Hair Loss

Hair Loss

1. History

   • Localized or generalized?
   • Itchiness, erythema, dandruff
   • Hair loss - on pillow, during combing?
   • Area? Frontal (androgenic) vs occipital (Infant, friction alopecia)
   • Hair thinning? (Terminal -> Vellus hair)
   • Hair pulling? (Trichotillomania)
   • Chronic medical diseases, psycho stressors
   • FHx: androgenetic baldness
   • SLE: Facial rashes, joint pain, oral ulcers
   • Hypothyroidism: Malaise, oedema, constipation, cold intolerance

2. Normal hair loss: ~50-100 lost/day on scalp

3. DDX

   • Autoimmune, endocrine: SLE, hypothyroidism
   • Drugs: Chemotherapy, valproiac acid, androgens, steroids
   • Infection: Tinea capitis (fungal)
   • Autoimmune: Alopecia areata
   • Androgenic alopecia
   • Traction alopecia, Friction alopecia
   • Trichotillomania, stress-induced

4. Ix

   • Autoimmune markers, TFT
   • Woods lamp: Fluorescence with Microsporum species (None if Trichophytons spp)

5. Tx

   • Systemic antifungal: Griseofulvin, Terbinafine, Itraconazole (bulb of hair shaft cannot be effectively tx topically)