Alopecia history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogechukwu Hannah Nnabude, MD


The quantity, timing, and onset of hair loss can be important clues in narrowing down a diagnosis. It may happen overnight or over a span of months or years. Also, the clinician should inquire about the presence of stressors, co-morbidities, family history, use of bathing and hair care products, hygiene, diet, and overall health. Physical examination may also uncover important indicators of the cause of hair loss. Characteristics such as the pattern of hair loss as in androgenetic alopecia in which male patients tend to lose hair from the frontal and temporal area and female patients tend to lose hair at the central scalp area, or classic alopecia areata in which patients may lose hair from a single area or the face and scalp, as seen in alopecia totalis. In tinea capitis, the classic presentation is black dots associated with broken hair, while favus correlates with the scarring type of alopecia. Telogen effluvium classically presents with diffuse thinning of hair and a positive hair pull test. In a patient with alopecia mucinosa, the patient would have multiple flesh-colored papules and nodules infiltrating the skin of the scalp.

History and Symptoms


The patient history is largely dependent on the type of alopecia:


The locations and patterns of the hair loss are often used as a clue to determine the likely cause of the hair loss

  • In androgenetic alopecia, the hair loss is at the crown of the head in both men and women. However, the frontal hair line is also affected in men unlike in women where it is often spared. [2]
  • Alopecia areata often presents with patchy, well-defined areas of hair loss that can affect anywhere on the body. However, the scalp and beard are the most commonly affected areas [2] [12]
  • Telogen effluvium is characterized by excessive hair loss that is often preceded by a trauma, illness, or any other kind of psychological, or physiological stress. [13]
  • Uneven patterns and broken hairs around the scalp, beard, moustache, side burns, and eyebrows are a finding associated with trichotillomania. This is especially true if seen in adolescents as the disorder is more common in the age group [14] [15]
  • Loss of the lateral parts of the eyebrows, along with the commonly seen symptoms of cold intolerance, weight gain, constipation, and dry skin are suggestive of hypothyroidism [16] [17]


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  3. Villasante Fricke AC, Miteva M (2015). "Epidemiology and burden of alopecia areata: a systematic review". Clin Cosmet Investig Dermatol. 8: 397–403. doi:10.2147/CCID.S53985. PMC 4521674. PMID 26244028.
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  5. Kim BK, Chung HC, Jun M, Oh SS, Lee WS (2017). "Prevalence of fronto-vertex baldness and its association with family history of androgenetic alopecia in Korean men using basic and specific classification". J Dermatol. 44 (7): 850–852. doi:10.1111/1346-8138.13566. PMID 27599903.
  6. Watras MM, Patel JP, Arya R (2016). "Traditional Anticoagulants and Hair Loss: A Role for Direct Oral Anticoagulants? A Review of the Literature". Drugs Real World Outcomes. 3 (1): 1–6. doi:10.1007/s40801-015-0056-z. PMC 4819463. PMID 27747798.
  7. Thomson SR, Mamulpet V, Adiga S (2017). "Sodium Valproate Induced Alopecia: A Case Series". J Clin Diagn Res. 11 (9): FR01–FR02. doi:10.7860/JCDR/2017/28564.10658. PMC 5713753. PMID 29207731.
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  9. Etminan M, Sodhi M, Procyshyn RM, Guo M, Carleton BC (2018). "Risk of hair loss with different antidepressants: a comparative retrospective cohort study". Int Clin Psychopharmacol. 33 (1): 44–48. doi:10.1097/YIC.0000000000000191. PMID 28763345.
  10. Guo EL, Katta R (2017). "Diet and hair loss: effects of nutrient deficiency and supplement use". Dermatol Pract Concept. 7 (1): 1–10. doi:10.5826/dpc.0701a01. PMC 5315033. PMID 28243487.
  11. Nicholson AG, Harland CC, Bull RH, Mortimer PS, Cook MG (1993). "Chemically induced cosmetic alopecia". Br J Dermatol. 128 (5): 537–41. doi:10.1111/j.1365-2133.1993.tb00231.x. PMID 8504045.
  12. Pratt CH, King LE, Messenger AG, Christiano AM, Sundberg JP (2017). "Alopecia areata". Nat Rev Dis Primers. 3: 17011. doi:10.1038/nrdp.2017.11. PMC 5573125. PMID 28300084.
  13. Asghar F, Shamim N, Farooque U, Sheikh H, Aqeel R (2020). "Telogen Effluvium: A Review of the Literature". Cureus. 12 (5): e8320. doi:10.7759/cureus.8320. PMC 7320655 Check |pmc= value (help). PMID 32607303 Check |pmid= value (help).
  14. Sperling LC, Cowper SE, Knopp EA. An atlas of hair pathology with clinical correlations. 2. Informa Healthcare; 2014. [Google Scholar]
  15. Quercetani R, Rebora AE, Fedi MC, Carelli G, Mei S, Chelli A; et al. (2011). "Patients with profuse hair shedding may reveal anagen hair dystrophy: a diagnostic clue of alopecia areata incognita". J Eur Acad Dermatol Venereol. 25 (7): 808–10. doi:10.1111/j.1468-3083.2010.03869.x. PMID 20946585.
  16. Chaker L, Bianco AC, Jonklaas J, Peeters RP (2017) Hypothyroidism. Lancet 390 (10101):1550-1562. DOI:10.1016/S0140-6736(17)30703-1 PMID: 28336049
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