Hair and Nail Conditions: Alopecia Evaluation

Alopecia, a condition causing hair loss, affects both men and women and can be categorized as nonscarring or scarring. Nonscarring alopecias include male and female pattern alopecias, alopecia areata, telogen effluvium, traction alopecia, trichotillomania, and tinea capitis. Scarring alopecias include central centrifugal cicatricial alopecia, lichen planopilaris, frontal fibrosing alopecia, discoid lupus erythematosus, dissecting cellulitis of the scalp, folliculitis decalvans, and acne keloidalis nuchae. Evaluating patients with alopecia involves assessing the duration and distribution of hair loss, associated scalp symptoms, and associated conditions. Clinical examination may include a hair pull test, tug test, hair mount, dermoscopy, laboratory tests, and/or scalp biopsy. Hair regrowth cannot occur in established lesions of scarring alopecia, so early identification and prompt initiation of treatment are critical. Patients with suspected or confirmed alopecias, alopecia areata, or alopecias refractory to treatment may benefit from referral to a dermatologist.