Alopecia

Presentaton

Alopecia may be scarring or non-scarring, localised or diffuse, inflamed or non-inflamed

Diffuse non-scarring

  • Physiological: normal ageing process
  • Female pattern hair loss (FPHL)- thinning over crown
  • Telogen effluvium/ excessive shedding occurs three–four months after pregnancy/ other major event
  • May be component of polycystic ovarian disease in young women
  • Consider any new medications

Localised non-scarring

  • Alopecia areata
  • Patchy hair loss with exclamation mark hair

Diffuse inflamed non-scarring

  • Consider seborrhoeic dermatitis or psoriasis (may also rarely cause scarring)

 

Localised inflamed non-scarring

  • Consider tinea infection (may also cause scarring)
  • Consider psoriasis or seborrhoeic dermatitis

Scarring

  • Loss of hair follicles with or without inflammation and accompanied by scarring
  • Local or diffuse
  • Causes include: Lichen planus
Management

Diffuse non-scarring

  • Reassure patients with mild FPHL that condition is physiological
  • Reassure patients that Telogen effluvium will recover spontaneously
  • Diffuse alopecia: check full blood count, ferritin and thyroid function
  • Patients with severe degree of alopecia caused by disease can be considered for NHS wig prescription

Localised non-scarring

  • Reassure patients with alopecia areata that spontaneous regrowth is likely
  • Generally good outcome in patients with short history and limited extent
  • Trial of potent topical steroid lotion for three months

Diffuse inflamed non-scarring

Treatment:

  • Coal tar + salicylic acid ointment ( eg Cocois/Sebco)
  • Anti-fungal shampoo ( eg ketoconazole)
  • Topical steroid lotion/mousse/foam

Localised inflamed non-scarring

  • Send hair pluckings to mycology lab
  • If dermatophyte infection confirmed, treat with oral terbinafine
  • Treat as for diffuse inflamed non-scarring if psoriasis or seborrhoeic dermatitis

Scarring

  • Requires secondary care referral
Referral

Dermatology Referral Criteria

  • Inflammatory scarring alopecia
  • Diagnostic uncertainty
  • Persistent or extensive alopecia (scarring or non-scarring)
  • Hairpiece or wig prescription for alopecia caused by trauma or disease resulting in psychological distress (if available)
Patient Information