Hair Loss

See link for Some Pictures of Conditions Causing Hair Loss

FIRST — We examine the head to answer two main questions:

• Is there skin disease of the scalp, or not?
• Is hair being lost Diffusely (all over), or Focally (just one or a few spots)

Causes of Hair Loss

xxxxxNo Scalp Disease Noted • Telogen Effluvium  * • Natural Hair Loss Patterns …….. • Female-Pattern *, ** at start …….. • Male-Pattern * • Alopecia Areata  ** • Traction Alopecia  ** • 2º Syphilis  ** • Trichotillomania  **   xxxxxMisc. Rare Causes • Hyperthyroidism  * • Vitamin A toxicity  * • Iron Deficiency ???  * • Zinc Deficiency  * • Thallium Poisoning  * • Selenium toxicity  * • Cancer Chemotherapy  *

xxxxxScalp Involvement is Present • Tinea Capitis (Scalp Ringworm) ** • Seborrheic Dermatitis ** • Cellulitis / Folliculitis ** • Psoriasis ** • Discoid Lupus  ** • Numerous conditions which require a ……..Dermatologist’s evaluation   ….*  usually Diffuse hair loss ….**  usually Focal hair loss x . . . . x

Normal Scalp:  We determine if Hair Loss is

• Diffuse (affects the whole scalp); or
• Focal (just in one place)

If Diffuse Hair Thinning:

• “Inciting Event” 1-6 months prior  →  Telogen Effluvium
• Abrupt recent onset & ongoing loss <12 mos. w/o “inciting event”  →  Telogen Effluvium
• Post-menopausal woman, very gradual onset  →  Female-Pattern Hair Loss
• History of hair pulling/twisting  →  Trichotillomania
• Ask about possible Vitamin A toxicity (from pills) (blood test not accurate)
• Blood Tests: CBC (for Anemia), TSH (for Hyperthyroidism), Ferritin (for Iron Deficiency)
• If debilitated, alcoholic, cirrhotic  →  we try Multivitamins as treatment
• If diffuse extensive hair loss  →  we refer to Dermatology

If Focal Hair Loss:

• Patches of nearly-complete baldness  →  Alopecia Areata
• Patches of loss,, but where hair still grows  →  maybe 2º Syphilis  (we order blood test)
• Hair Style suggests traction / yanking of hair  →  Traction Alopecia
• Blood Tests:  RPR (for Syphilis) and ANA (for possible consider SLE)
• History of hair pulling/twisting  →  Trichotillomania
• Man with very gradual hair loss  →  Male-Pattern Hair Loss

Skin Involvement of Scalp (“scarring alopecia”)

We Consider some Common Diagnoses

• Child w/ round scaly plaque  →  Tinea Capitis
• Scales along hairline  →  Seborrheic Dermatitis / Psoriasis
• Individual hair follicles red, maybe oozing slight pus →  Folliculitis
• Patch of spreading redness (painful, warm & tender to touch) →  Cellulitis
• Red, scaly patches  →  Discoid Lupus
• None of Above  →  Refer to Dermatology
• Treatment of above not helpful  →  Refer to Dermatology

See Hair Loss — Full Text for more in-depth explanations and discussions.