Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

96 Alopecia

Alopecia............................................

JILL S. WAIBEL, MD and MICHAEL J. WHITE, MD

history & physical

History

■Onset sudden vs gradual

■Childhood vs. adult

➣Infantile may be congenital, even with normal-appearing hair at

birth.

■Recent physical or emotional stress (e.g., pregnancy, illness)

■Exposure history (e.g., medication, chemicals, radiation)

■History of a systemic disease or high fever (e.g., lupus, STDs)

■Family history of hair loss

Signs & Symptoms

■Pattern of hair loss:

➣Generalized vs. Localized

Generalized: diffuse or global hair loss affecting hair through-

out scalp in a uniform pattern

Localized: focal or patchy hair loss, most or all hair missing

from involved area

If patchy, what is the pattern?

➣Scarring vs. nonscarring – although traditionally used for classi-

fication, it is often difficult to assess – late nonscarring may be

indistinguishable from scarring

■Inflammatory vs. non-inflammatory

■Hair density: normal or decreased

■Presence of follicular plugging

■Presence of other dermatologic disease on the scalp or elsewhere

tests

Basic Test

■Hair pluck vs. light hair pull

➣Light hair pull:∼20 hairs grasped between thumb and forefinger

and gently pulled

Normal result: < 2 telogen (club) hairs per light pull; more hairs

=telogen shedding

Most useful in early hair loss in central scalp; less useful in hair

loss of long duration