How is alopecia investigated? ProDerm UK‘s guide to investigating hair loss.

Losing one’s hair can be highly stressful and cause huge psychological trauma. Consultant dermatologists are very aware of this so it is important to try and identify the course of hair loss as quickly as possible in order to reverse it where possible.

Preliminary steps

A full medical history and examination with a consultant Dermatologist

You would see a dermatology consultant in the first instance who will take a detailed history from you about your hair loss particularly the medication you might be taking, a history as to how much stress you are under including bereavement or anxiety,  and your family history to see if there is an obvious cause.

The consult will then examine your scalp and critically will be looking for the the pattern of hair loss e.g. is this a genetic pattern such as male or female pattern hair loss or something different?

Areas of hair loss will be examined for any evidence of inflammation or scarring and the hair follicles also examined sometimes with a microscope to see if there is any Inflammation within the follicles.

Scarring is a critical feature and needs to be identified immediately in order to start treatment and try to prevent it worsening.  Scarring does not regrow!

Next investigations

If there is no evident cause for the hair loss the next step would be blood testing

The purpose of blood testing is to see if there are any hormonal imbalances such as thyroid or testosterone related problems and also looking for deficiencies such as ferritin (iron reserves).

Typical blood testing would include:

• Full blood count

• Liver function tests

• Kidney function

• Vitamin D

• Ferritin and iron

• Thyroid studies

•  Sex hormones and testosterone

Hopefully the blood test results and examination will lead to a diagnosis and treatment can be commenced.

If not, however when we move onto further investigations

Further investigation

This would comprise a biopsy of the scalp whereby two small 4mm diameter samples would be taken including areas of hair loss and normal hair roots.

These could be examined under a high powered microscope in both the longitudinal and transverse section thus giving a view of hair shafts, the underlying skin, any inflammation and the hair roots themselves.

A biopsy is very useful to differentiate between different causes of non-scarring hair loss such as stress related (telogen effluvium), also immune alopecia areata and genetic hair loss.

Importantly it will also highlight if there is any scarring and if this is the case then hair growth is unlikely to recover.

For scarring hair loss, it is imperative to try and switch off the underlying inflammatory process as quickly as possible to try and prevent further irreversible damage to the scalp and hair roots.