alopecia
ALOPECIA

Alopecia is an involuntary loss of hair usually in the scalp that may occur anywhere over the body.
Scarring alopecia is severe inflammation of the hair follicle result in irreversible damage.
Non-scarring alopecias are reversible.
Alopecia may  be abrupt or gradual in onset.
Most common causes include androgenic alopecia (male & female pattern baldness) & alopecia areata.
History should be reviewed for medications, severe diet restriction, vitamin A supplementation, thyroid symptoms, concomitant illness & stress factor.

History

Androgenic alopecia in men/women
  • 20% do not have a family history
  • An androgen-dependent trait
Alopecia areata
  • Family history of alopecia
  • Patients often give a history of emotional trauma/stress prior to its onset
  • Usually rapid hair loss in a well-defined, typically round area
  • Patients complain of 1-4 cm2 of hair loss on the scalp
    • Patch is usually clean-looking without scaling
  • May be asymptomatic, but some patients experience paresthesias with pruritus, burning sensation, pain or tenderness prior to loss of hair

Laboratory Tests

Androgenic alopecia in men/women

  • Rarely indicated for MPHL and women with normal menstrual cycle
  • If with evidence of androgen excess in FPHL, consider Total testosterone, free testosterone, DHEA-S, prolactin levels
  • If without evidence of androgen excess: Rule out thyroid disease, syphilis, Fe deficiency and Systematic Lupus Erythematosus (SLE) as cause of hair loss
  • Biopsy is sometimes necessary for FPHL to exclude chronic telogen effluvium, diffuse alopecia areata or cicatricial hair loss
  • Hair pull positive in active early hair loss but negative in long standing hair loss

Alopecia areata

  • Diagnosis is usually clinical
  • Hair pull test may be positive at the margins which is indicative of active disease
  • Patch biopsy of the scalp in rare difficult cases
  • Thyroid Stimulating Hormone (TSH) hormone level determination is routinely performed by many physicians to rule out any related thyroid abnormality

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