Proper Diagnosis of Hair Loss

Before one can decide if they might need medical treatment or a hair transplant, a proper diagnosis of their hair loss condition should be made by a  hair loss specialist. Hair loss may be pattern hair loss (male or female) or non-pattern hair loss. Dr. McBeth employs a thorough history and physical examination of the patient’s scalp and pertinent body systems plus  when appropriate, uses dermoscopy, trichoscopy, laboratory tests, and scalp biopsy to get the most precise and accurate diagnosis of your hair loss problem. Additionally, we use the Tricholab Handyscope to measure hair counts, image hair shaft health, and even get a second opinion from a pathologist, if necessary.

Time is of the essence. Don’t wait to investigate what can be done to improve, treat, or reverse your hair loss. Call today for a consultation at 310 734 7481.



Find Your Hair Loss Pattern

Pattern Hair Loss

The great majority of all hair loss is male or female pattern alopecia which is the result of a genetic predisposition to the hormone effect of DHT ( a metabolite of testosterone) on 3 different areas of the hair follicle. The effect DHT causes the slow miniturization of the follicle units over time and eventually the follicles will fall out and never regrow. This is why we see thinning of the hair or the “see through appearance” of the scalp, particularly when light shines upon it and ultimately, there can be complete baldness. The proper diagnosis of this genetic process is accomplished by dermatoscopic examination of the scalp by a hair restoration surgeon or specialist, amongst other methods. It is paramount that men or women with this type of hair loss, seek immediate help to prevent future loss of hair, before the hair pores are completely gone. Male or Female Patterned Hair Loss or androgentic alopecia is treatable with medications, non-surgically with Regenera AMT, and FUE/FUT hair transplant surgery. Call Dr. McBeth at 310 734 7481 to get a consultation today!

Non-Pattern Hair Loss

Hair loss (or alopecia) that is not in a genetic male or female pattern is divided into:
  • Hair Shedding
  • Scarring Or Cicatricial
  • Alopecia
  • Focal Non-scarring
  • Alopecia
  • Telogen Effluvium
  • Hair Breakage Problems
  • Diffuse Thinning

Hair Shedding

Sometimes generalized hair thinning is caused by hair shedding. More than 100 hairs per day is significant – this usually is a telogen effluvium (hairs which have entered the resting or telogen phase of the growth cycle – and are thus falling out). When hair follicles enter the telogen phase, the hairs held firmly in those follicles become loose and fall out. Certain severe toxins, radiation or chemo can cause anagen effluvium – where hairs are shed during the anagen (growth) phase of the cycle – as the follicles are destroyed. A telogen effluvium usually occurs about three months after the precipitating event, whereas anagen effluvium occurs closer to the toxic event.
Telogen Effluvium (Common Precipitating Events)
  • Childbirth
  • General Anesthesia
  • High Fever
  • Hormonal Changes
  • Protein-Deficient Diet
  • Starting or Stopping OCAs
  • Stress
  • Sudden Weight Loss
  • Systemic Diseases
Common Drugs That Can Cause Telogen Effluvium
  • ACE Inhibitors
  • Androgens
  • Anti-Cholesterol Agents
  • Beta Blockers
  • Cimetidine
  • Coumadin, Heparin
  • Lithium
  • Oral Contraceptives (OCAs)
  • Vitamin A
  • Childbirth
  • General Anesthesia
  • High Fever
  • Hormonal Changes
  • Protein-Deficient Diet
  • Starting or Stopping OCAs
  • Stress
  • Sudden Weight Loss
  • Systemic Disease

Cicatricial (Scarring) Alopecia

Hair transplant surgeons often find unusual cases where the normal patterns of male-pattern baldness or female-pattern baldness are not present. These are  irregular patterns of hair loss on the scalp, frequently accompanied by loss of pores and hair in the area in question, and often a smooth, glassy appearance on the scalp. Unfortunately, these causes for hair loss are growing in epidemic proportions, especially amongst perimenopausal and menopausal women and women of color. This can be considered a “hair emergency” when early diagnosis and treatment is key to minimize permanent loss of hair. Although, sometimes there may be no symptoms besides hair shedding, itching, burning, irritation, redness of the scalp especially around the hair follicles,  excessive flakiness of the scalp, or loss of eyebrows may occur.

When these are present, it is often necessary to do a biopsy to determine the process that is active. Generally, loss of pores and smooth shiny scalp indicate a scarring alopecia.

The Following Are The Types Of Scarring Alopecia Which Require A Biopsy:

  • Chronic cutaneous lupus erythematosus
  • Lichen planus pilaris
  • Frontal fibrosing alopecia
  • Graham-Little Syndrome
  • Pseudopelade of Brocq
  • Central centrifugal cicatricial alopecia
  • Alopecia mucinosa
  • Keratosis follicularis spinulosa decalvans
  • Folliculitis decalvans
  • Dissecting cellulitis/folliculitis

Focal Non-Scarring Alopecia

  • Entity / Distinguishing features
  • Secondary syphilis: Serology for syphilis (contagious)
  • Tinea capitis (ringworm): Broken hairs, scaling, erythema, positive smear and culture (contagious)
  • Traction alopecia: Typical pattern from traction
  • Triangular alopecia: Pattern, configuration and history on temple
  • Trichoterlomania: Shaved hairs
  • Trichotillomania: Broken hairs present from manipulation, hairs of various lengths
  • Alopecia areata: Irregular patches, frequently round, of missing hair, scattered throughout the scalp, usually characterized by fine, silvery hairs at the base. This is thought to be an autoimmune condition which lasts for several months to several years, may be characterized by hair regrowth in some of the areas, followed by development of patchy hair loss in other areas. This is diagnosed by biopsy, appearance, hair-pull test and history.

Hair Breakage

These are different Causes Of Hair Breakage

Diffuse Hair Loss

Pattern Baldness Versus Generalized Diffuse Hair Loss
Note that male and female pattern baldness are just that, hair loss in a pattern, generally on the top, sides, and back of the head, but sparing a thick donor area. Other types of systemic problems such as low thyroid, iron deficiency, collagen disorder, growth or sex hormone deficiency, secondary syphilis all may cause diffuse hair thinning. If you have generalized hair thinning, you need a complete medical workup for the various causes. Also note that some people have both a pattern hair loss as well as a diffuse or generalized decrease in density. These people may well have both conditions simultaneously, but still require a complete medical workup, normally with lab tests and biopsy.

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