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Alopecia may be scarring or non-scarring, localised or diffuse, inflamed or non-inflamed. Diffuse non-scarring • Physiological: normal aging process. • Telogen effluvium occurs three–four months after pregnancy / other major event. • May be component of polycystic ovarian disease in young women. • Consider any new medications. Localised non-scarring • Alopecia areata. • Patchy hair loss with exclamation mark hairs.

This clinical pathway has been developed in conjunction with the Scottish Dermatological Society

Diffuse non-scarring • Reassure patients with mild androgenetic alopecia that condition is physiological. • Occurs 3–4 months after pregnancy but will recover spontaneously. • Diffuse alopecia: check full blood count, ferritin and thyroid function. • Women with severe degree of alopecia caused by disease can be considered for NHS wig prescription. Localised non-scarring • Look for exclamation mark hairs. • Reassure patients with alopecia areata that spontaneous regrowth is likely. • Generally good outcome in patients with short history and limited extent. • Trial of potent topical steroid lotion/cream for three months. Diffuse inflamed non-scarring • Treatment: -- Coal tar + salicylic acid ointment -- Anti-fungal shampoo (ketoconazole) -- Calciptriol or topical steroid lotion Localised inflamed non-scarring • Send hair pluckings to mycology lab. • If dermatophyte infection confirmed, treat with oral terbinafine, in children, consider griseofulvin 10mg/kg as terbinafine is unlicensed in children. (see British National Formulary for further information). Scarring • Non-inflammatory scarring alopecia: burns, tumours or surgery. • Inflammatory scarring alopecia: lichen planus, discoid lupus erythematosus. • If there diagnostic uncertainty refer to Dermatology.

Dermatology Consultant
Criteria for referral • Diagnostic uncertainty. • Persistent or extensive alopecia. For localised non-scarring • Intra-lesional injection of triamcinolone. Scarring alopecia • Wig prescription only for alopecia caused by disease.

Diffuse inflamed non-scarring • Consider psoriasis or seborrhoeic dermatitis. Localised inflamed non-scarring • Consider tinea infection (may also cause scarring).

Scarring • Loss of hair follicles with or without inflammation and accompanied by scarring.

Patient Information
NHS Inform NHS24 Tel: 08454 24 24 24 Text phone: 18001 08454 24 24 24
November 2010