What is the appropriate workup in an otherwise healthy woman aged 75 years with new-onset hair loss? What medications might be contributory? — Mary Ellen Wilkosz, RN, FNP-BC, PhD, Novato, Calif.

The approach to evaluating hair loss in women has recently been reviewed (Dermatol Nurs. 2007;19:531-535 and J Fam Pract. 2009;58:378-380). Alopecia areata, androgenic alopecia, and telogen effluvium are the most common forms of nonscarring alopecia; other causes include hair-shaft abnormalities, traction alopecia, tinea capitis and trichotillomania.

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Discoid lupus erythematosus, infections (bacterial and inflammatory fungal), lichen planus, local surgery, morphea, neoplastic disease (cutaneous metastases and skin cancer), and trauma (burn or injury) are disorders associated with scarring alopecia.

Similar to the new onset of alopecia in men, the workup begins with a comprehensive history that includes family history, hair-care practices, endocrine dysfunction (thyroid disease), chronic systemic illnesses, dermatologic conditions (lichen planus and lupus erythematosus) and medications (anticoagulants, nonsteroidal anti-inflammatory drugs, beta-blockers, H2 receptor antagonists, neoplastic drugs, hormones, retinoids, and antihyperlipidemic agents) (Int J Dermatol. 1995;34:149-158).

A scalp biopsy may be useful—especially if a scarring alopecia is suspected (Can Fam Physician. 2000;46:1469-1477). — Philip R. Cohen, MD (154-06)