Alopecia in Women -- American Family Physician
نویسنده
چکیده
www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 1007 the hair is broken or shed at the roots, and whether shedding or thinning has increased. The patient’s diet, medications, present and past medical conditions, and family history of alopecia are other important factors. The physical examination has three parts. First, the scalp is examined for evidence of erythema, scaling, or inflammation. Follicular units are apparent in nonscarring alopecias but absent in scarring types. Second, the density and distribution of hair are assessed. Third, the hair shaft is examined for caliber, length, shape, and fragility. The “pull test” is an easy technique for assessing hair loss. Approximately 60 hairs are grasped between the thumb and the index and middle fingers. The hairs are then gently but firmly pulled. A negative test (six or fewer hairs obtained) indicates normal shedding, whereas a positive test (more than six hairs obtained) indicates a process of active hair shedding. Patients should not shampoo their hair 24 hours before the test is performed. If the diagnosis is not clear based on the history and physical examination, selected laboratory tests and, occasionally, punch biopsy may be indicated. A stepwise approach to the diagnosis of hair loss is provided in Figure 1.
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