Alopecia history and symptoms

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

History and Symptoms

History

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.