A Simplified Approach to the Diagnosis of Alopecia

In 1996, a simplified diagnostic approach for alopecia was introduced, focusing on the patient's history and physical examination. Key historical factors included the patient's age and hair loss duration. The physical exam concentrated on the scalp's condition, hair loss pattern, pull test results, and follicular unit integrity. For children, tinea capitis and alopecia areata were common, distinguishable by exclamation mark hairs and a positive potassium hydroxide exam. In adults, hair loss under a year might indicate telogen effluvium, while over a year could suggest androgenetic alopecia. Scalp abnormalities and hair loss patterns could point to conditions like syphilis or androgenetic alopecia, and the pull test assessed hair shedding or breakage. Follicular unit examination with a hand lens helped estimate hair loss density. This method aimed to enable dermatologists, particularly residents, to quickly diagnose 97% of common hair loss cases, though some might still require confirmatory lab tests.