Alopecia Approach to the Patient
The history should focus on several areas. First, one should ascertain the duration of the hair loss. This can be easily done by asking the patient how long has it been since your hair last seemed normal to you? This should be followed up with several questions have you noticed increased hair shedding (falling out) or does the hair on your scalp just seem thinner? Also ask the patient has your hair loss generalized (all over the scalp) or are there areas where you notice more loss or thinning? The answers to these questions are helpful in making a diagnosis as we shall discuss later.
Additional important history includes medications, recent surgeries, illnesses, fevers or hospitalizations, hormonal/OB/Gyn history in women, history of thyroid disease or symptoms of thyroid disease, history of general anesthesia, significant weight loss, dietary practices including vegetarianism, and history of psychological trauma (not the normal stress we all have). Eliciting any family history of hair loss can also be helpful.