Systematic approach to hair loss in women.

Diffuse hair loss is a common complaint and cause of significant emotional distress particularly in women. The best way to alleviate the anxiety is to effectively treat the hair loss. It is paramount to address the symptom systematically. In addition to its psychological impact, hair loss may be a manifestation of a more general medical problem. The diagnosis can be established with a detailed patient history focussing on chronology of events, examination of the scalp and pattern of hair loss, a pull test with examination of bulbs of shed hairs, trichoscopy, and few pertinent screening blood tests. In selected cases a scalp biopsy may be required. The most important differential diagnoses include acute and chronic telogen effluvium, female pattern hair loss, and diffuse alopecia areata. Occasionally, patients seeking advice are not necessarily losing hair. In the absence of convincing evidence of hair loss, they are suffering of psychogenic pseudoeffluvium, and thought should be given to an underlying psychological disorder. Once the diagnosis is established, treatment appropriate for that diagnosis is likely to control the hair loss. Finally, appropriate psychological support and education about the basics of the hair cycle, and why considerable patience is required for effective cosmetic recovery, are essential to help limit patient anxiety.