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 Diagnosing Hair Loss
Localized hair loss which causes bald patches is easily recognized as abnormal; you should see a doctor immediately. This is because some conditions that cause patchy hair loss such as discoid lupus erythematosus, lichen planus and scleroderma may go on to produce scarring. Once scarring .sets in, there is no prospect of any hair growing again.
Clumps of hair falling out as in telogen effluvium is so alarming that the patient usually wastes no time in consulting the doctor. The problem lies in detecting gradual hair loss of the type seen in male pattern baldness, particularly in its early stages. Thinning will eventually become obvious when 40-50% of the hairs in one area are lost, but the recognition of early hair loss is important because early treatment is more likely to be effective.
Not every patient that consults the doctor for hair loss is suffering from true hair loss. For example, people who brush their hair for the first time may notice an alarming number of hairs in the hair brush. This is quite normal. I've also seen women with long hair who come to the clinic in a state of great anxiety, concerned that they are going bald. When asked how they arrived at such a conclusion, they would gather their hair behind the head and say, "Look how thin it is; it used to be very much thicker."
The truth, of course, is long hairs tend to break easily and what is gathered together behind the head are only the long ones. These women do not suffer from true hair loss. A change of hairstyle is all that is necessary. More objective tests for hair loss are necessary. Below are two examples:
Shed Hair Count
This involves collecting hairs lost in combs, hair brushes, showers, basins, on clothes and pillow cases over three days (remember to clear these areas of hair beforehand). Each day's collection is carefully placed in an envelope and labeled accordingly.
After completing three days' collection, examine the hairs with a magnifying glass and separate those with from those without roots. Those without roots are indicative of hair breakage whereas those with roots indicate true hair loss. Divide each by three to obtain the daily rate of hair breakage or hair loss.
Normal hair loss may range from 50 to 100 per day, but for purposes of this test, 50 is considered to be the cut-off point. Any loss beyond that may indicate excessive hair loss. But relax! It does not mean that you are on the verge of baldness. Consult a doctor for proper diagnosis.
Hair breakage is not a serious problem because the hair follicles are not damaged and hair has the potential to grow again. However, hair breakage indicates improper hair care and this calls for some modification in your hair care routine. If you lose more than 30 broken hairs a day, see your doctor or hairdresser for advice.
Unfortunately, collecting hairs lost in the shower and basin can be a rather messy business and some patience is required to count the number of hairs lost.
Long hairs are also difficult to count because they often get entangled. A much simpler screening test for excessive hair loss is the pull test described below.
The Pull Test
Ensure that you have not washed or brushed your hair during the preceding 24 hours. In this test, about 10 hairs are grasped at the base with the thumb, index and middle fingers and firm pulling pressure is exerted while the hairs slip through the fingers.
85% of hair are in anagen and 15 % in telogen. For practical purposes, however, doctors regard 20% as the maximum proportion of hairs that should be in telogen. If 20% of the hairs are in telogen, then not more than two hairs should be pulled out from a clump of 10.
The test result would indicate, therefore, that hair loss is abnormal when more than two hairs with roots are pulled out. It can be repeated over different areas of the scalp to detect where the abnormal hair loss is occurring.
Like the shed hair count, an abnormal pull test only indicates possible hair loss. More objective testing by the doctor is required to confirm whether or not you are losing excessive hair.
Diagnosing the type of hair loss is not as straightforward as you may think. The doctor relies heavily on your history and his physical and laboratory findings. Let us examine each of these to give you an idea of what to expect when you consult a dermatologist (skin specialist).
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