Hair and Nail Conditions: Alopecia Evaluation

Alopecia affects men and women and can result in significant distress for patients. Alopecias can be categorized as nonscarring or scarring. Nonscarring alopecias include male and female pattern alopecias, alopecia areata, telogen effluvium, traction alopecia, trichotillomania, and tinea capitis. Scarring alopecias include central centrifugal cicatricial alopecia, lichen planopilaris, frontal fibrosing alopecia, discoid lupus erythematosus, dissecting cellulitis of the scalp, folliculitis decalvans, and acne keloidalis nuchae. Evaluation of patients with alopecia involves assessment of the duration and distribution of hair loss, associated scalp symptoms, and associated conditions. Clinical examination of the hair and scalp may include a hair pull test, tug test, hair mount (ie, trichogram), dermoscopy, laboratory tests, and/or scalp biopsy, depending on the suspected etiology. Hair regrowth cannot occur in established lesions of scarring alopecia, so early identification and prompt initiation of treatment are critical in these cases. Patients with suspected or confirmed alopecias, alopecia areata, or alopecias refractory to treatment may benefit from referral to a dermatologist.