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Determining the Cause of Hair Loss

Determining the Cause of Hair Loss

Hair loss, also known as alopecia, is one of the of most common disorders that dermatology practitioners diagnose and treat. With so many potential causes, it can be challenging to figure out, but pinpointing the source can assist in treatment success. The first step is to do a thorough patient history. Important things to note that may aid in your diagnosis are patient age, genetics, hair styles, hair care, new medications, recent illness or surgery, pregnancy or hormonal changes, personal or family stressors, thyroid or autoimmune disorders, significant weight gain or loss, nutrition, onset, and duration and characteristics of the hair loss.

Alopecia areata is a common condition affecting as many as 6.8 million people in the US, with a lifetime risk of 2.1%. Most people develop it during childhood or their teenage years, but it can occur at any age and may be hereditary. It presents as patchy baldness that can develop anywhere on the body, including the scalp, beard, eyebrows, eyelashes, armpits, inside of the nose, or ears. In about one-half of cases, hair regrowth is seen within 12 months without treatment. However, it is a very unpredictable condition and patients may or may not have further episodes. Many people who develop alopecia are otherwise healthy, but if an underlying condition is suspected, additional laboratory studies may be helpful. These include levels of thyroid-stimulating hormone, ferritin, vitamin D, and zinc. For female patients, a workup for androgens, which includes free and total testosterone, DHEA-S, and 17-OH-progesterone, may be added.

Treatment options depend on the underlying identifiable cause. Emotionally, hair loss can be quite taxing on the patient, bringing feelings of grief, anxiety, loss, fear, embarrassment, loneliness, and anger. As providers, it is important to offer patients information on their condition, as well as support groups such as the National Alopecia Areata Foundation, whose goal is to focus on emotional wellness.


Filed under: Dermatology

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