Practical Management of Hair Loss

The document from 23 years ago provides an organized diagnostic approach for both nonscarring and scarring alopecias to help family physicians establish an accurate in-office diagnosis. The most common forms of nonscarring alopecias were androgenic alopecia, telogen effluvium, and alopecia areata, while scarring alopecia was caused by trauma, infections, discoid lupus erythematosus, or lichen planus. Key to establishing an accurate diagnosis was a detailed history, including medication use, systemic illnesses, endocrine dysfunction, hair-care practices, and family history. A 4-mm punch biopsy of the scalp was useful, particularly to diagnose scarring alopecias. Once a diagnosis had been established, specific therapy could be initiated. The evidence for therapeutic intervention for hair loss was quite strong at the time.