Practical management of hair loss

OBJECTIVE To describe an organized diagnostic approach for both nonscarring and scarring alopecias to help family physicians establish an accurate in- office diagnosis. To explain when ancillary laboratory workup is necessary to confirm the diagnosis. QUALITY OF EVIDENCE Current diagnostic and therapeutic interventions for ha ir loss are based on randomized controlled studies, uncontrolled studies, a nd case series. MEDLINE was searched from January 1966 to December 1998 wit h the MeSH words alopecia, hair, and alopecia areata. Articles were selecte d on the basis of experimental design, with priority given to the most curr ent large multicentre controlled studies. Overall global evidence for thera peutic intervention for hair loss is quite strong. MAIN MESSAGE The most common forms of nonscarring alopecias are androgenic alopecia, telogen effluvium, and alopecia areata. Other disorders include t richotillomania, traction alopecia, tinea capitis, and hair shaft abnormali ties. Scarring alopecia is caused by trauma, infections, discoid lupus eryt hematosus, or lichen planus. Key to establishing an accurate diagnosis is a detailed history, including medication use, systemic illnesses, endocrine dysfunction, hair-care practices, and family history. All hair-bearing site s should be examined. A 4-mm punch biopsy of the scalp is useful, particula rly to diagnose scarring alopecias. Once a diagnosis has been established, specific therapy can be initiated. CONCLUSIONS Diagnosis and management of hair loss is an interesting challen ge for family physicians. An organized approach to recognizing characterist ic differential features of hair loss disorders is key to diagnosis and man agement.