HEALTHY LIVING

Hair is considered one of the most defining aspects of human appearance. Hair loss, or alopecia, in women is often met with significant emotional distress and anxiety (Cash, Price, & Savin, 1993). Clinicians play a key role in providing women with a thorough evaluation, a specific diagnosis, evidence-based treatment options, and counseling. In this review article, a systematic approach to history taking, examination, and diagnosis of hair loss is provided. Specific types of hair loss are discussed in the context of disturbances of the hair cycle, damage to the hair shaft, and disorders affecting the follicle. Lastly, recommendations for effectively counseling women with hair loss are provided.


Hair is considered one of the most defining aspects of hu man appearance. Through out history, hair length, style, and color have been used to make statements about virility, sexuality, religion, military status, and more. Alopecia, or hair loss, is a common and distressing problem and is often met with feelings of grief and a lost sense of "self" (Cash et al., 1993). Women with alopecia must not only face the loss of their hair, but they often feel isolated, embarrassed to seek care, and may be frustrated by misdiagnosis or poor treatment options. Clinicians play a key role in providing women with a thorough evaluation, a specific diagnosis, evidence-based treatment options, and counseling.

During our lifetime, each hair follicle undergoes continuous cycles of growth (anagen), resorption (catagen), and rest (telogen). The portion of hair that is seen is called the hair shaft. That which is below the surface of skin is the follicle. Hair loss can occur due to disturbances of the hair cycle, damage to the hair shaft, or disorders affecting the follicle. A systematic approach to the patient with hair loss will enable the clinician to classify and diagnose the hair problem accurately in the majority of cases. The correct diagnosis is based on a detailed history, physical examination, and in some cases, scalp biopsy and pertinent laboratory tests. With the appropriate diagnosis, proper patient counseling and treatment can be initiated (Han & Mirmirani, 2006).

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