History
The medical history is of utmost
importance in identifying the cause of hair
loss. A detailed history includes the chief
complaint, past medical history, medications
(including supplements), allergies, family
history, and diet. In a woman, a history of
menses, pregnancy, and menopause should also
be assessed.
After a general review of systems,
specific hair-related questions should be
asked since all too frequently, the chief
complaint is "hair loss." Thus, the
practitioner needs to clarify and qualify
the complaint to narrow the differential
diagnosis. Specific questions that can be
helpful include:
- "When did the hair loss
start?" "Was the hair loss
sudden in onset or gradual?"
The duration and onset of
alopecia should be
determined. For example, if
hair loss is sudden, there
is likely a disruption of
the hair cycle (telogen
effluvium) whereas chronic
hair loss may indicate an
abnormality of the hair
follicle (androgenetic
alopecia).
- "Where have you noticed
the most hair loss?"
Localized, diffuse, or
patterned thinning can be
the key to diagnosis. When a
patient presents for
evaluation of hair loss, she
may be referring to a single
patch of alopecia or to
extensive hair breakage from
use of hair products (hair
shaft damage). Patterned
alopecia is seen most
commonly in androgenetic
alopecia.
- "What is your normal
hair care routine?" Hair
care practices and use of
hair cosmetics (for example,
bleaching, permanent waving)
can be key factors in
determining the cause of
hair loss.
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