Introduction

There are numerous potential etiologic factors in alopecia (hair loss). Endocrine abnormalities, genetic factors, systemic illness, drugs, psychological abnormalities, diet, trauma, infections, and structural hair defects can all cause hair loss. Evaluation of the patient must be thorough and include history, physical examination, and appropriate laboratory work-up.

History is of utmost importance in making the correct diagnosis. The duration of hair loss, family history, location of hair loss (diffuse vs. focal), drug intake history, hair care habits (bleaching, back brushing, permanent waving), and presence of coincidental acne and abnormal menstrual cycles are all important clues.

Questions your doctor may ask you
    • What is the duration of the hair loss problem?
    • Is the hair coming out by the roots, or is it breaking?
    • Do you notice increased shedding or increasing thinning?
    • At what age did hair loss begin?
    • What drugs are you taking?
    • Are you experiencing menses? pregnancy? menopause?
    • In the past, how would you describe your health?
    • Do you have a family history of hair loss?
    • What are your hair care? hair cosmetic habits?
    • How would you describe your diet?

It is important to determine whether the hair falls out from the roots or breaks off along the shaft,
since there are distinct diagnoses for each of these problems.
Possible Causes for:
Hair coming out by the roots Hair breaking
Telogen effluvium

Androgenetic alopecia

Alopecia areata

Drugs

 Tinea capitis

Structural hair shaft abnormalities

Breakage due to improper
use of hair care cosmetics

Anagen arrest

Clinical examination of all hair-bearing areas should be performed. Checking for inflammation, infection and scarring (loss of the hair follicle) is of utmost importance. The differential diagnosis of hair loss is based on whether the loss is a result of scarring or not.

Possible Causes for:
Non-scarring hair loss Scarring hair loss
Androgenetic alopecia

Telogen effluvium

Alopecia areata

Tinea capitis

 Discoid lupus erythematosus

Lichen planus

Pseudopelade

Severe fungal, viral or bacterial infection

In cases of non-scarring alopecia, laboratory testing may include a complete blood count, thyroid-stimulating hormone, serum ferritin, and VDRL. In women with androgenetic alopecia and other virilizing signs, an androgen work-up for free testosterone, androstenedione, and dehydroepiandrosterone
(DHEAS) is advised. Scarring alopecias are difficult to differentiate from one another clinically, and almost always require a 4-mm scalp biopsy to determine the correct diagnosis.
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