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Thread: Dermatologic Symptoms - Hair Loss

  1. #1
    PharmD Year 1 TomHsiung's Avatar
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    Default Dermatologic Symptoms - Hair Loss

    Hair loss affects nearly 50% of people throughout their lives and often has a profound psychosocial impact. Hair loss may be due to primary disease of the hair follicle, system disease, hormonal changes, or vitamin deficiencies.

    A careful history may provide the diagnosis and will often guide a directed physical examination and laboratory testing. The history should be guided by a consideration of the patient's demographics and the characteristics of the hair loss.
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease.

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    PharmD Year 1 TomHsiung's Avatar
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    Default Re: Dermatologic Symptoms - Hair Loss

    Etiology
    There are 2 principal types of hair loss: those associated with hair follicle destruction and those where the follicle is preserved. Alopecia with destruction of the hair follicle is referred to as "scarring" alopecia, whereas alopecia with preserved follicles is "nonscarring." This is an important distinction because scarring and nonscarring alopecia have different differential diagnoses and prognoses. Scarring alopecias necessitate early intervention in order to minimize the amount of permanent hair loss. Nonscarring alopecias are more common than scarring ones, but the prevalence of specific types of alopecias varies with age.

    Differential Diagnosis
    Dermatologic Symptoms - Hair Loss-screen-shot-2016-12-09-at-11-46-55-am-png
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease.

  3. #3
    PharmD Year 1 TomHsiung's Avatar
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    Default Re: Dermatologic Symptoms - Hair Loss

    Getting Started with the History
    • Remember that hair loss is often very traumatic and upsetting for patients; taking concerns seriously is imperative to establishing good rapport.
    • Consider the patient's age and sex because these demographic features will focus the differential diagnosis.
    • Although the final diagnosis of the cause for hair loss requires a careful physical examination and often laboratory testing or skin biopsy, the history will narrow the differential diagnosis and guide further evaluation.


    Interview Framework

    • The first goal is to determine whether the alopecia is scarring or nonscarring.
    • Ask the patient to precisely describe the hair loss.
    • Inquire about hair loss characteristics including:
      • Duration
      • Onset
      • Pattern
      • Whole hairs falling out or hair breakage
      • Precipitating factors
      • Hair care routine
      • Associated symptoms
    Last edited by TomHsiung; Fri 9th December '16 at 1:13pm.
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease.

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    PharmD Year 1 TomHsiung's Avatar
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    Default Re: Dermatologic Symptoms - Hair Loss

    Alarm Symptoms
    The following symptoms raise concern for scarring alopecia. Scarring alopecia may be irreversible and therefore require immediate intervention to prevent progression.
    • Itching
    • Pain
    • Crusting
    • Bleeding
    • Pustulation
    • Scaling of the scalp


    Focused Questions
    Dermatologic Symptoms - Hair Loss-screen-shot-2016-12-09-at-2-35-32-pm-png
    Dermatologic Symptoms - Hair Loss-screen-shot-2016-12-09-at-2-35-50-pm-png

    A careful history of medication use serves 2 purpose. First, it can be used to determine if the patient is taking a medication that may cause alopecia. Second, each medication implies a particular chronic medical condition, some of which may be associated with hair loss. Table 23-2 lists medications that commonly cause alopecia.

    Dermatologic Symptoms - Hair Loss-screen-shot-2016-12-09-at-2-22-01-pm-png
    Last edited by TomHsiung; Fri 9th December '16 at 1:37pm.
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease.

  5. #5
    PharmD Year 1 TomHsiung's Avatar
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    Default Re: Dermatologic Symptoms - Hair Loss

    Diagnostic Algorithm

    Dermatologic Symptoms - Hair Loss-screen-shot-2016-12-09-at-2-25-27-pm-png
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease.

  6. #6
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    Default Re: Dermatologic Symptoms - Hair Loss

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