Hair Loss — Pictures

The following pictures of select conditions are organized as such:

1.  NORMAL SCALP (no skin conditions)

1.a.  Focal Hair Loss
  • Alopecia Areata
  • Secondary Syphilis
  • Male-Pattern Hair Loss
  • Traction Alopecia
1.b.  Diffuse Hair Loss
  • Telogen Effluvium
  • Female-Pattern Hair Loss
  • Tricotillomania  (may be focal or diffuse)
2.  SCALP DISEASE PRESENT  (Scarring Alopecia)
  • Tinea Capitus
  • Seborrheic Dermatitis
  • Psoriasis
  • Cellulitis / Folliculitis
  • Discoid Lupus (may be focal or diffuse)

NORMAL SCALP WITH FOCAL HAIR LOSS

Alopecia Areata  (patches of total hair loss)

Alopecia Areata
1 or more patches of complete hair loss, no skin involvement

Alopecia Areata (need to R/O 2° Syphilis)

Secondary Syphilis

Hair loss from 2° Syphilis can mimic Alopecia Areata. Draw RPR.

Secondary Syphilis (RPR pos. 1:32)

Male-Pattern Hair Loss  (normal skin)

Male-Pattern Hair Loss begins at hairline or vertex, and spreads

Traction Alopecia

Traction Alopecia caused here by tight braiding.

Traction Alopecia: May need to inquire about how patient styles hair

NORMAL SCALP WITH DIFFUSE HAIR LOSS

Telogen Effluvium

Telogen Effluvium Diffuse hair loss with normal skin

Telogen Effluvium: Diffuse hair loss (normal scalp)

Female-Pattern Hair Loss

Female-Pattern Hair Loss may start focal but often diffuse. onset usually post-menopausal. May mimic Telogen Effluvium.

Tricotillomania

Tricotillomania — Patterns completely variable. History of compulsive hair-pulling may be difficult to obtain.

Tricotillomania

SCARRING ALOPECIA  (Skin Disease Noted)

Tinea Capitus

Tinea Capitus: In developed countries only occurs in children. requires systemic therapy.

Tinea Capitus: annular lesion with leading edge is give-away.

Seborrheic Dermatitis

Seb Derm: Red, greasy patches at hairline, may extend down face

Seborrheic Dermatitis: If only at hairline, may mimic Psoriasis

Psoriasis

Reddish component looks like Seb Derm, but the white/silver scales are a give-away for Psoriasis.

Psoriasis: Patients may not be aware of scalp involvement that’s subtle or concealed.

Folliculitis / Cellulitis

Pustular lesions suggest Folliculitis (invariably Staph) as cause of hair loss.

Folliculitis: Inflammation of hair follicles. Untreated, can cause permanent scarring hair loss.

Folliculitis can extend to frank Cellulitis. Given the pustules here, would treat for Staph (not Strep)

Discoid Lupus

Discoid Lupus (alone, or as a component of SLE)
Red papule or plaque, spreads with peripheral hyperpigmentation and central pallor, atrophy, or scarring.

Discoid Lupus: Diagnosis is easier if body lesions accompany those of the scalp.

Though a picture may be worth 1,000 words, posting on Hair Loss is also worth reading.

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