Male with patchy loss of scalp hair and grey hair in the eyebrows and beard diagnosis is (AIIMS Nov 2014)
a. Patchy loss, exclamation mark hair, autoimmune–Alopecia areata
b. Loss of Hair following a stress, infection, etc–Telogen effluvium
c. Loss of hair after chemotherapy–Anagen effluvium
d. Frontotemporal recession–Androgenetic alopecia
e. Causes of diffuse alopecia with no sign of inflammation non-scarring
a. Telogen effluvium
a. Post-partum b. Severe illness c. Major operations d. Malnutrition
2). Anagen effluvium, e.g., chemotherapy
3). Male pattern baldness
4). Female pattern baldness
5). Diffuse alopecia areata
6). Drugs, e.g., heparin, antithyroid drugs, etretinate, isotretinoin
7). Systemic disease, e.g., Iron deficiency, thyroid disease, secondary syphilis, SLE
8). Ageing: usually causes thinning of hairs Telogen effluvium
a. When a severe insult strikes our bodies (severe infection, delivery, major operation) the anagen hairs (>90% of hair population) will shift to telogen phase. As a result, about 3 months after the insult, more than 30% of the hair will fall off at the same time giving rise to the condition which is called telogen effluvium.
b. The diagnosis can be made from a detailed history of the past health. In case when the diagnosis is in doubt, it can be confirmed by the telogen hair count test.
c. It is done by plucking a bundle of hairs and counting for the percentage of telogen hairs present.
d. Normally, the telogen hair count should not exceed 10% of the total hair count. Unfortunately, this test is not available in most centers.
e. For telogen effluvium, no specific treatment is needed since spontaneous remission is the rule.
f. Anagen effluvium: Chemotherapy attacks the rapidly dividing cells, i.e., anagen hair. As a result, more than 90% of the hair fall off soon after chemotherapy. Usually, there is no problem with the diagnosis since it is obvious from the history.
g. Male pattern baldness (Androgenetic alopecia): Typically, it starts off with bitemporal recession and subsequently, thinning or complete loss of hair at the crown. Hair on the occiput and around the sides of the scalp is seldom affected and it seems that hair in those areas are more resistant to the effect of androgen. The diagnosis can often be made by the characteristic pattern of hair loss and the frequently presence of a positive family history.
h. Alopecia areata/Totalis/Universalis: These 3 conditions all belong to a spectrum of the same disease. They only differ in the degree of severity. When all the scalp hair is lost, it is called alopecia totalis. If both scalp and body hair are involved, it becomes alopecia universalis.
i. Alopecia areata is the commonest cause of patchy alopecia.