Hair loss diagnosis
In order to pinpoint the cause of hair loss, you have to know that there can be weeks between the triggering event and hair loss. Hair is not always lost immediately. In this article, we will talk about hair loss diagnosis and care.
Often, they stop to grow first, followed by a lot of hair suddenly falling out at the same time.
It is advised, to speak with your family doctor, your gynecologist or pediatrician. If you already know a dermatologist, then you can speak to him/her directly. But note it is always better to do this via your Doctor.
The dermatologist will first ask about the duration, and severity of the hair loss, about other symptoms, such as itching or nail changes, about other illnesses, any medication you are taking, even if used several weeks ago can be important here.
Basically, the dermatologist will ask questions about living conditions that could influence hair growth.
Do not be dismayed when the conversation steers into the dermatologist asking whether a close relative suffers from hair loss or not.
Particularly, women with suspected hair loss will be asked by their doctor about changes in their menstrual cycle, pregnancy and childbirth, the use of hormonal contraceptives, and depending on one’s age, the onset of menopause.
Hair loss diagnosis and care
How a dermatologist diagnoses hair loss
For a dermatologist to say you have hair loss, the pattern of hair loss and the appearance of the bald skin often point to the diagnosis. In some cases, the doctor may also use a magnifying glass (dermatoscope).
A dermatoscope allows a multiple enlarged view of the skin.
Sometimes additional examinations are necessary, for example a blood or hair analysis, less often a scalp biopsy is also done.
Then the doctor will carefully examine the hair and its distribution pattern, the nails and the scalp and assess whether there is a skin disease, whether the nails are also affected and whether the hair is thinned only in certain areas or diffusely over the whole head.
The doctor will also check the rest of the body hair pattern. An orienting physical examination may reveal other symptoms, such as swollen lymph nodes on the neck, such as those that can occur with head fungus.
Pluck test – the dermatologist may possibly test how many hairs can be loosened with light, and painless plucking of the hair.
If the doctor has more than ten loose hairs in his/her hand when testing a patient with freshly washed hair from around 60 detected hairs, this indicates active hair loss.
He will possibly also examine whether the pores of the hair follicles can still be seen on the hairless scalp. If that is the case, then the hair loss is not scarring. This suggests that the hair could, in principle, grow back.
Microscope – If necessary, the dermatologist looks at individual hairs under the microscope and assesses their structure, for example, whether he has anagen or telogen hair (see picture gallery in the “Diffuse hair loss” chapter) or broken hair in front of him.
The microscopic hair root analysis is also called a trichogram. On the one hand, it shows what proportion of the hair is currently growing, for example, whether an unusually large number of hairs has stopped growing. Usually, 80-90 percent of hair grows actively and less than 10 to 20 percent is at rest. On the other hand, the doctor can assess hair roots and hair shafts more precisely.
The percentage of hair loss and hair growth capacity can be prognostically assessed using the trichogram. For the examination, about 50 to 100 hairs are plucked in different areas of the scalp (for comparison purposes). This is a bit uncomfortable, but this hair grows back again.
In this case, four to five days before, the patient should have washed their hair for the last time for the examination to be meaningful.
Phototrichogram – No hair sample is required for this, but some hair is cut off at one or two places, as inconspicuous places as possible.
These areas are then tattooed and photographed with a camera. Three days later, the same areas are photographed again, and the images are compared. The examination allows an exact determination of growing and resting or falling hair and is used more often in studies.
Trichoscan – This is an extension of phototrichogram described above. The area with the cut hair is stained or marked and three days later photographed with a digital camera in microscopic magnification (reflected light microscopy). A computer analyzes the recordings and provides information on the number and percentage of hair in the various phases of growth and cycle.
Special examinations for hair loss
Pathogen culture: In unclear cases where the cause of hair loss has not been diagnosed, a pathogen culture from swabs of hair from a diseased can be done. It is used, for example, to detect a fungal disease of the scalp. However, it will take a few weeks for the result to be available.
A tissue sample from the scalp: In order to arrive at a diagnosis, it is sometimes necessary to examine a tissue sample from the scalp, a scalp biopsy, possibly also in a specialized center. The collection takes place with local anesthesia under sterile conditions.
Searching for traces in the blood: If the doctor suspects illnesses or deficiency symptoms as the cause, further examinations can be useful. For example, a blood test can be used to detect iron, thyroid, or inflammation values and pathological immune phenomena and the results may reveal a disease.
An examination of the sex hormone levels in women only makes sense if androgenic alopecia is suspected, for example, because of visibly increased signs of masculinization such as male hair distribution patterns.
Hair loss therapy: Each alopecia is treated separately.
Hair loss can have many causes. Sometimes there is a disease behind it, for example, a hormone disorder or anemia due to iron deficiency – causes that need to be specifically treated. One form of hair loss can also override another.
That is why it is always advisable to see a doctor, and on time. The earlier the correct diagnosis is made, and therapy is started, the greater the chance of “saving” and maintaining as much hair as possible.
In principle, the order of dealing with hair loss should be the diagnosis first, then (if necessary) the treatment. Note that there is also no therapy for all hair loss, and not all hair loss needs to be treated. Sometimes the hair grows back by itself.
Sometimes cosmetic measures such as hair styling, hair replacement parts, and permanent make-up can also make it easier for one to accept why there is hair loss. The fact is that the way some people style their hair for fashion’s sake is a major cause of hair loss symptoms.
It is worthy of note that, even with hereditary hair loss to not treat without a doctor.
To the men who suffer hair loss, androgenetic alopecia in men is extremely widespread and does not automatically give rise to extensive medical examinations. Nevertheless, expert advice can also be helpful here if therapy is desired.
There are numerous products available on the market that are designed to stimulate hair growth or stop hair loss. However, very few have been tested for effectiveness in good clinical studies. If you want an (optional) therapy, you should inform yourself beforehand from your doctor or pharmacist exactly what effects and what possible side effects you can expect.
Tips for proper hair care
With the right care, your hair can look better and healthy. Here are some basic tips:
- Shampoos are intended for cleaning the hair and scalp, do not use too much, shampoo only once per wash, and then rinse the hair well.
- Do not rub your hair dry after washing, but rather gently “press it dry” and leave it in the towel for a few minutes.
- Blow-dry only with lukewarm air, do not hold the hairdryer too close to your hair, alternatively, let your hair air dry.
- Use brushes with rounded bristles and combs with teeth that are wide apart.
- Avoid using styling procedures such as bleaching, straightening, or perming too often – this can damage the hair and make it more fragile.
- Protect your hair and scalp from direct UV radiation.
- Do not just use any hair product that has not been clinically tested.
- Use only hair care products that are made for the hair and scalp.
- Hair conditioners are good but check to know the chemicals in them before using them. Also do not overuse them.
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This article is for general guidance only and is not intended to be used for self-diagnosis or self-treatment. You should not substitute a visit to the doctor.