Presentations Aren’t Always Classic
Every hair specialist who first learns how to diagnose hair loss first learns about something known as the “classical presentation.” This refers to the way the specific condition might be described in textbooks. Not surprising, the classic presentation is also referred to as the “textbook presentation” of the condition.
Physicians often say statements like “it was a classic presentation” or “the hair loss was textbook” reflecting the common use of these terms.
Despite this, we must remember that sometimes the way hair loss develops on the scalp hair is not quite classic. Sometimes, the patient in the next room does not have a textbook presentation. Alopecia areata, some scarring alopecias and even some types of hair loss from drugs show up on the scalp in ways we just don’t see as we flip through the textbooks. These are in essence variations on the classic or textbook presentation.
There is always some aspect of the disease that is still seen in these “non classic” presentations. Consider as an example the patient with the scarring alopecia lichen planopilaris who has little in the way of scalp scaling or redness yet shows clear pockets of evolving scarring. Or the patient without great amounts of miniaturization who is clearly thinning in a localized patterned distribution.
These sets of photographs of Canadian geese reminded me that we can generally figure out what’s going on if we consider everything in context - even if the presentation isn’t quite classic.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887