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Examining Hair Loss in Women

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Female Alopecia
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Abstract

As with any medical problem, the female patient complaining of hair loss requires a comprehensive medical and drug history, physical examination of the hair and scalp, and appropriate laboratory evaluation to identify the cause. The clinician also has a host of diagnostic techniques that enable classification of the patient’s disorder as a shedding disorder or a decreased density disease and documentation of true pathology or only perceived pathology.

The first, never to accept anything for true which I do not clearly know to be such; that is to say, carefully to avoid precipitancy and prejudice, and to comprise nothing more in my judgement than what is presented to my mind so clearly and distinctly as to exclude all ground of doubt.

The second, to divide each of the difficulties under examination into as many parts as ­possible, and as might be necessary for its adequate solution.

The third, to conduct my thoughts in such order that, by commencing with objects the simplest and easiest to know, I might ascend by little and little, and, as it were, step by step, to the knowledge of the more complex; assigning in thought a certain order even to those objects which in their own nature do not stand in a relation of antecedence and sequence.

And the last, in every case to make enumerations so complete, and reviews so general, that I might be assured that nothing was omitted.

René Descartes, Discourse on the Method of Rightly Conducting the Reason, and Seeking Truth in the Sciences (1637)

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Suggested Reading

  • Descartes R (2000) Rules for the direction of the mind. Bobbs-Merrill Co., Indianapolis. ISBN 0-672-60334-9

    Google Scholar 

Patient History

  • Archer VE, Luell E (1960) Effect of selenium sulfide ­suspension on hair roots. J Invest Dermatol 35:65–67

    Article  CAS  PubMed  Google Scholar 

  • Carlini P, Di Cosimo S, Ferretti G et al (2003) Alopecia in a premenopausal breast cancer woman treated with letrozole and triptorelin. Ann Oncol 14:1689–1690

    Article  CAS  PubMed  Google Scholar 

  • Grover RW (1956) Diffuse hair loss associated with selenium (Selsun) sulfide shampoo. J Am Med Assoc 160:1397–1398

    Article  CAS  PubMed  Google Scholar 

  • Jackson D, Church RE, Ebling FJ (1972) Hair diameter in female baldness. Br J Dermatol 87:361–367

    Article  CAS  PubMed  Google Scholar 

  • Johnson KA, Bernard MA, Funderberg K (2002) Vitamin nutrition in older adults. Clin Geriatr Med 18:773–799

    Article  PubMed  Google Scholar 

  • Kullavanijaya P, Gritiyarangsan P, Bisalbutra P (1992) Absence of effects of dimethicone- and non-dimethicone-containing shampoos on daily hair loss rates. J Soc Cosm Chem 43:195–206

    CAS  Google Scholar 

  • Mirmirani P, Hessol NA, Maurer TA et al (2003) Hair changes in women from the Women’s Interagency HIV Study. Arch Dermatol 139:105–106

    Article  PubMed  Google Scholar 

  • Orentreich N, Berger RA (1964) Selenium disulfide shampoo. It’s influence on hair growth and the follicular cycle. Arch Dermatol 90:76–80

    Article  CAS  PubMed  Google Scholar 

  • Riedel-Baima B, Riedel A (2008) Female pattern hair loss may be triggered by low oestrogen to androgen ratio. Endocr Regul 42:13–16

    CAS  PubMed  Google Scholar 

  • Sawin CT, Geller A, Herschman JE (1979) The aging thyroid: increased prevalence of elevated serum TSH levels in the elderly. JAMA 242:247–250

    Article  CAS  PubMed  Google Scholar 

  • Tosti A, Piraccini BM, van Neste DJ (2001) Telogen effluvium after allergic contact dermatitis of the scalp. Arch Dermatol 137:187–190

    CAS  PubMed  Google Scholar 

  • Williams RH (1947) Thyroid and adrenal interrelations with special reference to hypotrichosis axillaries in thyrotoxicosis. J Clin Endocrinol 7:52–57

    Article  CAS  Google Scholar 

  • York J, Nicholson T, Minors P, Duncan DF (1998) Stressful life events and loss of hair among adult women, a case–control study. Psychol Rep 82:1044–1046

    Article  CAS  PubMed  Google Scholar 

Clinical Examination

  • Caserio RJ (1987) Diagnostic techniques for hair disorders part III: clinical hair manipulations and clinical findings. Cutis 40:442–448

    Google Scholar 

  • Davis-Daneshfar A, Trüeb RM (1995) Tonsural trichotillomania. Hautarzt 46:804–807

    Article  CAS  PubMed  Google Scholar 

  • Hamilton JB (1951) Patterned loss of hair in man; types and incidence. Ann N Y Acad Sci 53:708–728

    Article  CAS  PubMed  Google Scholar 

  • Ludwig E (1977) Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol 97:247–254

    Article  CAS  PubMed  Google Scholar 

  • Navarini AA, Nobbe S, Trüeb RM (2009) Marie Antoinette syndrome. Arch Dermatol 145:656

    Article  PubMed  Google Scholar 

  • Norwood OT (1975) Male pattern baldness: classification and incidence. South Med J 68:1359–1365

    Article  CAS  PubMed  Google Scholar 

  • Savin RC (1992) A method for visually describing and quantitating hair loss in male pattern baldness. J Invest Dermatol 98:604

    Google Scholar 

Trichoscopy

  • Annessi G (1998) Tufted folliculitis of the scalp: a distinctive clinicohistological variant of folliculitis decalvans. Br J Dermatol 138:799–805

    Article  CAS  PubMed  Google Scholar 

  • Bakos RM, Bakos L (2007) Dermoscopy for diagnosis of pediculosis capitis. J Am Acad Dermatol 57:727–728

    Article  PubMed  Google Scholar 

  • de Lacharrière O, Deloche C, Misciali C et al (2001) Hair diameter diversity: a clinical sign reflecting the follicle miniaturization. Arch Dermatol 137:641–646

    PubMed  Google Scholar 

  • Deloche C, de Lacharrière O, Misciali C et al (2004) Histological features of peripilar signs associated with androgenetic alopecia. Arch Dermatol Res 295:422–428

    Article  PubMed  Google Scholar 

  • Galliker NA, Trüeb RM (2012) Value of trichoscopy versus trichogram for diagnosis of female androgenetic alopecia. Int J Trichology 4:19–22

    Article  PubMed Central  PubMed  Google Scholar 

  • Guarrera M, Rebora A (1996) Anagen hairs may fail to replace telogen hairs in early androgenic female alopecia. Dermatology 192:28–31

    Article  CAS  PubMed  Google Scholar 

  • Guarrera M, Rebora A (2005) Kenogen in female androgenetic alopecia. A longitudinal study. Dermatology 210:18–20

    Article  CAS  PubMed  Google Scholar 

  • Hidvégi B (2008) Dermoscopy of hair and scalp disorders. Eur J Dermatol 18:607

    Google Scholar 

  • Hofbauer GF, Tsambaos D, Spycher MA, Trüeb RM (2001) Acquired hair fragility in pili annulati: causal relationship with androgenetic alopecia. Dermatology 203:60–62

    Article  CAS  PubMed  Google Scholar 

  • Inui S, Nakajima T, Itami S (2007) Dry dermoscopy in clinical treatment of alopecia areata. J Dermatol 34:635–639

    Article  PubMed  Google Scholar 

  • Inui S, Nakajima T, Nakagawa K, Itami S (2008) Clinical significance of dermoscopy in alopecia areata: analysis of 300 cases. Int J Dermatol 47:688–693

    Google Scholar 

  • Inui S, Nakajima T, Itami S (2008) Significance of dermoscopy in acute diffuse and total alopecia of the female scalp: review of twenty cases. Dermatology 217:333–336

    Google Scholar 

  • Inui S, Nakajima T, Shono F, Itami S (2008) Dermoscopic findings in frontal fibrosing alopecia: report of four cases. Int J Dermatol 47:796–799

    Google Scholar 

  • Itin PH, Schiller P, Mathys D, Guggenheim R (1997) Cosmetically induced hair beads. J Am Acad Dermatol 36:260–261

    Article  CAS  PubMed  Google Scholar 

  • Kossard S, Zagarella S (1993) Spotted cicatricial alopecia in dark skin. A dermoscopic clue to fibrous tracts. Australas J Dermatol 34:49–51

    Article  CAS  PubMed  Google Scholar 

  • Kurwa AR, Abdel-Aziz AH (1973) Pili torti-­congenital and acquired. Acta Derm Venereol 53(5):385–392

    CAS  PubMed  Google Scholar 

  • Lacarrubba F, Dall’Oglio F, Nasca MR, Micali G (2004) Videodermoscopy enhances diagnostic capability in some forms of hair loss. Am J Clin Dermatol 5:205–208

    Article  PubMed  Google Scholar 

  • Loewenthal JA (1947) “Compound” and grouped hairs of the human scalp: their possible connection with follicular infection. J Invest Dermatol 8:263–273

    Article  CAS  PubMed  Google Scholar 

  • Olszewska M, Rudnicka L, Rakowska A et al (2008) Trichoscopy. Arch Dermatol 144:1007

    Article  PubMed  Google Scholar 

  • Powelll J (2000) Increasing the likelihood of early diagnosis of Netherton syndrome by simple examination of eyebrow hairs. Arch Dermatol 136:423–424

    Article  Google Scholar 

  • Rebora A, Guarrera M (2002) Kenogen. A new phase of the hair cycle? Dermatology 205:108–110

    Article  PubMed  Google Scholar 

  • Requena L, Sarasa JL, Ortiz Masllorens F et al (1995) Follicular spicules of the nose: a peculiar cutaneous manifestation of multiple myeloma with cryoglobulinemia. J Am Acad Dermatol 32:834–839

    Article  CAS  PubMed  Google Scholar 

  • Ross EK, Vincenzi C, Tosti A (2006) Videodermoscopy in the evaluation of hair and scalp disorders. J Am Acad Dermatol 55:799–806

    Article  PubMed  Google Scholar 

  • Rudnicka L, Olszewska M, Rakowska A et al (2008) Trichoscopy: a new method for diagnosing hair loss. J Drugs Dermatol 7:651–654

    PubMed  Google Scholar 

  • Sewell LD, Elston DM, Dorion RP (2007) “Anisotrichosis”: a novel term to describe pattern alopecia. J Am Acad Dermatol 56:856

    Article  PubMed  Google Scholar 

  • Toncić RJ, Lipozencić J, Pastar Z (2007) Videodermoscopy in the evaluation of hair and scalp disorders. Acta Dermatovenerol Croat 15:116–118

    PubMed  Google Scholar 

  • Tosti A (2007) Dermoscopy of hair and scalp disorders with clinical and pathological correlations. Informa Healthcare, Hampshire

    Book  Google Scholar 

  • Tosti A, Whiting D, Iorizzo M et al (2008) The role of scalp dermoscopy in the diagnosis of alopecia areata incognita. J Am Acad Dermatol 59:64–67

    Article  PubMed  Google Scholar 

Trichogram

  • Blume-Peytaivi U, Orfanos CE (1995) Microscopy of the hair – the trichogram. In: Derup J, Jemec GBE (eds) Handbook of non-invasive methods and the skin. CRC Press, London, pp 549–554

    Google Scholar 

  • Braun-Falco O, Heilgemeir GP (1985) The trichogram. Structural and functional basis, performance, and interpretation. Sem Dermatol 4:40–52

    Google Scholar 

  • Caserio RJ (1987) Diagnostic techniques for hair disorders part III: clinical hair manipulations and clinical findings. Cutis 40:442–448

    Google Scholar 

Laboratory Evaluation

  • Kantor J, Kessler LJ, Brooks DG, Cotsarelis G (2003) Decreased serum ferritin is associated with alopecia in women. J Invest Dermatol 12:985–988

    Article  Google Scholar 

  • Moltz L (1988) Hormonale Diagnostik der sogenannten androgenetischen Alopezie der Frau. Geburtsh u Frauenheilk 48:203–214

    Article  CAS  Google Scholar 

  • Orfanos CE, Hertel H (1988) Disorder of hair growth in hyperprolactinemia. Z Hautkr 63:23–26

    CAS  PubMed  Google Scholar 

  • Park H, Kim CW, Kim SS, Park CW (2009) The therapeutic effect and the changed serum zinc level after zinc supplementation in alopecia areata patients who had a low serum zinc level. Ann Dermatol 21:142–146

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Pierard GE (1979) Toxic effects of metals from the environment on hair growth and structure. J Cutan Pathol 6:237–242

    Article  CAS  PubMed  Google Scholar 

  • Rushton DH (1993) Investigating and managing hair loss in apparently healthy women. Can J Dermatol 5:455–461

    Google Scholar 

  • Rushton DH, Ramsay ID, James KC et al (1990) Biochemical and trichological characterization of diffuse alopecia in women. Br J Dermatol 123:187–197

    Article  CAS  PubMed  Google Scholar 

  • Schmidt JB, Lindmaer A, Spona J (1991) Hyperprolactinemia and hypophyseal hypothyroidism as cofactors in hirsutism and androgen-induced alopecia in women. Hautarzt 42:168–172

    CAS  PubMed  Google Scholar 

  • Trüeb RM (2010) Hormones and hair growth. Hautarzt 61:487–495

    Article  PubMed  Google Scholar 

Scalp Biopsy

  • Caserio RJ (1987) Diagnostic techniques for hair disorders part III: clinical hair manipulations and clinical findings. Cutis 40:442–448

    Google Scholar 

  • Elston DM, McCollough ML, Angeloni VL (1995) Vertical and transverse sections of alopecia biopsy specimens. Combining the two to maximize diagnostic yield. J Am Acad Dermatol 32:454–457

    Article  CAS  PubMed  Google Scholar 

  • Harries MJ, Trueb RM, Tosti A et al (2009) How not to get scar(r)ed: pointers to the correct diagnosis in patients with suspected primary cicatricial alopecia. Br J Dermatol 160:482–501

    Article  CAS  PubMed  Google Scholar 

  • Headington JT (1996) Cicatricial alopecia. Dermatol Clin 14:773–782

    Article  CAS  PubMed  Google Scholar 

  • Solomon AR (1994) The transversely sectioned scalp biopsy specimen: the technique and a algorithm for ist use in the diagnosis of alopecia. Adv Dermatol 9:127–157

    CAS  PubMed  Google Scholar 

  • Ross EK, Tan E, Shapiro J (2005) Update on primary cicatricial alopecias. J Am Acad Dermatol 53:1–37

    Article  PubMed  Google Scholar 

  • Sperling LC (2001) Scarring alopecia and the dermatopathologist. J Cutan Pathol 28:333–342

    Article  CAS  PubMed  Google Scholar 

  • Templeton SF, Solomon AR (1994) Scarring alopecia: a classification based on microscopic criteria. J Cutan Pathol 21:97–109

    Article  CAS  PubMed  Google Scholar 

  • Trachsler S, Trüeb RM (2005) Value of direct immunofluorescence for differential diagnosis of cicatricial alopecia. Dermatology 211:98–102

    Article  PubMed  Google Scholar 

Quantifying Hair Loss

  • Guarrera M, Semino MT, Rebora A (1997) Quantitating hair loss in women: a critical approach. Dermatology 1997:12–16

    Article  Google Scholar 

  • Hoffmann R (2001) TrichoScan: combining epiluminiscence microscopy with digital image analysis for the measurement of hair growth in vivo. Eur J Dermatol 11:362–368

    CAS  PubMed  Google Scholar 

  • Ihm CW, Lee JY (1991) Evaluation in daily hair counts. Dermatologica 182:67

    Article  CAS  PubMed  Google Scholar 

  • Olsen EA (1993) Clinical tools for assessing hair loss. In: Olsen EA (ed) Disorders of hair growth: ­diagnosis and treatment. McGraw-Hill, New York, pp 59–69

    Google Scholar 

  • Rampini P, Guarrera M, Rampini E, Rebora A (1999) Assessing hair shedding in children. Dermatology 199:256–257

    Article  CAS  PubMed  Google Scholar 

  • Seung Ho Lee, Oh Sang Kwon, Jun Gyu Oh et al (2004) Phototrichogram: Evaluation of Modified Methods with Bleaching and Trichoscan. Poster presentation at the European Hair Research Society, Seoul, 2004

    Google Scholar 

  • Van Neste D, Trüeb RM (2006) Critical study of hair growth analysis with computer-assisted methods. J Eur Acad Dermatol Venereol 20:578–583

    Article  PubMed  Google Scholar 

Hair Database Sheet

  • Caserio RJ (1987) Diagnostic techniques for hair disorders part III: clinical hair manipulations and clinical findings. Cutis 40:442–448

    Google Scholar 

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Trüeb, R.M. (2013). Examining Hair Loss in Women. In: Female Alopecia. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35503-5_2

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  • DOI: https://doi.org/10.1007/978-3-642-35503-5_2

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