5-Minute Clinical Consult
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Alopecia

Physical Exam

  • Pattern of hair loss:
    • Is hair loss generalized or local?
    • If local, is it symmetrical at the vertex and/or the hairline at the forehead?
  • Scalp scaling, inflammation (in tinea capitis)
  • Changes in the hair:
    • Hair-pull test: Pinch 25–50 hairs between thumb and forefinger, and exert slow, gentle traction while sliding fingers up:
      • Normal: 1–2 dislodge
      • Abnormal: ≥6 hairs dislodged (in effluvium, alopecia areata)
    • Broken hairs (tinea capitis, traction alopecia)
    • Broken-off hair at the borders of the patch that are easily removable (in alopecia areata)
    • Hair loss in circular pattern (in alopecia areata, tinea capitis)
  • Clinical signs of thyroid disease, lupus, or other diseases
  • Clinical signs of virilization: Acne, hirsutism, acanthosis nigrans, truncal obesity (in androgenic alopecia)

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