Hair Loss — [very] Rare Causes

Thyroid Disease: Other Sx invariably present

• Can order a simple TSH (very low yield)

Vitamin A Toxicity (not so rare)

• Skin turns orange-color
• History of excessive carrot juice or high-dose vitamins

Selenium toxicity:  Only among OTC vitamin faddists

Thallium Poisoning:

• Nausea & vomiting occur right away
• Rapidly progressive hair loss begins at 2-3 weeks
• Hair loss accompanied by painful peripheral neuropathy
• Call poison control if suspicious

Zinc Deficiency:

• Consider in the debilitated, or elderly without adequate food access
• Consider in persons with cirrhosis or chronic pancreatitis
• Can be exacerbated by diuretics and ACE-Inhibitors
• Diagnose by empiric supplementation (serum zinc testing unreliable)

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