Alopecia history and symptoms: Difference between revisions
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{{ | {{alopecia}} | ||
{{CMG}} | {{CMG}}; {{AE}} [[Ogechukwu Hannah Nnabude, MD]] | ||
==Overview== | |||
The quantity, timing, and onset of hair loss can be important clues in narrowing down a diagnosis. It may happen overnight or over a span of months or years. Also, the clinician should inquire about the presence of stressors, co-morbidities, family history, use of bathing and hair care products, hygiene, diet, and overall health. Physical examination may also uncover important indicators of the cause of hair loss. Characteristics such as the pattern of hair loss as in [[androgenetic alopecia]] in which male patients tend to lose hair from the frontal and temporal area and female patients tend to lose hair at the central scalp area, or classic [[alopecia areata]] in which patients may lose hair from a single area or the face and scalp, as seen in [[alopecia totalis]]. In [[tinea capitis]], the classic presentation is black dots associated with broken hair, while [[favus]] correlates with the scarring type of [[alopecia]]. [[Telogen effluvium]] classically presents with diffuse thinning of hair and a positive [[hair pull test]]. In a patient with [[alopecia mucinosa]], the patient would have multiple flesh-colored [[papules]] and [[nodules]] infiltrating the skin of the scalp. | |||
==History and Symptoms== | ==History and Symptoms== | ||
===History=== | ===History=== | ||
The patient history is largely dependent on the type of [[alopecia]]: | |||
* | * In [[telogen effluvium]], there may be a history of recent childbirth, illness, high [[fever]] or extreme dieting <ref>Sperling LC, Cowper SE, Knopp EA. An atlas of hair pathology with clinical correlations. 2. Informa Healthcare; 2014. [Google Scholar]</ref> | ||
* [[Anagen effluvium]] is associated with a history of the use of [[chemotherapeutic agents]] or exposure to [[ionizing radiation]] <ref name="pmid24591533">{{cite journal| author=Qi J, Garza LA| title=An overview of alopecias. | journal=Cold Spring Harb Perspect Med | year= 2014 | volume= 4 | issue= 3 | pages= | pmid=24591533 | doi=10.1101/cshperspect.a013615 | pmc=3935391 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24591533 }} </ref> | |||
* | * In [[alopecia areata]], there is often a personal or family history of [[autoimmune diseases]] such as [[vitiligo]], [[thyroid disease]], and [[rheumatoid arthritis]] <ref name="pmid26244028">{{cite journal| author=Villasante Fricke AC, Miteva M| title=Epidemiology and burden of alopecia areata: a systematic review. | journal=Clin Cosmet Investig Dermatol | year= 2015 | volume= 8 | issue= | pages= 397-403 | pmid=26244028 | doi=10.2147/CCID.S53985 | pmc=4521674 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26244028 }} </ref> <ref name="pmid21616562">{{cite journal| author=Chu SY, Chen YJ, Tseng WC, Lin MW, Chen TJ, Hwang CY | display-authors=etal| title=Comorbidity profiles among patients with alopecia areata: the importance of onset age, a nationwide population-based study. | journal=J Am Acad Dermatol | year= 2011 | volume= 65 | issue= 5 | pages= 949-56 | pmid=21616562 | doi=10.1016/j.jaad.2010.08.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21616562 }} </ref> | ||
* [[Androgenetic alopecia]] is often associated with a strong family history of the disorder. <ref name="pmid27599903">{{cite journal| author=Kim BK, Chung HC, Jun M, Oh SS, Lee WS| title=Prevalence of fronto-vertex baldness and its association with family history of androgenetic alopecia in Korean men using basic and specific classification. | journal=J Dermatol | year= 2017 | volume= 44 | issue= 7 | pages= 850-852 | pmid=27599903 | doi=10.1111/1346-8138.13566 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27599903 }} </ref> | |||
* History of the use of certain medications such as [[anticoagulants]] <ref name="pmid27747798">{{cite journal| author=Watras MM, Patel JP, Arya R| title=Traditional Anticoagulants and Hair Loss: A Role for Direct Oral Anticoagulants? A Review of the Literature. | journal=Drugs Real World Outcomes | year= 2016 | volume= 3 | issue= 1 | pages= 1-6 | pmid=27747798 | doi=10.1007/s40801-015-0056-z | pmc=4819463 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27747798 }} </ref>, [[anticonvulsants]] <ref name="pmid29207731">{{cite journal| author=Thomson SR, Mamulpet V, Adiga S| title=Sodium Valproate Induced Alopecia: A Case Series. | journal=J Clin Diagn Res | year= 2017 | volume= 11 | issue= 9 | pages= FR01-FR02 | pmid=29207731 | doi=10.7860/JCDR/2017/28564.10658 | pmc=5713753 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29207731 }} </ref> <ref name="pmid13715510">{{cite journal| author=HOLOWACH J, SANDEN HV| title=Alopecia as a side effect of treatment of epilepsy with trimethadione. Report of two cases. | journal=N Engl J Med | year= 1960 | volume= 263 | issue= | pages= 1187 | pmid=13715510 | doi=10.1056/NEJM196012082632308 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13715510 }} </ref> and [[antidepressants]] <ref name="pmid28763345">{{cite journal| author=Etminan M, Sodhi M, Procyshyn RM, Guo M, Carleton BC| title=Risk of hair loss with different antidepressants: a comparative retrospective cohort study. | journal=Int Clin Psychopharmacol | year= 2018 | volume= 33 | issue= 1 | pages= 44-48 | pmid=28763345 | doi=10.1097/YIC.0000000000000191 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28763345 }} </ref>, poor diet <ref name="pmid28243487">{{cite journal| author=Guo EL, Katta R| title=Diet and hair loss: effects of nutrient deficiency and supplement use. | journal=Dermatol Pract Concept | year= 2017 | volume= 7 | issue= 1 | pages= 1-10 | pmid=28243487 | doi=10.5826/dpc.0701a01 | pmc=5315033 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28243487 }} </ref> and chemical hair products <ref name="pmid8504045">{{cite journal| author=Nicholson AG, Harland CC, Bull RH, Mortimer PS, Cook MG| title=Chemically induced cosmetic alopecia. | journal=Br J Dermatol | year= 1993 | volume= 128 | issue= 5 | pages= 537-41 | pmid=8504045 | doi=10.1111/j.1365-2133.1993.tb00231.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8504045 }} </ref> are also associated with hair loss. | |||
* | |||
* | |||
===Symptoms=== | ===Symptoms=== | ||
The locations and patterns of the hair loss are often used as a clue to determine the likely cause of the hair loss | |||
* In [[androgenetic alopecia]], the hair loss is at the crown of the head in both men and women. However, the frontal hair line is also affected in men unlike in women where it is often spared. <ref name="pmid24591533">{{cite journal| author=Qi J, Garza LA| title=An overview of alopecias. | journal=Cold Spring Harb Perspect Med | year= 2014 | volume= 4 | issue= 3 | pages= | pmid=24591533 | doi=10.1101/cshperspect.a013615 | pmc=3935391 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24591533 }} </ref> | |||
* [[Alopecia areata]] often presents with patchy, well-defined areas of hair loss that can affect anywhere on the body. However, the scalp and beard are the most commonly affected areas <ref name="pmid24591533">{{cite journal| author=Qi J, Garza LA| title=An overview of alopecias. | journal=Cold Spring Harb Perspect Med | year= 2014 | volume= 4 | issue= 3 | pages= | pmid=24591533 | doi=10.1101/cshperspect.a013615 | pmc=3935391 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24591533 }} </ref> <ref name="pmid28300084">{{cite journal| author=Pratt CH, King LE, Messenger AG, Christiano AM, Sundberg JP| title=Alopecia areata. | journal=Nat Rev Dis Primers | year= 2017 | volume= 3 | issue= | pages= 17011 | pmid=28300084 | doi=10.1038/nrdp.2017.11 | pmc=5573125 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28300084 }} </ref> | |||
* [[Telogen effluvium]] is characterized by excessive hair loss that is often preceded by a trauma, illness, or any other kind of psychological, or physiological stress. <ref name="pmid32607303">{{cite journal| author=Asghar F, Shamim N, Farooque U, Sheikh H, Aqeel R| title=Telogen Effluvium: A Review of the Literature. | journal=Cureus | year= 2020 | volume= 12 | issue= 5 | pages= e8320 | pmid=32607303 | doi=10.7759/cureus.8320 | pmc=7320655 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32607303 }} </ref> | |||
* Uneven patterns and broken hairs around the scalp, beard, moustache, side burns, and eyebrows are a finding associated with [[trichotillomania]]. This is especially true if seen in adolescents as the disorder is more common in the age group <ref>Sperling LC, Cowper SE, Knopp EA. An atlas of hair pathology with clinical correlations. 2. Informa Healthcare; 2014. [Google Scholar]</ref> <ref name="pmid20946585">{{cite journal| author=Quercetani R, Rebora AE, Fedi MC, Carelli G, Mei S, Chelli A | display-authors=etal| title=Patients with profuse hair shedding may reveal anagen hair dystrophy: a diagnostic clue of alopecia areata incognita. | journal=J Eur Acad Dermatol Venereol | year= 2011 | volume= 25 | issue= 7 | pages= 808-10 | pmid=20946585 | doi=10.1111/j.1468-3083.2010.03869.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20946585 }} </ref> | |||
* Loss of the lateral parts of the eyebrows, along with the commonly seen symptoms of cold intolerance, weight gain, constipation, and dry skin are suggestive of [[hypothyroidism]] <ref name="pmid28336049">Chaker L, Bianco AC, Jonklaas J, Peeters RP (2017) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=28336049 Hypothyroidism.] ''Lancet'' 390 (10101):1550-1562. [http://dx.doi.org/10.1016/S0140-6736(17)30703-1 DOI:10.1016/S0140-6736(17)30703-1] PMID: [https://pubmed.gov/28336049 28336049]</ref> <ref name="pmid21250172">{{cite journal| author=Walker HK, Hall WD, Hurst JW| title=Clinical Methods: The History, Physical, and Laboratory Examinations | journal= | year= 1990 | volume= | issue= | pages= | pmid=21250172 | doi= | pmc= | url= }} </ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
Latest revision as of 03:58, 29 December 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogechukwu Hannah Nnabude, MD
Overview
The quantity, timing, and onset of hair loss can be important clues in narrowing down a diagnosis. It may happen overnight or over a span of months or years. Also, the clinician should inquire about the presence of stressors, co-morbidities, family history, use of bathing and hair care products, hygiene, diet, and overall health. Physical examination may also uncover important indicators of the cause of hair loss. Characteristics such as the pattern of hair loss as in androgenetic alopecia in which male patients tend to lose hair from the frontal and temporal area and female patients tend to lose hair at the central scalp area, or classic alopecia areata in which patients may lose hair from a single area or the face and scalp, as seen in alopecia totalis. In tinea capitis, the classic presentation is black dots associated with broken hair, while favus correlates with the scarring type of alopecia. Telogen effluvium classically presents with diffuse thinning of hair and a positive hair pull test. In a patient with alopecia mucinosa, the patient would have multiple flesh-colored papules and nodules infiltrating the skin of the scalp.
History and Symptoms
History
The patient history is largely dependent on the type of alopecia:
- In telogen effluvium, there may be a history of recent childbirth, illness, high fever or extreme dieting [1]
- Anagen effluvium is associated with a history of the use of chemotherapeutic agents or exposure to ionizing radiation [2]
- In alopecia areata, there is often a personal or family history of autoimmune diseases such as vitiligo, thyroid disease, and rheumatoid arthritis [3] [4]
- Androgenetic alopecia is often associated with a strong family history of the disorder. [5]
- History of the use of certain medications such as anticoagulants [6], anticonvulsants [7] [8] and antidepressants [9], poor diet [10] and chemical hair products [11] are also associated with hair loss.
Symptoms
The locations and patterns of the hair loss are often used as a clue to determine the likely cause of the hair loss
- In androgenetic alopecia, the hair loss is at the crown of the head in both men and women. However, the frontal hair line is also affected in men unlike in women where it is often spared. [2]
- Alopecia areata often presents with patchy, well-defined areas of hair loss that can affect anywhere on the body. However, the scalp and beard are the most commonly affected areas [2] [12]
- Telogen effluvium is characterized by excessive hair loss that is often preceded by a trauma, illness, or any other kind of psychological, or physiological stress. [13]
- Uneven patterns and broken hairs around the scalp, beard, moustache, side burns, and eyebrows are a finding associated with trichotillomania. This is especially true if seen in adolescents as the disorder is more common in the age group [14] [15]
- Loss of the lateral parts of the eyebrows, along with the commonly seen symptoms of cold intolerance, weight gain, constipation, and dry skin are suggestive of hypothyroidism [16] [17]
References
- ↑ Sperling LC, Cowper SE, Knopp EA. An atlas of hair pathology with clinical correlations. 2. Informa Healthcare; 2014. [Google Scholar]
- ↑ 2.0 2.1 2.2 Qi J, Garza LA (2014). "An overview of alopecias". Cold Spring Harb Perspect Med. 4 (3). doi:10.1101/cshperspect.a013615. PMC 3935391. PMID 24591533.
- ↑ Villasante Fricke AC, Miteva M (2015). "Epidemiology and burden of alopecia areata: a systematic review". Clin Cosmet Investig Dermatol. 8: 397–403. doi:10.2147/CCID.S53985. PMC 4521674. PMID 26244028.
- ↑ Chu SY, Chen YJ, Tseng WC, Lin MW, Chen TJ, Hwang CY; et al. (2011). "Comorbidity profiles among patients with alopecia areata: the importance of onset age, a nationwide population-based study". J Am Acad Dermatol. 65 (5): 949–56. doi:10.1016/j.jaad.2010.08.032. PMID 21616562.
- ↑ Kim BK, Chung HC, Jun M, Oh SS, Lee WS (2017). "Prevalence of fronto-vertex baldness and its association with family history of androgenetic alopecia in Korean men using basic and specific classification". J Dermatol. 44 (7): 850–852. doi:10.1111/1346-8138.13566. PMID 27599903.
- ↑ Watras MM, Patel JP, Arya R (2016). "Traditional Anticoagulants and Hair Loss: A Role for Direct Oral Anticoagulants? A Review of the Literature". Drugs Real World Outcomes. 3 (1): 1–6. doi:10.1007/s40801-015-0056-z. PMC 4819463. PMID 27747798.
- ↑ Thomson SR, Mamulpet V, Adiga S (2017). "Sodium Valproate Induced Alopecia: A Case Series". J Clin Diagn Res. 11 (9): FR01–FR02. doi:10.7860/JCDR/2017/28564.10658. PMC 5713753. PMID 29207731.
- ↑ HOLOWACH J, SANDEN HV (1960). "Alopecia as a side effect of treatment of epilepsy with trimethadione. Report of two cases". N Engl J Med. 263: 1187. doi:10.1056/NEJM196012082632308. PMID 13715510.
- ↑ Etminan M, Sodhi M, Procyshyn RM, Guo M, Carleton BC (2018). "Risk of hair loss with different antidepressants: a comparative retrospective cohort study". Int Clin Psychopharmacol. 33 (1): 44–48. doi:10.1097/YIC.0000000000000191. PMID 28763345.
- ↑ Guo EL, Katta R (2017). "Diet and hair loss: effects of nutrient deficiency and supplement use". Dermatol Pract Concept. 7 (1): 1–10. doi:10.5826/dpc.0701a01. PMC 5315033. PMID 28243487.
- ↑ Nicholson AG, Harland CC, Bull RH, Mortimer PS, Cook MG (1993). "Chemically induced cosmetic alopecia". Br J Dermatol. 128 (5): 537–41. doi:10.1111/j.1365-2133.1993.tb00231.x. PMID 8504045.
- ↑ Pratt CH, King LE, Messenger AG, Christiano AM, Sundberg JP (2017). "Alopecia areata". Nat Rev Dis Primers. 3: 17011. doi:10.1038/nrdp.2017.11. PMC 5573125. PMID 28300084.
- ↑ Asghar F, Shamim N, Farooque U, Sheikh H, Aqeel R (2020). "Telogen Effluvium: A Review of the Literature". Cureus. 12 (5): e8320. doi:10.7759/cureus.8320. PMC 7320655 Check
|pmc=value (help). PMID 32607303 Check|pmid=value (help). - ↑ Sperling LC, Cowper SE, Knopp EA. An atlas of hair pathology with clinical correlations. 2. Informa Healthcare; 2014. [Google Scholar]
- ↑ Quercetani R, Rebora AE, Fedi MC, Carelli G, Mei S, Chelli A; et al. (2011). "Patients with profuse hair shedding may reveal anagen hair dystrophy: a diagnostic clue of alopecia areata incognita". J Eur Acad Dermatol Venereol. 25 (7): 808–10. doi:10.1111/j.1468-3083.2010.03869.x. PMID 20946585.
- ↑ Chaker L, Bianco AC, Jonklaas J, Peeters RP (2017) Hypothyroidism. Lancet 390 (10101):1550-1562. DOI:10.1016/S0140-6736(17)30703-1 PMID: 28336049
- ↑ Walker HK, Hall WD, Hurst JW (1990). "Clinical Methods: The History, Physical, and Laboratory Examinations". PMID 21250172.