarring

Scarring 

  • Loss of hair follicles with or without inflammation and accompanied by scarring 
  • Local or diffuse 
  • Causes include: Lichen planus

Scarring

 Scarring  Scarring

Referral Management

  • Dermatology Referral Criteria 
  • Inflammatory scarring alopecia 
  • Diagnostic uncertainty 
  • Persistent or extensive alopecia (scarring or non-scarring) 
  • Hairpiece or wig prescription for alopecia caused by trauma or disease resulting in psychological distress (if available) 

Clinical tips

Diffuse non-scarring 

  • Reassure patients with mild FPHL that condition is physiological 
  • Reassure patients that Telogen effluvium will recover spontaneously 
  • Diffuse alopecia: check full blood count, ferritin and thyroid function 
  • Patients with severe degree of alopecia caused by disease can be considered for NHS wig prescription 

Localised non-scarring 

  • Reassure patients with alopecia areata that spontaneous regrowth is likely 
  • Generally good outcome in patients with short history and limited extent 
  • Trial of potent topical steroid lotion for three months 

Diffuse inflamed non-scarring 

Treatment: 

  • Coal tar + salicylic acid ointment ( eg Cocois/Sebco) 
  • Anti-fungal shampoo ( eg ketoconazole) 
  • Topical steroid lotion/mousse/foam 

Localised inflamed non-scarring 

  • Send hair pluckings to mycology lab 
  • If dermatophyte infection confirmed, treat with oral terbinafine 
  • Treat as for diffuse inflamed non-scarring if psoriasis or seborrhoeic dermatitis 

Scarring 

  • Requires secondary care referral 

Patient information resources

  1. NHS Inform: www.nhsinform.scot 
  2. Alopecia help and advice Scotland: https://www.alopecia.org.uk/ 
  3. British Association of Dermatologists: http://www.bad.org.uk/for-the-public/patient-information-leaflets 
  4. Dermnet NZ: www.dermnetnz.org 

Editorial Information

Author(s): Adapted from Dermatology Patient Pathways.

Co-Author(s): NHS Scotland, Scottish Dermatology Society.