Alopecia physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Ogechukwu Hannah Nnabude, MD

Overview

The quantity, pattern, presence of scarring, scaling, or erythema are all helpful clues in determining the cause of the hair loss.

Physical Examination

Appearance of the Patient

The appearance of the patient can provide clues to the diagnosis of alopecia.

Head

• Scalp
  • Normal or with features of scarring
  • If the scalp is abnormal it provides clues to the differential diagnosis
    • Scarring, which is a feature of many irreversible causes of hair loss such as tufted hair folliculitis
    • Scaling
    • Erythema, which may be seen in vitamin A toxicity
    • Pustules
    • Dyspigmentation
• Pattern: Diffuse or patchy
  • Male pattern (diffuse): Bitemporal recession +/or vertex loss
  • Female pattern (diffuse): Coronal thinning with preserved anterior hairline
  • Patchy: With preserved hair of variable length as seen in trichotillomania
    • With exclamation point hairs (alopecia areata)
    • With no hair (scarring, traction, syphilis, tinea)

• 

  Alopecia acquisitum centrifugum. Adapted from Dermatology Atlas.

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  Alopecia acquisitum centrifugum. Adapted from Dermatology Atlas.

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  Alopecia acquisitum centrifugum. Adapted from Dermatology Atlas.

• 

  Alopecia acquisitum centrifugum. Adapted from Dermatology Atlas.

• 

  Alopecia acquisitum centrifugum. Adapted from Dermatology Atlas.

• 

  Alopecia acquisitum centrifugum. Adapted from Dermatology Atlas.

• 

  Alopecia acquisitum centrifugum. Adapted from Dermatology Atlas.

• 

  Alopecia acquisitum centrifugum. Adapted from Dermatology Atlas.

• 

  Alopecia acquisitum centrifugum. Adapted from Dermatology Atlas.

• 

  Alopecia acquisitum centrifugum. Adapted from Dermatology Atlas.

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  Alopecia acquisitum centrifugum. Adapted from Dermatology Atlas.

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  Syringolymphoid hyperplasia with alopecia. Adapted from Dermatology Atlas.

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  Syringolymphoid hyperplasia with alopecia. Adapted from Dermatology Atlas.

Extremities

• Patient may also have nails that have a hammered brass appearance, as seen in alopecia areata.