Some Hair Loss Conditions Look Alike - but that not mean they can not be distinguished

Look-alike does not mean alike

I’m often asked how it’s possible to distinguish different hair loss conditions if sometimes they can look so similar. How can we distinguish a challenging case of seborrheic dermatitis from lichen planopilaris? How can we be sure that a patient who is concerned about hair shedding has early androgenetic alopecia not telogen effluvium?

The answer is to dig deeper and get more clues if one is not sure. Few detectives solve a complex mystery by sitting at the coffee shop. They get out on the scene and gather necessary clues. If the detective is not sure, they ask more questions, examine things closer or in more detail …. or perform more tests.

The same is true with hair medicine. We need to ask good questions that direct us in the right direction. We need to perform a careful scalp examination (including trichoscopy). We also have available a plethora of tests that we can use if we need to. These include blood tests, biopsies, swabs, pull tests, trichograms, and hair collections. When put to use at the right time and interpretted correctly - these tests also provide important information. A good doctor puts all the pieces together.

It’s true that some hair loss conditions can look similar. But that is far from needing to express frustration that we simply can’t tell them apart. In cases of frustration, I tell my trainees “Be an expert!” A golden retriever dog can look like a yellow lab dog but an expert can easily tell them apart. A wine expert can easily distinguish a Chardonnay from a Riesling, Pinot Grigio or Pinot Blanc. There are lots of things that seem alike but people who understand the subject can tell them apart. A knowledgeable hair expert can sort through challenging hair loss diagnoses.

Many hair loss conditions can look similar. Yes, this is true! If one is not sure, they ask more questions, examine things closer or in more detail …. or perform more tests. Few detectives solve a complex mystery by sitting at the coffee shop and few hair specialists can solve complex cases by sitting back in the office chair.