Traction alopecia: history of tight hairstyles and marginal hairline
Trichotillomania: history of pulling hair or evidence of traumatic folliclesPull Test
This test is performed to estimate the severity of hair loss and refine the differential diagnosis. A clinician grabs sections of hair and observes for active hair loss. A positive pull test is usually caused by telogen effluvium, androgenetic alopecia, and alopecia areata.Tug Test
A doctor holds the top and bottom of a strand of hair and observes for a break in the middle which may be caused by a hair shaft abnormality.Card Test
A part in the hair is created and a small card is placed to contrast the color of the hair and visualize thin strands of hair (seen in telogen effluvium) vs short broken strands (seen in hair shaft abnormalities).Fungal Culture
Scalp is scraped and the specimen is incubated for fungal growth commonly seen in tinea capitis.Scalp biopsy
If the diagnosis of hair loss is unclear or not responsive to the treatment, a scalp biopsy may be required. Scalp biopsy will show evidence of inflammation, location, and change in the follicles. This will frequently refine the diagnosis.Blood Tests
In the case of suspected iron deficiency, thyroid disease, or androgen excess a blood test may be necessary to rule in these causes.Trichoscopy
A new technique which allows for magnified visualization of the hair and scalp, providing a high definition, detailed look at follicles. Treatment
Steroids
Steroids may be used for the short-term treatment of autoimmune causes of hair loss such as alopecia areata.
Topical or oral preparations may be used for a few weeks to reduce inflammation. Long term use of topical steroids has not shown benefits for growth and the use of long term oral steroids has many risks that typically outweigh the benefits.Immunotherapy
Diphenylcyclopropenone or squaric acid may be used topically for the treatment of alopecia areata as an alternative to steroids. This treatment may cause a local skin reaction.Minoxidil
Minoxidil is a topical treatment that comes in a solution or foam. The foam provides increased delivery of the drug and less irritation. This drug has been shown to decrease telogen and increase anagen phase of hair follicles, increase VEGF expression, and have indirect vasodilation effects. FDA has approved this drug for use in androgenetic alopecia, but frequent offlabel uses include alopecia areata, chemotherapy induced alopecia, telogen effluvium, and traction alopecia.Redensyl
Redensyl is emerging as an alternative hair loss treatment containing a newly discovered molecule called dihydroquercetin-glucoside (DHQG), a compound derived from plant extracts known to target the stem cells in hair follicles and encourages the division of the cells. Still in development stage it has been approved by FDA as many of its medication are available widelyHormone modulating
Androgenetic alopecia is routinely treated with drugs that alter hormonal function, in particular DHTs effects. Male pattern hair loss is treated with oral finasteride which is a 5-alpha reductase inhibitor that blocks the formation of DHT from testosterone. Finasteride may cause sexual dysfunction, but it is typically reversed upon discontinuation of the treatment.