Visit the above link to see all photos

Remember these –
-
-
-
Androgenic alopecia – the commonest ( 50% of men by 40 and females by 60 )
-
Alopecia areata – ( PATCHY LOSS with non inflamed normal skin ) – bad prognosis if it begins in childhood and if there are several patches involved
-
seborrheic dermatitis – see the yellow discharge
-
Tenia capitis (Patchy losswith inflamed skin )
-
scalp psoriasis – see the scales – silver colour
-
Trichotalamenia ( Patchy loss with non inflamed normal skin )
-
Anagen Effluvium
-
Telogen Effluvium
-
Lichen planus
-
-
Algorithm
-
-
-
First look for patchy or full hair loss
-
if patchy – is the skin in the patch normal or inflamed
-
If normal skin – its either Alopecia Areata or tricotalamenia
-
However, Alopecia Areata – complete hair loss in the patch
-
And Tricotalamenia – there is hair in the patch ( not complete loss of hair as the patient pulls him/her self )
-
If inflamed skin – Tinea capitis, Seborrheic dermatitis or Psoriasis are the D/D – ( however, silver scales are noted in psoriasis and scales are yellow in Seborrheic dermatitis )
-
if there is no patch, but generalised – after Chemo – its anagen effluvium
-
if the number of hair lost in a day is around 100 -150 ( rather than usual 50 to 100/ more than usual hair loss ) – its telogen effluvium
-
Lichen planus would have other signs in the body – so easy to differentiate from the above
-
-
Alopecia Areata – Alopecia totalis – Alopecia Universalis –
Alopecia Areata – patches of complete hair loss ( This is the only reason/diagnosis for complete patch of loss. In trichotalamenia visible small hair in the patch is noted )
If the patch is small – it may recover –
can trial topical steroids – or intra lessional steroids as a treatment
if larger patches with > 50% loss – – referral to dermatologist for oral steroids
Alopecia totalis- ( all hair in scalp lost ) – if in children – unlikely to recover – in healthy fit adults, may recover
Alopecia Universalis ( all hair in the body lost ) – would not recover
Patchy hair loss – look at the skin in the patch –

silver scales are noted in psoriasis and scales are yellow in Seborrhic dermatitis
Tiena capitis – features of fungal infection can be notes in skin
Traumatic forms of hair loss

Note – Skin is usually normal
Telogen Effuvium –

has a bulb at the end (club ). Excessive shedding is known as effluvium.
Scalp continues to grow but has a shorter natural length than normal.
Diffuse hair loss ( around 150 hair loss rather than the normal 50 – 100 )
It occurs 2–6 months after an event that stops active growth.
effluvium is caused by:
-
-
-
Child-bearing
-
-
Weight loss
-
-
A surgical operation, illness or psychological stress
-
Medications, including contraceptives, anticoagulants, anticonvulsants.
-
-
Hair would grow again
recover in 5-6 months
if not recovering after 6 months – refer to specialist.
Anagen Effuvium

Anagen Effuvium is caused by
-
-
-
Autoimmune disease – E.G – severe diffuse alopecia areata
-
Medications E.G – cytotoxic / chemotherapy drugs
-
Inherited/congenital conditions E.G – loose anagen syndrome
-
-
Short broken hairs and empty may be observed.
If caused by a drug or toxin, growth can return to normal within 3–6 months of its withdrawal.
Balding patters – Normal

Pattern loss is due to programming or hormonal influences. It is also called androgenetic because it is influenced by .
Pattern is apparent in about 50% of individuals by the age of 50 years.
Male pattern affects vertex and scalp.
Female pattern is less pronounced and affects the scalp
Hair pull test –
Hair loss associated with excessive shedding results in a positive “gentle hair pull” test. Grasp a lock of hairs to determine if any can be extracted with firm pull. Normally 0-2 telogen hairs can be extracted: these are hairs in the resting phase, identified using magnification by a rounded bulb at the proximal end. An elongated or tapered end indicates anagen hair (growing phase); anagen hairs extracted by the gentle hair pull test are pathologic.
Previous TopicNext Topic