Evaluation of Hair Loss

Abstract

The evaluation of a patient with hair problems is a fundamental step for the correct diagnosis of disease, as it gives important information and helps in choosing the diagnostic tools that should be utilized to confirm the clinical suspicion. The evaluation includes a clinical history and patient examination and is followed by invasive and noninvasive tests. Often, the sole clinical examination permits the correct diagnosis of the hair disease and the evaluation of its severity and progression. For this reason, time should be spent to get all of the necessary anamnestic data and to carefully examine the patient. Dermoscopy (trichoscopy) will afterward add additional data that can be further increased by scalp biopsy for histopathology and/or by other more specific tests. When approaching a patient with hair problems, it is mandatory to consider the strong psychological impact of hair diseases, which are very often associated with severe emotional distress. For this reason, patients should be managed with care by spending time listening to their complaints and by explaining in detail their disease and its possible treatments. The patient will only be able to properly adhere to treatment and to obtain the best result if she/he understands her/his hair problem and its possible solutions.

Primary scalp alopecia: new histopathological tools, new concepts and a practical guide to diagnosis

“…This test is useful for pathologists in order to indicate whether alopecia is active or non‐active. Pulling more than 5–6 hairs after having grasped 50 to 60 hairs between the thumb, index and middle fingers is considered a positive hair pull test; a positive hair pull test indicates an active alopecia, and a negative test indicates a non‐active alopecia . Microscopic examination of the hair roots reveals terminal anagen hair (with a darkly pigmented and triangular‐shaped bulb and preserved inner root sheath) and terminal telogen hair (with a lightly pigmented club‐shaped bulb and without inner root sheath) (Fig.…”