Hair Loss

Hair loss (alopecia) can have various causes. The differential diagnosis (ddx) for hair loss is broad and can be categorized based on the pattern of hair loss (diffuse vs. localized) and the presence or absence of scarring. Here is a non-exhaustive differential diagnosis for hair loss:

Diffuse Hair Loss:

  1. Telogen Effluvium: Sudden hair loss that can occur after a significant stressor such as childbirth, surgery, severe illness, or high fever.
  2. Anagen Effluvium: Hair loss during the growth phase, often seen after chemotherapy.
  3. Androgenic Alopecia (Male and Female Pattern Baldness): A hereditary thinning of hair that affects both men and women.
  4. Alopecia Areata: An autoimmune condition where hair falls out in round patches.
  5. Hypothyroidism and Hyperthyroidism: Thyroid diseases can lead to diffuse hair loss.
  6. Iron Deficiency Anemia: A common cause of hair loss in premenopausal women.
  7. Syphilis: Secondary syphilis can cause diffuse hair loss.
  8. Dietary deficiencies: Such as zinc, biotin, or protein deficiency.
  9. Medications: Numerous medications, including anticoagulants, beta-blockers, retinoids, antithyroid medications, and birth control pills, among others.
  10. Chronic Illnesses: Such as liver disease, systemic lupus erythematosus (SLE), or sarcoidosis.

Localized Hair Loss:

  1. Traction Alopecia: Hair loss due to tight hairstyles that pull at the hair.
  2. Trichotillomania: A psychological condition where individuals pull out their hair.
  3. Tinea Capitis: Fungal infection of the scalp causing hair loss.
  4. Secondary Syphilis: Can cause a “moth-eaten” pattern of hair loss.
  5. Folliculitis Decalvans: An inflammatory condition leading to scarring and hair loss.

Scarring (Cicatricial) Alopecia:

  1. Lichen Planopilaris: A condition where lichen planus affects the scalp.
  2. Discoid Lupus Erythematosus: A chronic skin condition causing sores with inflammation and scars.
  3. Central Centrifugal Cicatricial Alopecia: A scarring alopecia, most common in African-American women.
  4. Frontal Fibrosing Alopecia: Slow recession of the frontal hairline.
  5. Folliculitis Decalvans: Mentioned above; also causes scarring alopecia.

This is a broad overview of the differential diagnosis for hair loss. A detailed history, physical examination, and sometimes additional tests are required to determine the exact cause of alopecia in a given patient. It’s also important to remember that hair loss can have multiple concurrent causes in some individuals.

Management

Hair loss (alopecia) can be distressing for both men and women. Management strategies vary depending on the type and cause of hair loss. Here’s a breakdown of both non-pharmacological and pharmacological treatments:

Non-Pharmacological Management:

  1. Proper Hair and Scalp Care: Using gentle shampoos and avoiding harsh chemicals or styling practices that can damage hair or aggravate hair loss.
  2. Nutrition and Supplements: Ensuring a balanced diet rich in essential vitamins and minerals like iron, zinc, vitamin D, and biotin, which are important for hair health. Supplements can be considered if dietary intake is inadequate.
  3. Stress Management: Stress can contribute to certain types of hair loss, so techniques like meditation, yoga, and regular exercise can be beneficial.
  4. Hairpieces and Wigs: These can be used for cosmetic reasons to cover thinning hair or bald patches.
  5. Scalp Massage: Some evidence suggests that scalp massage may increase hair thickness by stretching the cells of hair follicles.
  6. Laser Therapy: Low-level laser therapy (LLLT) is believed to stimulate hair growth by increasing blood flow to the scalp and hair follicles.
  7. Platelet-Rich Plasma (PRP) Therapy: Involves injecting plasma enriched with platelets from the patient’s own blood into the scalp to promote hair growth.

Pharmacological Management:

  1. Minoxidil Topical: The only over-the-counter medication approved for hair loss in both men and women.
  2. Minoxidil Tablets: Used off label at low dose for both men and women.
  3. Finasteride: Used in men with androgenetic alopecia (male pattern baldness). It works by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), a hormone that can shrink hair follicles.
  4. Hormone Therapy: Used in women, especially those experiencing hair loss due to menopause or hormonal imbalances, hormone replacement therapy or oral contraceptives may be beneficial.
  5. Spironolactone: Used in women for androgenetic alopecia, as it acts as an androgen blocker.
  6. Topical Corticosteroids: For certain types of hair loss like alopecia areata, topical corticosteroids can be used to reduce inflammation around the hair follicles.
  7. Anthralin (Dithranol): A topical synthetic tar medication used to treat alopecia areata and washed off after 30-120 minutes

The choice of treatment depends on the type of hair loss and its underlying cause, and often a combination of treatments is most effective. It’s important for individuals experiencing hair loss to consult with a healthcare provider or dermatologist to determine the most appropriate treatment plan. Patience is also key, as many treatments for hair loss take months to produce visible results.