Hair loss

Question 1

What are some required points when taking a history of hair loss?

Answer 1

• Duration and course
• Associated illness
• Psychological or physical stresses
• Drugs
• Menstrual or hormonal cycle
• Family history

Question 2

What needs to be examined for in hair loss?

Answer 2

Pattern, signs of underlying inflammation, density, follicular plugging and the presence of disease elsewhere

Question 3

What are some clinical investigations used in hair loss?

Answer 3

• Skin scrapings
• Hair pluckings
• Woods lamp examination
• Dermoscopy
• Scalp biopsy
• Blood tests (FBC, TFTs, Iron and zinc, hormone profile)

Question 4

What are some ways in which hair loss can be classified?

Answer 4

Local or general
Scarring or non-scarring

Question 5

What is meant by scarring hair loss?

Answer 5

Hair follicles are lost in the condition

Question 6

What is meant by non-scarring hair loss?

Answer 6

Follicles are still present, so the hair can regrow

Question 7

What are some conditions causing non-scarring hair loss?

Answer 7

• Alopecia areata
• Androgenetic
• Trichotillomania
• Traction alopecia
• Tinea capitis

Question 8

What are some conditions causing scarring hair loss?

Answer 8

• Burns/Trauma
• CDLE
• Lichen planus
• Frontal fibrosing alopecia

Question 9

What are some causes of generalised hair loss (Usually non-scarring)?

Answer 9

• Telogen effluvium (E.g. severe illness, childbirth, stress)
• Endocrine (E.g. thyroid disease)
• Drugs
• Dietary deficiency (E.g. iron, zinc, vitamin D)
• Diffuse alopecia areata
• Malnutrition
• Androgenetic alopecia

Question 10

What is alopecia areata?

Answer 10

This is an autoimmune form of hair loss which can affect either just the scalp or the whole body

Question 11

How will alopecia areata present?

Answer 11

This is usually localised and non-scarring, leading to broken or tapering hair (Cadaver hair)

This can affect parts of the scalp, the whole scalp (Alopecia totalis) or the whole body (Alopecia universalis)

There will often be recurrent episodes of hair loss with possible growth between

Question 12

How is alopecia areata managed?

Answer 12

Supportive management only as it will usually regrow

Question 13

What are some supportive management options used in alopecia areata?

Answer 13

• Topical steroids
• IL steroids
• Wig provision

Question 14

What is trichotillomania?

Answer 14

This is a psychological condition in which the patient tears out pieces of hair

Question 15

Who is most at risk of tinea capitis?

Answer 15

This is most frequent in prepubertal children, in areas of poverty and crowded living conditions

Question 16

What are some investigations required for tinea capitis?

Answer 16

Skin scrapings
Hair plucking
Woods lamp

Question 17

How is tinea capitis usually managed?

Answer 17

Oral anti-fungals

Question 18

What is a possible complication of tinea capitis?

Answer 18

Kerion

Question 19

What is kerion?

Answer 19

Dramatic immune response to fungal infection, may be abscess formation, can cause localised scarring hair loss

Question 20

What is androgenic (Male pattern) hair loss?

Answer 20

This is a natural process of ageing in which there is pattern hair loss

Question 21

What are some treatment options for androgenic hair loss?

Answer 21

Minoxidil
Anti-androgens

Question 22

What are some patterns of male pattern hair loss?

Answer 22