Alopecia: evaluation and management

The patient presenting with hair loss may have a primary dermatologic disease, a genetically engineered process, an infectious disease, an underlying systemic illness, a drug reaction, or a psychological disorder. By first dividing the process into one of three categories, scarring, diffuse-nonscarring, or patchy-nonscarring, one then can approach the evaluation in a rational manner. Using the bedside techniques of a hair pull, hair pluck, and microscopic hair examination and directed laboratory tests, one can narrow the differential diagnosis and can recommend directed therapy.