Alopecia physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Physical Examination

Appearance of the Patient

The appearance of the patient can provide clues to the diagnosis of alopecia.

Head

• Scalp
  • Normal or with features of scarring
  • If scalp is abnormal it provides clues to the differential diagnosis
    • Scaling
    • Erythema
    • Pustules
    • Dyspigmentation
• Pattern: Diffuse or patchy
  • Male pattern (diffuse): Bitemporal recession +/or vertex loss
  • Female pattern (diffuse): Coronal thinning with preserved anterior hairline
  • Patchy: With preserved hair of variable length (breakage)
    • With exclamation point hairs (alopecia areata)
    • With no hair (scarring, traction, syphilis, tinea)

Extremities

• Patient may also have nails that have a hammered brass appearance.