Evaluation and diagnosis of the hair loss patient: part I. History and clinical examination

Diet and hair loss: effects of nutrient deficiency and supplement use

Patients presenting with hair loss should be screened by medical history, dietary history and physical exam for risk factors for nutrient deficiency. If warranted, laboratory studies may be performed. In patients with no risk factors, further laboratory evaluation searching for nutritional deficiencies is not warranted. For patients with nutritional deficiencies, it is clear that those deficiencies should be corrected. Further research is required to determine whether any benefit exists for nutrient supplementation in the absence of documented deficiency. At this time, patients must be informed that such research is lacking and that in fact some supplements carry the risk of worsening hair loss or the risk of toxicity.

Diagnosis and management of hair loss in children

PURPOSE OF REVIEW

Hair loss is common in infants and children and the ability to distinguish why a child is losing hair enables providers to distinguish hair loss that is related to infection, autoimmune conditions, nutrition, medications, trauma/traction, or underlying genetic disorders such as ectodermal dysplasias. Making these distinctions leads to best management and guidance for patients and their families.

RECENT FINDINGS

Careful physical examination of the hair, scalp, skin, and nails coupled with dermoscopy or trichoscopy, or both, can yield more accurate and faster diagnosis. Biopsy is rarely needed in children for hair loss conditions.

SUMMARY

Hair loss, particularly on the scalp, can affect all ages and can impact patients socially and emotionally. The majority of hair loss in children is nonscarring. Diagnosis begins with a good history, including personal and family history, medication use, a thorough physical examination, and use of dermoscopy or trichoscopy, or both. With these, providers can begin to divide hair loss into congenital vs. acquired, and then further subdivide into focal vs. diffuse and scarring vs. nonscarring. Secondary change, including scale and erythema, can further help with diagnosis.

Folliculitis decalvans: a multicentre review of 82 patients

BACKGROUND

Folliculitis decalvans (FD) is a rare neutrophilic scarring alopecia that represents a therapeutic challenge for dermatologists.

OBJECTIVE

To describe the epidemiology, comorbidities, clinical presentation, diagnostic findings and therapeutic options in a large series of patients with FD.

METHODS

This retrospective multicentre review includes patients diagnosed with FD based on clinical and histopathologic findings. The clinical severity was determined by the maximum diameter of the largest alopecic patch (slight: <2 cm, moderate: 2-4.99 cm, severe: 5 cm or more). Response to therapy was assessed as improvement, worsening or stabilization depending on the clinical symptoms (pruritus and trichodynia), inflammatory signs (erythema, pustules and crusts) and the extension of the alopecic patch.

RESULTS

Overall, 82 patients (52 males and 30 females) with a mean age of 35 years were included. No significant comorbidities were present. A family history was present in three males. Severe FD was observed in 17 patients (21%). The independent factors associated with severe FD after multivariate analysis were: onset of FD before 25 years of age and presence of pustules. Oral antibiotics (tetracyclines and the combination of clindamycin and rifampicin) improved 90% and 100% of the patients, with a mean duration of response of 4.6 and 7.2 months respectively.

CONCLUSIONS

The onset of FD before 25 years of age and the presence of pustules within the alopecic patch were associated with severe FD. Tetracyclines and the combination of clindamycin and rifampicin were the most useful treatments.