Clinical features differ depending on the type of hair loss you are experiencing. Hair loss can occur as hairless lesions on the scalp or as a receding hairline. In some cases, there can be abrupt shedding that ceases but where new hair fails to regrow. To determine the appropriate treatment for hair loss, there are four main evaluations that can be used to asses hair loss type and also to record progress.
The following tests can be used diagnose hair loss:
Hair pull test – This involves pulling a section of around 40-60 hair to establish how many are easily removed from the scalp. If more than 10% of hair can be removed with a light tug this would be regarded as a positive result. This would signal to the practitioner that a higher number of hairs than normal are in the ‘resting’ phase. This type of test is normally used to diagnose telogen effluvium or diffuse hair loss.
Scalp biopsy – This procedure is usually carried out by a dermatologist and can identify high numbers of antibodies and white blood cells around the hair follicle. This is useful for determining of hair loss is due to an autoimmune condition such as hair loss. A scalp biopsy can identify abnormal bacteria within the follicle that can restrict hair growth. Scalp biopsies are stern used to identify hair loss conditions such as alopecia areata and scarring alopecia.
Blood tests – Blood tests are often used to determine whether hair loss is due to a vitamin or mineral deficiency or due to an androgen/estrogen imbalance. A blood test can also pick up thyroid disorders or other inflammatory conditions. Blood tests are good for confirming a diagnosis of andrognic alopecia and can also direct potential treatment of diffuse hair loss by pin-pointing issues such as iron deficiency or low folate levels. Whilst blood tests are helpful it is important they are correctly interpreted or your blood test results may be misleading.
Trichograms – A trichogram is a technique of evaluating how many hairs are in the growing phase and it can also determine differences in the width of hair follicles in different areas of your scalp. This method of evaluation allows your practitioner to evaluate individual roots that are at different stages in the hair growth cycle. This diagnostic method is good for diagnosing early stages of androgenic alopecia.
Examination with a dermascope – This simple examination can pick up ‘exclamation mark’ hairs that are characteristic in the early stages of alopecia areata.