- 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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