Alopecia history and symptoms: Difference between revisions
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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 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 Physical Examination
A careful medical history and examination of the hair and scalp are usually enough to diagnose the cause of hair loss. Questions may include:
- Is the hair loss isolated to only hair from the scalp or from other parts of the body as well?
- Is there a pattern to the hair loss, such as a receding hairline or thinning or bald areas on the crown, or is the hair loss throughout the head?
- History of recent illness or high fever
- History of dyeing of hair
- History of use of blow dry? How often?
- History of frequency of using shampoo, kind of shampoo, hair spray, gel, or other product on hair
- History of unusual stress lately
- History suggestive of nervous habits that include hair pulling or scalp rubbing?
- Other symptoms like itching, flaking, or redness of your scalp
- Medication history including over-the-counter drugs?
Some of the specific observations that should be noted are as follows:
- Age
- Childhood: only 2 common diagnoses tinea capitis, alopecia areata
- Adulthood: tinea capitis rare; all the rest possible
- Duration
- <1 year: suggests telogen effluvium if diffuse loss
- >1 year: suggests androgenetic alopecia if diffuse loss
- Pattern of loss
- Shedding: “lots of hair coming out,” may be due to hair breakage or loss by the root
- Thinning: scalp more visible without noticeable hair fallout, suggests androgenetic alopecia
- Family history: may be positive in androgenetic alopecia, alopecia areata
- Grooming practices: can cause hair fragility/breakage
- Chemical treatments (relaxers, perms, bleaching) most damaging; hair dye less so
Symptoms
Hair loss usually develops gradually and may be patchy or all over (diffuse). You lose roughly 100 hairs from your head every day. The average scalp contains about 100,000 hairs.