Clinical Approach to the Patient With Alopecia

March 2006 in “ Seminars in Cutaneous Medicine and Surgery ”

Amy Han, Paradi Mirmirani

alopecia androgenetic alopecia telogen effluvium alopecia areata syphilitic alopecia loose anagen hair tinea capitis trichotillomania anagen arrest anagen effluvium cicatricial alopecia microscopic hair analysis scalp biopsy laboratory tests AGA AA

TLDR Most hair loss disorders can be accurately diagnosed and treated in an outpatient setting.

The 2006 document outlines a systematic approach for diagnosing and treating alopecia, emphasizing the importance of patient history, physical examination, and diagnostic tests such as microscopic hair analysis, scalp biopsy, and laboratory tests. It details the diagnostic criteria for various types of alopecia, including androgenetic alopecia (AGA), telogen effluvium, alopecia areata (AA), syphilitic alopecia, loose anagen hair, and tinea capitis, highlighting the significance of clinical findings and history in diagnosis. Additionally, it discusses less common conditions like trichotillomania, anagen arrest/effluvium, and cicatricial alopecia, noting the prevalence of trichotillomania at 0.6% among 2,500 college students and primary cicatricial alopecias ranging from 3.2 to 7.3% in retrospective studies. The document concludes that most hair loss disorders can be accurately diagnosed in an outpatient setting, which is crucial for effective patient counseling and treatment initiation.

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Research cited in this study

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research Primary Cicatricial Alopecias: Clinicopathology of 112 Cases

254 citations, December 2003 in “Journal of the American Academy of Dermatology”

Accurate diagnosis and aggressive treatment are crucial to prevent permanent hair loss in cicatricial alopecia.

research Tinea Capitis

46 citations, January 2002 in “Paediatric drugs”

Tinea capitis, a scalp fungal infection in children, is best treated with newer antifungal agents for shorter periods.

research Alopecia Areata Update

49 citations, April 2000 in “Journal of The American Academy of Dermatology”

Despite progress in treatment, the exact cause of Alopecia areata is still unknown.

research Treatment of Hair Loss

370 citations, September 1999 in “The New England Journal of Medicine”

Finasteride and minoxidil are effective for hair loss, but continued research is needed for better treatments.

research Acquired Scalp Alopecia: A Review

37 citations, May 1999 in “Australasian Journal of Dermatology”

Early diagnosis and treatment are crucial for preventing permanent hair loss in various scalp conditions, and while new treatments are promising, more research is needed to evaluate their effectiveness.

research Postmenopausal Frontal Fibrosing Alopecia: A Frontal Variant of Lichen Planopilaris

329 citations, January 1997 in “Journal of the American Academy of Dermatology”

Frontal fibrosing alopecia is a hair loss condition in postmenopausal women, similar to lichen planopilaris, with ineffective treatments.

research Essential Syphilitic Alopecia Revisited

53 citations, May 1995 in “Journal of The American Academy of Dermatology”

Syphilis can cause hair loss that looks like other conditions, but it improves with treatment.

research Androgenetic Alopecia: An Autosomal Dominant Disorder

80 citations, January 1995 in “The American Journal of Medicine”

Hair loss in androgenetic alopecia is caused by genetic factors and androgen excess, and can be treated with combined therapies.

research Drug-Induced Hair Loss and Hair Growth

147 citations, April 1994 in “Drug Safety”

Some drugs can cause hair loss or increase hair growth, but these effects are usually reversible when the drug is stopped.

research Alopecia Areata: Pathogenesis And Treatment

122 citations, November 1984 in “Journal of the American Academy of Dermatology”

No single treatment is consistently effective for alopecia areata, and more research is needed.

research Management of Hair Problems

8 citations, March 1979 in “International Journal of Dermatology”

Dr. Vera H. Price's 1979 work emphasizes the importance of accurate diagnosis and personalized treatment for hair loss.

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