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Hair loss
Hair loss is sorted by pattern: a round, smooth patch — alopecia areata; diffuse shedding two to three months after an event — telogen effluvium; gradual thinning at the crown — androgenetic alopecia; and a scaly patch in a child — tinea.
Why it matters in the exam
The exam presents a woman a year after delivery with diffuse shedding (telogen), a woman with a round, smooth bald patch on the scalp (alopecia areata), a young woman with obesity, hirsutism and thinning hair (androgen excess), and a child with a scaly patch and nodes (tinea). It asks for the diagnosis, work-up and treatment.
Remember that alopecia areata is linked to autoimmune disease (thyroid, vitiligo), and that telogen effluvium usually resolves by itself within 6–12 months.
Hair loss causes much worry, especially in women; a diagnosis by pattern and a focused work-up allow most to be reassured and the few who need treatment to be treated.
A recurring question is shedding after childbirth: explaining that the hair will return within months and checking for iron deficiency and a thyroid problem are usually enough. Another question describes a woman with obesity, hirsutism and hair loss at the crown — here think of androgen excess and polycystic ovary syndrome, and check testosterone. In alopecia areata in a child, explain to the parents that in most cases the hair returns within a year.
Key points
- Diffuse after an event — telogen; resolves within 6–12 months.
- Round smooth patch — alopecia areata; steroid injection.
- Androgenetic — minoxidil; in men also finasteride.
- In a woman with signs of androgen excess — PCOS work-up.
- Scaly patch in a child — tinea, oral treatment.
Summary table
| Type | Presentation | Work-up | Treatment |
|---|---|---|---|
| Telogen effluvium | Diffuse shedding 2–4 months after childbirth, febrile illness, surgery, crash diet or a drug | TSH, ferritin, blood count | Explanation; resolves within 6–12 months |
| Alopecia areata | Round smooth patch, "exclamation-mark" hairs at the edge | Clinical; ask about autoimmune disease | Intralesional or topical steroid; JAK inhibitors in extensive disease |
| Androgenetic alopecia in men | Temporal recession and thinning at the crown | Clinical | Minoxidil, finasteride |
| Androgenetic alopecia in women | Widening central parting, frontal hairline preserved | With signs of androgen excess — testosterone, DHEAS, PCOS work-up | Minoxidil; finasteride is forbidden in a woman who may become pregnant |
| Tinea capitis | Child, scaly patch, broken hairs, nodes | Culture | Oral antifungal treatment |
| Trichotillomania | Broken hairs of different lengths, irregular patch | Clinical | Behavioural therapy |
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Sources
- British Association of Dermatologists, 2012 (alopecia areata, updated) — Guidelines for the management of alopecia areata
- European Dermatology Forum (S3), 2011 (updated) — Guideline for the treatment of androgenetic alopecia in women and men
- Phillips TG et al., American Family Physician, 2017 — Hair loss: common causes and treatment
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.