Consultation and Diagnosis of Female Hair Loss

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A first consultation serves as an introduction to the patient’s hair loss concerns; hair loss pattern and medical/family history.


During the consultation an initial evaluation is made, and the need for blood tests , microscopic analysis of the hair shafts or scalp biopsy is established. When the cause of hair loss is uncertain, further diagnostic information can be obtained from a scalp scrapings and culture for fungus; as well as a scalp biopsy and/or blood tests.


The diagnosis is made based on the history, hair loss presentation and where necessary supplementary special investigations. In many cases there may be no surgical intervention required.


Diagnosing Androgenic Alopecia in women

“Female pattern” hair loss (FPHL) is diagnosed when there is a history of gradual thinning in the front and/or top of the scalp. In females the frontal hairline is mostly preserved. The thinning is most often centrifugal (confined to the central top region of the scalp) in nature; and there is a family history of hair loss. Miniaturisation of the hair follicles with diminished hair shaft calibre will be seen in the thinning areas.


Diffuse hair loss all over the scalp can make diagnosis more difficult, but miniaturisation usually indicates that the cause is most likely due to androgenetic alopecia or female pattern hair loss.


Diagnosing Telogen Effluvium

Telogen effluvium generally occurs 2-3 months after a stressful event. Over 300 club hairs (telogen hairs that have rounded ends) may be shed per day.


Diagnostic tests are the ‘hair-pull’ and ‘hair- pluck’ tests. In the ‘hair- pull’, the surgeon takes 20 or 30 hairs and gently tugs on them from proximal (bottom end) to distal (top end); if 5 or more hairs come loose then this is suggestive of increased shedding associated with telogen effluvium.


Another test for Telogen Effluvium is the ‘hair-pluck’test which involves plucking 20 to 30 hairs with a small clamp and examining them under a microscope to determine the ratio of anagen (growing) hairs to telogen (resting) hairs.


If less than 80% of the follicles are in the anagen stage, Telogen Effluvium (TE) is probable. Chronic TE affects women age 40 to 60 years and can start abruptly with or without an initial causative factor or trigger event. It can cause diffuse thinning with accentuation at the temples, and patients can lose from 50-400 hairs/day. The condition does not lead to complete baldness and should ultimately resolve by itself.

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