Hair Loss

See link for Some Pictures of Conditions Causing Hair Loss

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

  • Isย 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
โ€ข Telogen Effluviumย  *
โ€ข Natural Hair Loss Patterns
…….. โ€ข Female-Pattern *, ** at start
…….. โ€ข Male-Pattern *
โ€ข Alopecia Areataย  **
โ€ข Traction Alopeciaย  **
โ€ข 2ยบ Syphilisย  **
โ€ข Trichotillomaniaย  ** ย 

xxxxxMisc. Rare Causes
โ€ข Hyperthyroidismย  *
โ€ข Vitamin A toxicityย  *
โ€ข Iron Deficiency ???ย  *
โ€ข Zinc Deficiencyย  *
โ€ข Thallium Poisoningย  *
โ€ข Selenium toxicityย  *
โ€ข Cancer Chemotherapyย  *
xxxxxScalp Involvement is Present
โ€ข Tinea Capitis (Scalp Ringworm) **
โ€ข Seborrheic Dermatitis **
โ€ข Cellulitis / Folliculitis **
โ€ข Psoriasis **
โ€ข Discoid Lupusย  **
โ€ข Numerous conditions which require a ……..Dermatologistโ€™s evaluation

….*ย  usually Diffuse hair loss
….**ย  usually Focal hair loss

Normal Scalp:  We determine if Hair Loss is

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

If Diffuse Hair Thinning:

  • โ€œInciting Eventโ€ 1-6 months priorย  โ†’ย ย Telogen Effluvium
  • Abrupt recent onset & ongoing loss <12 mos. w/o โ€œinciting eventโ€ย  โ†’ย ย Telogen Effluvium
  • Post-menopausal woman, very gradual onset ย โ†’ย ย Female-Pattern Hair Loss
  • History of hair pulling/twistingย  โ†’ย ย 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, cirrhoticย  โ†’ย ย we try Multivitamins as treatment
  • If diffuse extensive hair lossย  โ†’ย  we refer to Dermatology

If Focal Hair Loss:

  • Patches of nearly-complete baldnessย  โ†’ย  Alopecia Areata
  • Patches of loss,, but where hair still growsย  โ†’ย  maybe 2ยบ Syphilis ย (we order blood test)
  • Hair Style suggests traction / yanking of hairย  โ†’ย  Traction Alopecia
  • Blood Tests:ย  RPR (for Syphilis) and ANA (for possible consider SLE)
  • History of hair pulling/twistingย  โ†’ย  Trichotillomania
  • Man with very gradual hair lossย  โ†’ย ย Male-Pattern Hair Loss

Skin Involvement of Scalp (โ€œscarring alopeciaโ€)

We Consider some Common Diagnoses

  • Child w/ round scaly plaqueย  โ†’ย ย Tinea Capitis
  • Scales along hairlineย  โ†’ย ย Seborrheic Dermatitisย /ย Psoriasis
  • Individual hair follicles red, maybe oozing slight pus โ†’ย  Folliculitis
  • Patch of spreading redness (painful, warm & tender to touch) โ†’ย ย Cellulitis
  • Red, scaly patchesย  โ†’ย ย Discoid Lupus
  • None of Aboveย  โ†’ย ย Refer to Dermatology
  • Treatment of above not helpfulย  โ†’ย ย Refer to Dermatology

Seeย Hair Loss โ€” Full Textย for more in-depth explanations and discussions.

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