Hair Loss Conditions

A scarring alopecia primarily affecting Black women

What will the patient tell you? (History)

• Onset: Gradual thinning on the vertex (crown), spreading outward.

• Symptoms: Burning, itching, and tenderness.

• Risk Factors: Chemical relaxers, heat styling, tight practices.

What will it look like? (Examination)

• Location: Scarring patch on the vertex enlarging centrifugally.

• Late Stage: Smooth, shiny scalp with loss of follicular openings (scarring).

• Differential: Must be differentiated from Female Pattern Hair Loss (FPHL).

How can you help? (Treatment)

• Goal: Halt inflammation early to prevent permanent loss.

• First-line: Potent topical steroids or Intralesional Triamcinolone.

• Systemic: Oral Tetracyclines or Hydroxychloroquine (anti-inflammatory).

• Lifestyle: Avoid all chemical relaxers, heat, and tight hairstyles.

A fungal infection, a common cause of hair loss in children.

What will the patient tell you? (History)

• Children: Scalp scaling, circular alopecia patches, itchiness.

• Kerion: Sudden, boggy, painful swelling (severe inflammation)

What will it look like? (Examination)

• Appearance: Patchy alopecia with scaling. Black dot hairs (broken hairs at the scalp surface) are common.

• Kerion: Boggy, pustular, tender swelling with lymphadenopathy.

How can you help? (Treatment)

• Systemic Antifungals are MANDATORY.

• First-line: Griseofulvin (for $8–10$ weeks).

• Kerion: Treat urgently to prevent scarring. Consider oral steroids if inflammation is severe.

The most common form of hair loss; non-scarring.

• Male Pattern Hair Loss (MPHL)

  • History: Gradual recession at temples $\to$ vertex thinning.

  • Examination: Bitemporal recession and vertex thinning. Miniaturized hairs.

  • Treatment: Topical Minoxidil 5%. Oral Finasteride 1 mg/day (male only).

• Female Pattern Hair Loss (FPHL)

  • History: Diffuse thinning on the crown with a preserved frontal hairline.

  • Examination: Diffuse thinning, leading to a widened part. No scarring.

  • Treatment: Topical Minoxidil 2%–5%. Antiandrogens (Spironolactone) for selected patients.

Acute, diffuse, non-scarring shedding.

What will the patient tell you? (History)

• Onset: Acute, diffuse shedding occurring 2–3 months after a trigger.

• Triggers: Postpartum, major illness/surgery, severe stress, iron deficiency, thyroid disease, crash dieting.

• Shedding: Sudden, large clumps of hair coming out.

What will it look like? (Examination)

• Appearance: Diffuse thinning all over the scalp (no focal bald patches).

• Diagnostic Test: Positive hair pull test (>3 hairs per 60 pulled).

• Course: No erythema or scarring.

How can you help? (Treatment)

• Prognosis: Self-resolving once the trigger is removed. Regrowth begins spontaneously at 3–6 months.

• Correct Deficiencies: Treat iron deficiency (aim for Ferritin>50 ng/mL) and thyroid disorders.

• Reassurance is key.

Pharmaceutical Journal - Common dermatological conditions in skin of colour (Belmo et al., 2021)

DermNet NZ - Hair Loss (Alopecia) (Oakley, 2015 & 2023)

StatPearls – Telogen Effluvium (Hughes et al., 2024)

StatPearls – Androgenetic Alopecia (Ho et al., 2024)

StatPearls – Alopecia Overview (Al Aboud et al., 2024)

Skinsight – Male Pattern Alopecia:

Skinsight – Female Pattern Alopecia: