Evaluation and Management of the Hair Loss Patient in the Primary Care Setting

The document from 2015 provides guidance on the evaluation and management of hair loss in the primary care setting. It classifies alopecias into noncicatricial (nonscarring) and cicatricial (scarring), with the latter leading to permanent hair follicle loss. Noncicatricial alopecias, which can be reversible, include androgenetic alopecia, alopecia areata, telogen effluvium, tinea capitis, traction alopecia, and trichotillomania. The evaluation process should include a clinical history, physical examination, laboratory testing, and possibly a scalp biopsy. Treatment varies by alopecia type and may involve medications, surgery, or addressing underlying conditions. Trichotillomania is highlighted as an impulse control disorder treated with cognitive behavioral therapy or medications. Cicatricial alopecias require a scalp biopsy for diagnosis and can be treated with steroids, antibiotics, antimalarial drugs, and androgen inhibitors. For male pattern alopecia, minoxidil and finasteride are first-line treatments, while female pattern alopecia may be treated with topical minoxidil, spironolactone, or finasteride. Alopecia areata can resolve spontaneously or be treated with corticosteroids or topical immunotherapy, and tinea capitis requires systemic antifungals. Early diagnosis and treatment are emphasized to prevent permanent hair loss and ensure patient comfort.