Alopecia physical examination

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

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.