Diagnosing Hair Loss
Most patients consulting a trichologist need some diagnostic procedures, because the diagnosis is essential for choosing the corresponding treatment method.
The variety of diagnosis includes the following methods:
Non-invasive – anamnesis, trichoscopy, phototrichogram
Semi-invasive – trichogram
Invasive – biopsy.
However the most important diagnostic tools in a dermatologist-trichologist practice to diagnose hair or skin deceases are: assessment scale (diagnostic questionnaire), hair stretching test, dermoscopy and trichoscopy.
Anamnesis – A patient’s personal and family anamnesis, medication taking history, gynecological anamnesis in women (pregnancy, birth, abnormal menstrual cycle), accompanying illnesses. Lifestyle assessment is also necessary (smoking, taking food supplements, diets, dramatic weight loss/gaining), specific hairstyles.
Hair loss starting age as well as baldness type and scales are often the starting points for diagnostics.
Patient’s psychological condition is necessary to be considered as well, in order to find immediate treatment the patient’s stress level should be assessed.
The severity of the disease progression can be assessed with different signs. There are classifications describing the clinical pictures of androgenic alopecia and alopecia areata. (find: Androgenic Alopecia; Alopecia Areata).
Stretching Test is the simplest, semi-invasive method showing active hair loss. A patient doesn’t wash hair for 4-5 day in order to avoid falling out of telogenic hairs with water. Approximately 50-60 hairs are taken between a thumb and indicating fingers and they are stretched gently from the bottom to top. If more than 10% fall out, it means that active hair loss has started. In case if it’s less than 10%, the hair loss can be assessed as normal. This method can be used to assess the intensity of hair loss in the areas like forehead and crown.
Dermoscopy – Trichoscopy is the main method to diagnose the deceases of the hairy area of head. A qualified specialist of Deamed Clinic can assess hair condition, its diameter, possible anomalies, follicle atrophy, perifollicular hyperkeratosis using a trichoscan.
There are also hair washing and hair mass examining tests, though they have less diagnostic value and they are characterized with high variability, that’s why it is rarely used in modern trichology..
Trichogram _ is semi-invasive method of diagnostics, which examines the condition of hair roots microscopically; it assesses their morphology and hair growth cycle. It also enables to distinguish hair loss types.
For this reason 60=80 hair are taken out of the hairy area of head with tweezers with quick movements, which are placed under a microspore in order to research the follicles. Due to its traumatic character (it’s quite unpleasant procedure for a patient), this method is more frequently used during clinical researches or in case when it’s necessary to examine the follicle condition (for example in case of distrophial anagenic alopecia).
Phototrichogram – During this method a small part of hairy area in dyed for contrast effect and then it is shaved after which the hair growth is observed. The hair density, amount of terminal hairs and vellus anagen-telogen ratio (percentage ratio of hair follicles in growing and shedding phase), hair growth speed and hair diameter are calculated. There are manual, semi-automated and automated methods of phototrichogram.
Taking photos before and after the treatment and comparing them helps to assess any changes of total volume of hair. Comparing such photos helps a doctor for objective assessment of hair growth activity. It is important to take the photos from the same angle, with the same illumination. Patient should have the same hair length and style. Hair mousse, lacquer or spray should not be used on the day of photographing..
Light and electric microscope are used in case if it’s necessary to examine hair cuticle, its Keratinization process and protein composition as well as studying hair length and width. The method is mainly used in clinical researches or in case there is a suspect of hair anomalies.
Hair skin biopsy – is an invasive, though quite important, method to diagnose scarring or sometimes not scarring alopecia. The procedure is conducted with local anesthetics using a special tool called punch. An area of skin and hair follicles are extracted from the scalp and examined. Biopsy is essential if there are visible clinical signs of skin cancer or nonspecific inflammatory diseases.
Spectral analysis of hair: One of the numerous causes of hair loss is lack of vitamins, microelements and amino acids.
The recent studies confirmed the importance of vitamin D, Ferritin (serum iron), vitamin B12, Zn –Zinc, lead and some of the other minerals in hair loss.
For this reason, one of the methods in hair loss diagnostics is defining the amount of minerals and vitamins in hair and blood.
DeaMed Clinic offers Spectral analysis of hair on microelements which give precise information about their composition in body. These microelements are: Ca, Zn, K, Fe, Cu, Se, Mn,Cr, Br, Cl, Co, Ag,V, Ni,Rb,Mo,Sr, Ti. Spectogram also identifies toxic microelements like Ba, Pb,As,Hg,Cd,Sb,Zr,Sn,Bi.