From the Guidelines
You should refer a patient with hair loss to dermatology even if their TSH is normal, as normal thyroid function does not rule out other potential causes of hair loss that dermatologists are specifically trained to evaluate. Hair loss can result from numerous conditions including androgenetic alopecia, telogen effluvium, alopecia areata, nutritional deficiencies, medication side effects, or inflammatory scalp disorders. A dermatologist can perform a thorough scalp examination, possibly including dermoscopy or scalp biopsy, to determine the specific cause, as seen in guidelines for the management of alopecia areata 1. They can then recommend appropriate treatments such as topical minoxidil, oral finasteride (for male patients), spironolactone (for female patients), platelet-rich plasma injections, or other therapies specific to the diagnosis.
Some key points to consider in the evaluation of hair loss include:
- The role of micronutrients, such as iron, in alopecia areata, with some studies suggesting a potential association between iron deficiency and hair loss 1
- The importance of early intervention, as some forms of hair loss can become permanent if not addressed promptly
- The need for specialized diagnosis and treatment, as primary care can manage some cases of hair loss, but persistent or significant hair loss warrants dermatology evaluation
- The potential impact of hair loss on a patient's quality of life, similar to other skin diseases such as psoriasis and atopic dermatitis 1
Overall, referral to dermatology is essential for accurate diagnosis and effective treatment of hair loss, even in patients with normal thyroid function.
From the Research
Referral to Dermatology for Hair Loss
- If a patient is experiencing hair loss and their TSH (thyroid-stimulating hormone) levels are normal, referral to dermatology may still be necessary depending on the underlying cause of the hair loss 2, 3.
- A comprehensive clinical history and physical examination, as well as targeted laboratory testing, can help determine the cause of hair loss and guide treatment decisions 4, 5.
- Nonscarring alopecias, such as androgenetic alopecia, alopecia areata, and telogen effluvium, can often be diagnosed and treated in a primary care setting 4, 3.
- However, scarring alopecia or diagnostically challenging cases may require referral to a dermatologist for further evaluation and treatment 2, 3.
- It's also important to consider the emotional and psychological impact of hair loss on patients, and referral to a dermatologist may be helpful in providing timely and appropriate treatment to improve outcomes and quality of life 6.