Hair loss is a gradual process where a person starts losing hair in patches or faces hair fall, hair thinning or premature baldness. The average scalp usually has 100,000 strands of hair of which it is normal to lose 75 ‘ 150 strands daily. Anything more than this needs medical attention and treatment. Hair loss can happen due to physical or psychological conditions. The diagnosis often depends on the doctor who will assess several factors before coming to a conclusion.
Diagnosis of the disease causing hair loss
Diagnosis of what is causing hair loss depends on the kind of hair loss one is suffering from. A dermatologist may have to consider many possible kinds and types of recognized hair ailments while diagnosing a patient. Most doctors will come across just twenty types of hair related diseases throughout their careers. Of the twenty just four will be the most common for 95% people suffering from hair loss conditions. These are namely, pattern baldness, telogen effluvium, chemical over processing and alopecia areata. When a patient first consults a doctor for his hair ailment the dermatologist will first collect information through questioning him, after which the use of techniques like the hair pluck test may help to understand diseases causing hair loss or baldness.
Diagnosis of hair loss diseases by questioning
The initial stages of diagnosis include the process of determining whether the hair loss is congenital, genetically inherited or acquired. The loss of hair by congenital hair disease would mean that the disease is present since birth. A genetically inherited disease is one that happens later in life due to genes that are inherited. The acquired form of hair loss disease is the ones that are due to the environment and its effect on the hair. If the doctor feels that the hair loss is congenital, he may ask a few questions to the patient related to his family members and background like he would like to know who else in the family suffer from the same condition and how are they related genetically. If the hair loss disease is acquired then the questions will be based on health and lifestyle. The questions may get more detailed and intense if the dermatologist suspects something more unusual.
Identifying loss of hair with tools
Tools like the hair pull test determines about the quantity of hair being shed from the scalp. The pull test is done by grasping some hair between the thumb and forefinger clutching about 50 strands of hair. Firmly pulling of the hair or traction is applied without involving any plucking.
Mechanism of the hair-pull test
The number of strands pulled gives an idea of the number of hair follicles residing in the telogen state. Telogen hairs are easily pulled out than the anagen growing hair. Hence, in the test while the telogen hairs will come out, the anagen hair will remain rooted in the scalp. Usually 5-15 strands of hair can be pulled out from a normal scalp. More than 15 strands suggest that more follicles are in the telogen area. The hair pull test may also be wrong as the number of pulled hair may vary. The fallen hair also depends on how often the person washes or brushes his hair. All activities like this usually involve the telogen hair.
Hair pluck test
This test is also known as trichogram. Here hair is pulled to examine the roots. It is done with rubber tipped tweezers that can hold upto 50 strands of hair at a time. This test can be a little painful for the patient but is in brief as the hair is plucked out quickly. The plucked out hair are cut out from the upper end to eliminate the extra length. This cutting needs to be done carefully so that the root is kept intact. The studied hair should be 1 cm in length when measured from the root to end. This cut-off strand is then soaked in a wet microscopic slide and a dye of 4-dimethylaminocinnamaldehyde is applied. This dye will only color the hair root that have the intact internal root sheaths which are present in anagen hair. The telogen hair will not be affected due to this dye as it contains small, unpigmented, ovoid bulbs are do not have healthy internal root sheath. Under the microscope the dermatologist can count the number of telogen and anagen hair strands that are present. He can also identify if there is any abnormality to the roots of the hair that might identify a defect of the hair shaft.
Laboratory testing to identify hair loss
If the person is suffering from an unexplained hair loss condition, a number of laboratory testing may be recommended. A potassium hydroxide may identify an infectious disease if any and this is specially recommended for people with localized hair loss. Localized hair loss may be Alopecia areata or also might be scalp ringworms. Some skin from the scalp mixed with potassium hydroxide are placed on the slide and tested under a microscope to detect any fungal infection. A positive result confirms ringworms and other tests are carried out by culturing skin in the laboratory to find out what type of bacteria or fungi is present. Other tests may include testing blood looking for viral infections and other inflammations.
Diagnosis through skin biopsy
Skin biopsies are usually done to diagnose diseases like cicatrical alopecia. A 2-4mm skin is taken from the scalp and put under the microscope for examination. A pathologist then tests the intensity of damage in the hair follicle along with the depth of skin involved and check to see the presence and the location of the inflammation in relation to the hair follicles. Most of the procedures do not take a long time and are straight forward in nature. These tests provide a clear understanding through which the dermatologist can identify the problem. The diagnosis is important to select the route of treatment for the hair loss. Once the causes of hair loss is determined, treatment is only a while away. Treatments are often successful in the re-growth of hair. The dermatologist will prescribe the best medical option to treat any of the above ailments. Hair should start growing as soon as you start reacting to medication. Diagnosis for hair loss may be intense but not difficult. With modern medical facilities one can dream about getting back the lost hair again. Do make time to visit your doctor as soon as you think you are losing hair, the rest will be taken care by him.