Diagnosing Hair Loss: All Steps Must be Considered

The Important Steps in Diagnosis

One can confidently diagnose the cause of a patient’s hair loss after they have completed a few steps: (1) they have heard the whole story about the hair loss and patient’s past health (2) they have examined the scalp including up close with use of trichoscopy and (3) they have reviewed the patient’s blood tests. (4) Sometimes a fourth step is needed and that is review of the results of a patient’s biopsy. One essentially puts the results of steps 1,2,3 and 4 into the brain and then out pops the diagnosis.

The diagnosis of hair loss is a multistep process. It comes from evaluating the patent’s story of their hair loss, examining the scalp, blood tests and biopsy results if needed.

We never diagnose hair loss by ordering up blood tests and sitting patiently for the results to come back. Blood tests can be an important part of the story but they are never the entire story. Similarly one never relies 100 % on the results of a biopsy. If one decides to do a biopsy and it comes back showing a non-scarring alopecia but the clinician in really thinking this is a scarring alopecia then one must either ignore the biopsy or take more biopsies from the patient’s scalp or get another pathologist to review the slide.

Many patients eagerly await the results of the biopsy to determine what it is they actually have. This is an error. The diagnosis of hair loss must take into account the whole story, as well as what the scalp looks like and what the blood tests show.

Diagnosing hair loss comes from reviewing information from multiple sources of information.