Approach to the Patient With Hair Loss

August 2023 in “ Journal of the American Academy of Dermatology ”

Kathryn Workman, Melissa Piliang

alopecia scarring alopecia cicatricial alopecia non-scarring alopecia noncicatricial alopecia dermatoscopy histopathological analysis iron deficiency female pattern hair loss chronic telogen effluvium direct immunofluorescence hair loss scarring hair loss non-scarring hair loss female hair loss chronic hair shedding

TLDR The guide helps dermatologists diagnose and treat different types of hair loss.

The document "Approach to the patient with hair loss" provides a comprehensive guide for diagnosing and categorizing different types of alopecia, including both scarring (cicatricial) and non-scarring (noncicatricial) forms. It emphasizes the importance of a thorough medical and social history, as well as the use of diagnostic tools such as dermatoscopy and histopathological analysis. The document includes visual aids and flowcharts to help clinicians identify patterns of hair loss and underlying conditions. It also discusses the role of iron deficiency in female pattern hair loss and chronic telogen effluvium, and highlights the value of direct immunofluorescence in differentiating cicatricial alopecia. The guide is intended to assist dermatologists in making accurate diagnoses and developing effective treatment plans for patients experiencing hair loss.

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Research cited in this study

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research Hair Breakage in Patients of African Descent: Role of Dermoscopy

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Dermoscopy helps quickly identify hair breakage in people of African descent.

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To diagnose hair loss, use a systematic approach including history, exams, and tests.

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The document concludes that using specific tools and tests is essential for identifying the cause of hair loss and deciding on the right treatment.

research Cicatricial (Scarring) Alopecias: Comprehensive Review and Management

44 citations, April 2012 in “American Journal of Clinical Dermatology”

Scarring alopecias are complex hair loss disorders that require early treatment to prevent permanent hair loss.

research Hair and Scalp Dermatoscopy

245 citations, March 2012 in “Journal of The American Academy of Dermatology”

Dermatoscopy is useful for identifying different hair and scalp conditions and can reduce the need for biopsies.

research Alopecia: Evaluation and Treatment

76 citations, July 2011 in “Clinical, Cosmetic and Investigational Dermatology”

The document concludes that proper diagnosis and FDA-approved treatments for different types of hair loss exist, but treatments for severe cases often fail and future improvements may focus on hair follicle stem cells.

research Iron Deficiency in Female Pattern Hair Loss, Chronic Telogen Effluvium, and Control Groups

72 citations, October 2010 in “Journal of The American Academy of Dermatology”

Iron deficiency common in women, not always linked to hair loss; more research needed.

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community Diffuse hair loss and scalp biopsies

in Research 692 upvotes 4 months ago

Scalp biopsies are crucial for diagnosing hair loss conditions like Diffuse Unpatterned Alopecia (DUPA) and retrograde hair loss, as treatments like finasteride and dutasteride may not be effective if other conditions are present. Combining PPAR-GAMMA agonists with retinoids could improve treatments for conditions like Lichen Planopilaris.

community I am a dermatologist with a clinical interest in alopecia. AMA

in Will treatment work for me? 2 years ago

In this conversation, 4990 discussed various treatments for hair loss, including oral minoxidil, PRP, transplan, Jak inhibitors, Dutasteride, Finasteride, Olumiant, Ketoconazole, RU58841, microneedling, baricitinib, and CCCA. They recommended scalp biopsies in unclear cases of DUPA, twice weekly to twice daily shampooing for topical minoxidil users, and two sessions spaced one month apart with follow up at month three to determine the effectiveness of PRP treatment.

community lost my hair in a single year of treatment at 20 years old

in Finasteride/Dutasteride 89 upvotes 4 months ago

A 20-year-old lost significant hair after one year of treatment, using minoxidil, finasteride, and later dutasteride. They are considering adding RU58841 but are advised to return to finasteride and minoxidil for a year before deciding.

community Comprehensive Microneedling Guide

in Microneedling 290 upvotes 2 years ago

Microneedling for hair restoration involves daily use of a 0.3 mm device and weekly use of a 0.5 mm device. Combining microneedling with Minoxidil can enhance hair growth.

community scarring alopecia awareness in this community

in Chat 33 upvotes 2 years ago

Lichen Planopilaris (LPP), a form of permanent hair loss, which can be mistaken for seborrheic dermatitis and is characterized by scalp itching, burning, redness, and dandruff. Treatment options discussed include steroidal creams, finasteride, minoxidil, and RU58841.

community Totally confused by doctors opinions, would appreciate some clarity

in Treatment 1 upvotes 2 weeks ago

The user is experiencing hair loss and confusion over conflicting medical advice, with treatments including minoxidil, finasteride, and topical corticosteroids. They are unsure about the necessity of a biopsy and the timing of using minoxidil, while also considering the impact of potential androgenetic alopecia and telogen effluvium.

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