Diffuse with no Rash

1. Telogen Effluvium occurs three months after the end of pregnancy, a severe illness or emotional/stressful events. The hair will regrow.

2. Androgenic alopecia. Characteristic pattern in males but diffuse in women. Ask for detailed family history.

3. Always check for thyroid disease and iron status as appropriate.

Patchy with no Rash

Probably alopecia areata especially if the patch is well demarcated and hair loss is complete- look for exclamation mark hairs. Topical corticosteroids may offer some help. Refer if extensive, but hospital treatments are not very effective. Some patients respond to injections with steroid or occasionally sensitisation with Diphencyprone.

Patchy with Scarring

Many causes of scarring alopecia exist eg discoid lupus erythematous and lichen planus. Refer for assessment and probable biopsy.

Patchy with Rash

Seborrhoeic dermatitis and psoriasis rarely produce significant hair loss.

1. Pityriasis amiantacea is usually seen in children and hair can be pulled out easily in a bundle with attached scale (asbestos-like scale).

2. Tinea. If broken hairs, please send hairs to the Lab for direct examination and culture. Scrapes alone are not suitable for this purpose. Hairs must be plucked and scales scraped.