What protocol and lab workup should be followed to diagnose alopecia in women? What are the causes and treatment? Is this a lifelong condition?
—Dawn Wells, PA-C, Dallas

The most common form of alopecia in women is androgenetic alopecia (Am Fam Physician. 2003;67:1007-1014). Alopecia areata, telogen effluvium, cicatricial alopecia, and traumatic alopecias are other common disorders that can cause hair loss in women. The treatment and duration of alopecia in women is dependent on the etiology of the hair loss. Begin by taking a careful history that includes (1) personal information, such as diet, medications, present and prior medical conditions, and family history of alopecia; (2) the pattern and duration of hair loss; (3) whether the hair is shed at the roots or broken; and (4) whether thinning or shedding has increased. Next, examine the hair (distribution and density), the hair shaft (caliber, fragility, length, and shape), and the scalp (for erythema, inflammation, scaling, and follicular units, which are absent in scarring alopecias). A punch biopsy may be indicated to assist in elucidating the etiology of a scarring alopecia. In addition to routine screening studies, such as a complete blood cell count (with differential and platelets) and serum chemistries, laboratory evaluation for patients with nonscarring alopecia may include studies to rule out androgen excess and/or an endocrinology-related etiology (dehydroepiandrosterone sulfate, follicle-stimulating hormone, free testosterone, luteinizing hormone, prolactin, and total testosterone), iron deficiency anemia (ferritin level), syphilis (Venereal Disease Research Laboratory test), systemic lupus erythematosus (antinuclear antibody), and thyroid disease (thyroid function tests).
—Philip R. Cohen, MD (107-7)

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