From the Guidelines
Diagnosing alopecia typically involves a combination of tests, including photography, trichoscopy, hair counts, hair diameter measurement, pull test, patient self-assessment questionnaire, trichogram, and in some cases, a scalp biopsy, as outlined in the most recent study 1. To determine the cause and type of hair loss, a detailed medical history and physical examination are essential. The diagnostic approach may involve:
- Photography: Before-and-After Photos for a visual comparison to evaluate any improvements or changes in hair growth.
- Trichoscopy: involves using a specialized magnifying device to examine the scalp and hair follicles in detail, helping to identify signs of hair thinning, hair miniaturization, and the presence of vellus hairs.
- Hair Counts: involve counting the number of hairs in a specific area of the scalp before and after treatment.
- Hair Diameter Measurement: measures the diameter of individual hair shafts using a micrometer or specialized tools.
- Pull Test: involves gently tugging on a cluster of hairs to assess their fragility.
- Patient Self-Assessment Questionnaire: patients assess their own hair growth and overall satisfaction with treatment using standardized questionnaires.
- Trichogram: involves taking photographs of the scalp and analyzing them using computer software to measure hair density, hair diameter, and T/V ratio. In some cases, a scalp biopsy may be necessary to examine the hair follicles under a microscope and perform immunohistology, as mentioned in 1. It's also important to consider other potential causes of hair loss, such as those outlined in 1, including trichotillomania, tinea capitis, early scarring alopecia, telogen effluvium, anagen effluvium, systemic lupus erythematosus, and secondary syphilis. However, the most recent and highest quality study 1 provides the most relevant guidance on diagnostic tests for alopecia.
From the Research
Diagnostic Tests for Alopecia
The diagnosis of alopecia involves a combination of medical history, physical examination, and diagnostic tests. The following are some of the tests used to diagnose alopecia:
- Medical history: A thorough medical history is taken to determine the cause of hair loss 2, 3, 4.
- Physical examination: A physical examination is conducted to examine the scalp and hair for any signs of hair loss or other conditions that may be causing the hair loss 2, 3, 4.
- Laboratory evaluation: Laboratory tests such as blood tests may be conducted to rule out any underlying medical conditions that may be causing the hair loss 3.
- Scalp biopsy: A scalp biopsy may be performed to confirm the diagnosis of certain types of alopecia, such as scarring alopecia 3, 5.
Types of Alopecia
There are several types of alopecia, including:
- Female pattern hair loss (androgenetic alopecia) 2, 5, 6
- Acute and chronic telogen effluvium 2, 5
- Diffuse alopecia areata 2, 5
- Loose anagen syndrome 2
- Lichen planopilaris 5
- Frontal fibrosing alopecia 5
- Discoid lupus erythematosus 5
Diagnostic Approach
The diagnostic approach to alopecia involves a systematic and organized evaluation of the patient's medical history, physical examination, and diagnostic tests. This approach allows the clinician to make a definitive diagnosis or limited differential diagnosis and to offer the patient therapeutic options 2, 3, 4.