Who Should You See for Hair Loss
You should consult a dermatologist for evaluation and management of hair loss, as they are the medical specialists trained to diagnose and treat all forms of alopecia. 1, 2
Why Dermatologists Are the Appropriate Specialists
Dermatologists are physicians who specialize in diseases of the skin, hair, and nails, making them uniquely qualified to evaluate hair loss. 1, 3 The British Association of Dermatologists has published comprehensive guidelines specifically for managing various types of alopecia, establishing dermatology as the primary medical specialty for this condition. 1
What Dermatologists Can Provide
- Accurate diagnosis through clinical examination, dermoscopy (looking for yellow dots, exclamation mark hairs, and cadaverized hairs), and when necessary, skin biopsy or fungal culture 1, 2
- Evidence-based treatments including intralesional corticosteroid injections for limited patchy alopecia areata (the strongest evidence-based treatment), contact immunotherapy for extensive disease, and appropriate medical therapies 1, 2
- Comprehensive evaluation to distinguish between different causes: alopecia areata, androgenetic alopecia (pattern baldness), telogen effluvium (stress-related), tinea capitis (fungal infection), trichotillomania, and systemic causes 1, 2
When to Start with Your Primary Care Physician
Your family physician can initiate the workup for hair loss and may manage straightforward cases. 3 They can:
- Perform initial history and physical examination, documenting onset, duration, progression, family history, medications, and systemic symptoms 4
- Order basic laboratory tests including thyroid function (TSH), ferritin, vitamin D, and zinc levels when nutritional deficiencies are suspected 2
- Diagnose and treat common conditions like telogen effluvium (stress-induced shedding) once the precipitating cause is identified 3
- Refer to dermatology when the diagnosis is uncertain, when specialized treatments are needed, or when scarring alopecia is suspected 3
Important Caveat About "Trichologists"
Avoid non-physician "trichologists" who are not medical doctors. 5 The term "trichologist" originated in 1860 in a London barbershop and is associated with cosmetics rather than medical professionalism, offering opportunities to possible imposters with primarily commercial interests. 5 Only board-certified dermatologists (sometimes called "dermatotrichologists" or "trichiatrists") have the medical training to properly diagnose and treat hair loss as a medical condition. 5
What to Expect at Your Appointment
The dermatologist will examine your scalp for:
- Pattern of hair loss (diffuse thinning at crown suggests androgenetic alopecia; patchy loss suggests alopecia areata) 4
- Exclamation mark hairs (short broken hairs around expanding patches, pathognomonic for alopecia areata) 1, 4
- Scalp inflammation or scaling (may indicate tinea capitis or other conditions) 1, 4
- Nail changes (pitting, ridging, or dystrophy occur in approximately 10% of alopecia areata patients) 4
Most cases of alopecia areata can be diagnosed clinically without laboratory testing. 1, 2 However, investigations may include fungal culture, skin biopsy, or serology for lupus or syphilis when the diagnosis is uncertain. 1
Key Takeaway
Dermatologists are the medical specialists who should evaluate and manage hair loss, as they have the training and expertise to accurately diagnose the cause and provide evidence-based treatments. 1, 2 While your primary care physician can initiate evaluation, referral to dermatology is appropriate for most cases requiring specialized diagnosis or treatment.