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Examination

This is the next step. The doctor conducts a careful physical examination, paying special attention to your hair and scalp.

The pattern of baldness is very important. Patchy hair loss may indicate alopecia areata, secondary syphilis, tinea capitis or trichotillomania. In men, thinning of the crown and a receding hairline is indicative of male pattern baldness; but in women, there may be thinning of the crown alone.

Diffuse hair loss may be the result of telogen effluvium, iron deficiency and thyroid disorders. The state of the scalp and hair is also noted. Exclamation mark hairs occurring in a bald patch are diagnostic of alopecia areata.

Broken-off hair stumps of different lengths may indicate trichotillomania or secondary syphilis. Tinea capitis may also cause broken-off hair stumps, but in this condition the scalp also shows redness, scaliness and in severe cases even swelling, inflammation and pus formation.

The doctor may also illuminate the area with a Wood's lamp. In some forms of tinea capitis, a green or pale yellow fluorescence may be seen. Hairs broken off a few millimeters from a normal-looking scalp may indicate a structural defect of the hair such as monolethrix and pili torti.

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