From the Guidelines
A comprehensive workup for hair loss begins with a detailed medical history and physical examination to identify the type and cause of hair loss, and should prioritize the correction of nutritional deficiencies, particularly vitamin D, zinc, and folate, which tend to be lower in patients with alopecia areata as compared to controls 1.
Key Components of the Workup
- Blood tests should include complete blood count, thyroid function tests, iron studies (ferritin, iron, total iron binding capacity), vitamin D levels, and hormone panels (testosterone, DHEAS, androstenedione) for women with signs of androgen excess.
- A scalp biopsy may be necessary in unclear cases.
- For male pattern baldness, FDA-approved treatments include topical minoxidil (5% solution applied twice daily) and oral finasteride (1mg daily) 1.
- For female pattern hair loss, options include topical minoxidil (2% or 5% solution) and, in some cases, spironolactone (50-200mg daily) or oral contraceptives with anti-androgenic properties.
- Hair loss from autoimmune conditions like alopecia areata may require topical or intralesional corticosteroids, or immunotherapy in severe cases, with intralesional corticosteroids showing promise in stimulating hair regrowth at the site of injection 1.
Considerations for Treatment
- Treatment should be maintained for at least 6-12 months to evaluate effectiveness, as hair regrowth is a slow process.
- Patients should understand that early intervention typically yields better results, and some treatments require lifelong continuation to maintain benefits.
- The role of micronutrients in alopecia areata is an area of ongoing research, with current evidence suggesting that vitamin D, zinc, and folate supplementation may be beneficial, but further studies are needed to confirm this 1.
From the Research
Evaluation and Diagnosis of Hair Loss
- A comprehensive clinical history and physical examination are essential in evaluating hair loss patients 2
- Laboratory testing and scalp biopsy may be necessary to determine the underlying cause of hair loss 2
- A thorough history and examination can give vital clues to the aetiology of hair loss 3
Types of Hair Loss
- Nonscarring alopecias can be categorized as diffuse, patterned, or focal 4
- Patterned hair loss, specifically androgenetic alopecia, is the most common form of alopecia and is typically genetic 4
- Focal hair loss includes alopecia areata, tinea capitis, and traction alopecia, each with distinct causes and treatments 4
Treatment Options
- Treatment methods vary depending on the type of alopecia and may include watchful waiting, topical and systemic formulations, surgery, and treatment of underlying conditions 2
- Minoxidil is a first-line treatment for androgenetic alopecia, while oral finasteride is another option for male patients 4
- Intralesional corticosteroid or oral immunosuppressant therapy may be used to treat alopecia areata 4
Systemic Diseases and Hair Loss
- Hair loss can be caused by several systemic diseases, including malnutrition, autoimmune diseases, and endocrine disease 4
- Iron deficiency has been linked to hair loss, particularly in women, and may be related to alopecia areata, androgenetic alopecia, telogen effluvium, and diffuse hair loss 5
- Screening for iron deficiency and treating underlying causes can enhance treatment for hair loss 5