Alopecia history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

History

A careful medical history and examination of the hair and scalp are usually enough to diagnose the cause of your hair loss.

Your doctor will ask detailed questions such as:

• Are you losing hair only from your scalp or from other parts of your body as well?
• Is there a pattern to the hair loss, like a receding hairline or thinning or bald areas on the crown, or is the hair loss throughout your head?
• Have you had a recent illness or high fever?
• Do you dye your hair?
• Do you blow dry your hair? How often?
• How often do you shampoo your hair?
• What kind of shampoo, hair spray, gel, or other product do you put on your hair?
• Have you been under unusual stress lately?
• Do you have nervous habits that include hair pulling or scalp rubbing?
• Do you have any other symptoms like itching, flaking, or redness of your scalp?
• What medications do you take, 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.

References

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