ALOPECIA

Alopecia (hair loss) usually develops gradually and affects the scalp; it may be diffuse
or patchy. It can be classified as scarring or nonscarring. Scarring alopecia
(permanent hair loss) results from hair follicle destruction, which smoothes the
skin surface, erasing follicular openings. Nonscarring alopecia (temporary hair
loss) results from hair follicle damage that spares follicular openings, allowing future
hair growth.
One of the most common causes of alopecia is the use of certain chemotherapeutic
drugs. Alopecia may also result from the use of other drugs; radiation therapy;
a skin, connective tissue, endocrine, nutritional, or psychological disorder; a
neoplasm; an infection; a burn; or exposure to toxins. Anxiety, high fever, and even
certain hairstyles or grooming methods may also cause alopecia. (See Recognizing
patterns of alopecia, page 32.)
Aging, genetic predisposition, and hormonal changes may contribute to gradual
hair thinning and hairline recession. This type of alopecia occurs in about 40% of
adult men and may also occur in postmenopausal women.
CULTURAL CUE People who have fine and relatively scanty hair, such as
natives of tropical areas, may not recognize their alopecia right away.
HISTORY
If the patient isn’t receiving a chemotherapeutic drug or radiation therapy, begin by
asking when he first noticed the hair loss or thinning. Does it affect the scalp alone,
or does it occur elsewhere on the body? Is it accompanied by itching or rashes?
Then carefully explore other signs and symptoms to help distinguish between normal
and pathologic hair loss. Ask about recent weight change, anorexia, nausea,
vomiting, excessive stress, and altered bowel habits. Also ask about urinary tract
changes, such as hematuria or oliguria. Has the patient been especially tired or irritable?
Does he have a cough or difficulty breathing? Ask about joint pain or stiffness
and about heat or cold intolerance. Inquire about exposure to insecticides. If
the patient is female, find out if she has had menstrual irregularities and note her
pregnancy history. If the patient is male, ask about sexual dysfunction, such as decreased
libido or impotence.
Next, ask about hair care. Does the patient frequently use a hot blow-dryer or
electric curlers? Does he periodically dye, bleach, or perm his hair? If the patient is
black, ask if he uses a hot comb to straighten his hair or a long-toothed comb to
achieve an Afro look. Does he ever braid the hair in cornrows? Check for a family
history of alopecia, and ask what age relatives were when they started experiencing
hair loss. Also ask about nervous habits, such as pulling the hair or twirling it
around a finger.