Hair today, gone tomorrow

When a female patient presents with hair loss, the first thing to establish is whether the loss is generalised or localised. If the hair pull test shows hairs with a small bulb on the end, coming out all over the scalp, then the diagnosis is likely to be telogen effluvium.

However, if the hair pull test is negative and the loss is localised to the frontal scalp, then the problem is androgenetic alopecia.

This hormonally based, genetic, slow miniaturisation of the frontal scalp hairs leads to the picture seen here.

Note the frontal hair line is maintained