Current standards in the diagnostics and therapy of hair diseases – hair consultation

Abstract

Hair and scalp diseases present an extensive diagnostic and therapeutic task. Treating them is often a challenge for the physician in daily practice. Unclear diagnoses, chronic conditions with long-lasting therapies and the uncertainty of the patient may often lead to unsatisfying situations for both the patient as well as the doctor. The complaints can be divided into (1) hair loss, (2) increased hair growth and (3) abnormal hair quality. A structured history and the objectification of the clinical findings with the help of standardized diagnostic methods and score systems or classifications enable a diagnosis in most patients already at the first visit. Moreover, such structured processes strengthen the treatment satisfaction and compliance of both the patient and the therapist. In the meantime, diagnostic measures and clinical practice guidelines are available for the most common hair disorders. Expertise in basic psychosomatic care and an empathetic approach to the fears and concerns as well as practical advice for the daily contact with hair disorders should be integrated as separate elements in the management of hair diseases; in most cases they are gratefully welcomed by the patients. The aim of this article is to provide the physician with a guideline for the structured management of a hair patient. An overview of recent new developments and the currently available clinical practice guidelines for diagnosis and therapy of hair disorders is presented.

Anagen effluvium

“…Moreover, follicles show no signs of inflammation, dystrophy of the inner sheath, or traction, which are helpful in the distinction of anagen effluvium from AA, androgenetic alopecia, and traction alopecia. [37][38][39] TREATMENT TREATMENT Anagen effluvium is usually reversible and appropriate hair and scalp care along with temporarily wearing of wig/hair-piece may be the most effective coping strategy required in these patients. If pharmacotherapy is to be prescribed, the goal should be to prevent or shorten the period of alopecia.…”

Imbalance of T‐helper 17 and regulatory T cells in patients with alopecia areata

“…Loss of scalp hair of more than 49% in aggregate was considered severe AA, with lesser degrees viewed as mild AA. A hair pull test was performed at the margin of the patch on every patient without grooming in 2 days, grasping 50–60 hairs and pulling moderately, repeating at different sites; epilation more than 10% was defined as positive . A positive hair pull test was indicative of active disease, whereas a negative test signaled stable disease.…”

Skin Academy: Hair, skin, hormones and menopause – current status/knowledge on the management of hair disorders in menopausal women

“…The similarities between alopecia and hirsutism mean there is overlap in the recommended treatments. The two approaches available are the application of topical preparations and the administration of systemic medication [92]. For both systemic and topical treatments there is some delay before patients begin to see an improvement.…”

“…There are limited data available which focus on the treatment of hair loss specifically in pre-and post-menopausal women. Treatments are often combined with a variety of cosmetic methods to improve aesthetics, including hair styling techniques, use of camouflaging products and replacement hair pieces to cover exposed areas of scalp and provide the illusion of more volume, and even laser hair combs [92]. Hair transplantation may be considered for cases of advanced FPHL which have not responded to medical treatment [54].…”