From the Guidelines
To assess hair loss in a 76-year-old patient with a history of stroke on multiple medications, I recommend a comprehensive approach starting with a detailed medical history and physical examination, considering the potential side effects of statins, amlodipine, and other cardiovascular drugs on hair loss, as suggested by various studies 1.
Initial Evaluation
First, evaluate the pattern, onset, and progression of hair loss, noting whether it's diffuse or localized. Examine the scalp for inflammation, scaling, or scarring. Review all medications thoroughly, as some cardiovascular drugs can potentially contribute to hair loss as a side effect.
Laboratory Testing
Laboratory testing should include:
- Complete blood count
- Thyroid function tests
- Iron studies (including ferritin)
- Vitamin D levels as deficiencies can cause hair loss, particularly in older adults, and are crucial for overall health, as emphasized in guidelines for primary prevention of stroke 1.
Considerations for Medication-Induced Hair Loss
Medication-induced hair loss is typically diffuse and non-scarring, often occurring months after starting treatment. If medication-related hair loss is suspected, consult with the patient's cardiologist or neurologist before making any changes to their stroke prevention regimen, as these medications are critical for secondary stroke prevention 1.
Additional Recommendations
Consider a scalp biopsy if the diagnosis remains unclear after initial evaluation. Nutritional assessment and addressing any deficiencies may help improve hair health. Dermatology referral should be considered if the cause remains unclear or if specialized treatments are needed. A healthy lifestyle, including a balanced diet and regular exercise, as recommended for primary prevention of stroke 1, may also contribute to overall hair health.
Prioritizing Morbidity, Mortality, and Quality of Life
In managing hair loss in this patient, it's essential to prioritize morbidity, mortality, and quality of life, ensuring that any interventions do not compromise the patient's cardiovascular health or increase the risk of stroke, as the primary goal is to maintain the patient's overall well-being and reduce the risk of future cardiovascular events 1.
From the Research
Assessment of Hair Loss
To assess hair loss in a 76-year-old patient with a history of stroke, who is taking statin, zeta, amlodipine, and placid, the following steps should be taken:
- Conduct a comprehensive clinical history and physical examination to identify potential underlying causes of hair loss 2, 3, 4
- Perform targeted laboratory testing to rule out systemic diseases, such as malnutrition, autoimmune diseases, and endocrine diseases, that may be contributing to hair loss 3, 5
- Consider the patient's medical history, including their history of stroke, and how it may be related to their hair loss
- Evaluate the patient's medication list, including statin, zeta, amlodipine, and placid, to determine if any of these medications may be contributing to hair loss
- Use dermoscopy (trichoscopy) to examine the scalp and hair follicles in more detail 6, 4
- Consider performing a scalp biopsy for histopathology if necessary 2, 4
Potential Causes of Hair Loss
Potential causes of hair loss in this patient include:
- Androgenetic alopecia, which is a common cause of hair loss in older adults 3, 5
- Telogen effluvium, which is a nonscarring alopecia caused by physiologic or emotional stress 3, 5
- Alopecia areata, which is an autoimmune disease that causes patchy hair loss 3, 5
- Tinea capitis, which is a fungal infection that causes patches of hair loss 3, 5
- Medication-induced hair loss, which may be caused by one or more of the patient's medications 2, 3
Importance of Patient Support
It is essential to provide emotional support and education to the patient, as hair loss can cause significant emotional distress and impact quality of life 2, 3, 4