Hair Loss

HAIR LOSS  —  DIFFERENTIAL DIAGNOSIS

No Scalp Disease

Misc. Rare Causes
  • Hyperthyroidism *
  • Vitamin A toxicity *
  • Iron Deficiency ??? *
  • Zinc Deficiency *
  • Thallium Poisoning *
  • Selenium toxicity *
  • Chemotherapy *

Scalp Involvement Present

 
 
*     usually Diffuse Involvement
**   may be Diffuse or Focal

Click link for a few Pictures.

SUMMARY APPROACH TO “HAIR LOSS”

1.  Determine if there’s Skin Disease of the scalp

Normal Scalp:  Determine if hair Loss is Diffuse or Focal

If Diffuse Hair Thinning:
  • “Inciting Event” 1-6 months prior  →  Telogen Effluvium
  • Abrupt onset w/o “inciting event”  →  Telogen Effluvium
  • Post-menopausal woman, insidious onset  →  Female-pattern Hair Loss
  • History of hair pulling/twisting  →  Tricotillomania
  • Seek history compatible w/ Vitamin A toxicity
  • Obtain CBC, TSH, serum ferritin
  • If debilitated, alcoholic, cirrhotic  →  empiric trial of Multivitamins
  • If diffuse complete hair loss  →  refer to Derm
If Focal Hair Loss:
  • Patches of near-complete baldness  →  Alopecia AreataHair Style suggests traction  →  Traction Alopecia
    • Obtain RPR (→  Syphilis) and ANA (→  consider SLE)
  • History of hair pulling/twisting  →  Tricotillomania
  • Man with insidious onset hair loss  →  Male-pattern Baldness

Skin Involvement of Scalp (scarring alopecia)

Consider some Common Diagnoses
  • Child w/ round scaly plaque  →  Tinea Capitus
  • Scales along hairline  →  Seborrheic Dermatitis / Psoriasis
  • Discrete erythema/pustules of follicles  →  Folliculitis
  • Patch of diffuse erythema  →  Cellulitis
  • Red, scaly patches  →  Discoid Lupus
  • None of Above  →  Refer to Derm
  • Treatment of above not helpful  →  Refer to Derm

Refer also to full posting Hair Loss.