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Assessment begins with obtaining a description of hair loss and the areas involved, as well as a medical history and family history.
Assessment of activity on the scalp may be done with a hair pull test, done by gripping about 20 hairs and gently pulling upward and away from the skin. Normally, about three hairs may fall out with each pull, while if more than 10 hairs are removed, the test is considered positive.
A noninvasive method of examining hair and scalp is trichoscopy, which is performed with the use of a dermatoscope. This traditionally consists of a magnifier, a non-polarised light source, a transparent plate and a liquid medium between the instrument and the skin.
In some cases, diagnostic techniques such as microscopic examination of cut or plucked hair fibers and scalp biopsies may provide additional information.
The pluck test is conducted by pulling hair out by the roots.
The root of the plucked hair is then examined under a microscope to determine the phase of growth, and is used to diagnose if there’s a defect of anagen or telogen.
Finally, getting a scalp biopsy from the centre of the lesion gives confirmation of permanent hair loss, whereas a biopsy from the edge or an area of active inflammation may shed light on the underlying disease, and depending on the suspected diagnosis, additional laboratory studies may be performed.
Alopecia means hair loss, but it is not limited to the scalp as it can be anywhere in the body. For cosmetic reasons, patients may become concerned with hair loss, but it can also be an important clue to systemic disease. Common causes of alopecia include androgenic alopecia, drugs, infections such as tinea capitis, and trauma.
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