Hair Loss Diagnosis

Alopecia differential diagnosis
Because of the multiplicity of disorders that can result in hair loss, a thorough history and physical examination are important, laboratory tests may be necessary.
Is the hair loss associated with scalp scarring or not?
Who is the patient?
Who else among the family members?
What exactly is the problem, shedding or thinning?
When did the problem start?
Where is the hair falling, scalp or other body parts?
Is hair falling with roots, or is it breaking?
Diffuse, localized or patterned?
Drugs
Diseases
Diet
Doing any hair care procedure?

1. Is the hair loss associated with scalp scarring or not?
It is important to determine if the hair loss is associated with scalp scarring, as this introduces an entirely different differential diagnosis
In non-scarring alopecias the follicular units are visible, while scarring alopecias are devoid of follicular units.

2. Who is the patient?
This question is to determine the sex and the age of the patient.
The age of the patient is very important. Certain conditions are more common in childhood compared to the adult.
The two most common forms of hair loss in children are Tinea capitis and alopecia areata.
If the patient is female, pharmacist should ask about menstruation, pregnancy or menopause.

3. Who else among the family members?
This question is to question the family history.
A positive family history of alopecia areata or androgenetic alopecia may point to a genetic predisposition for hair loss.

4. What exactly is the problem, shedding or thinning?
Patients should be asked regarding hair shedding (alopecia areata or telogen effluvium) versus simple hair thinning without shedding (androgenetic alopecia).

5. When did the problem start?
This question to determine the onset of hair loss, whether it is acute or gradual.

7. Is hair falling with roots, or is it breaking?
It is very important to detect whether the hair is coming out by roots or the hair is broken.

8. Diffuse, localized or patterned?
Generally, there are two main types of alopecia:
1. Diffuse alopecia: hair falls from the whole scalp.
2. Localized (patchy) alopecia: hair falls only from a part of the scalp.
Random patterns are more common for alopecia areata.
In Androgenetic alopecia hair loss follows certain patterns. There is specific patterns for both males and females.

9. Diseases
Conditions showing telogen effluvium are any pregnancy, high fever, operations/general anesthesia, crash diets, or weight loss in the preceding 6 months.
The presence or absence of coincidental acne and abnormal menstrual cycles may indicate an androgen excess causing androgenetic alopecia.
Psychological stress can cause telogen effluvium.
Telogen effluvium may sometimes be the first or only cutaneous sign of hypothyroidism.
Severe thyrotoxicosis can also cause telogen effluvium of the scalp.
Hodgkin’s disease may present with telogen effluvium as its first sign.
Chronic renal disease can cause scalp hair can become dry, brittle and sparse .
There may thinning of body hair, including pubic or axillary hair.
Hepatic disease disturbs liver metabolism of cystine and methionine which may cause telogen effluvium since the liver is the major site of amino acid inter-conversion.
Malabsorption should be investigated when sparse hair and growth retardation are associated with chronic frequent loose pale and bulky stools.

10. Drugs
A full list of current and past medication should be obtained, since many medications can induce hair loss.

11. Diet
Crash diet of salads and fruits lacking in protein can lead to telogen effluvium.
A strict vegetarian diet can implicate iron deficiency anemia.