The importance of taking a detailed history of people with alopecia cannot be overstated. With limited treatment options, while having to confront many challenges, this could very well count as part of treatment. A comprehensive history can provide your doctors with much-needed perspective about your hair issues, thus developing a better treatment plan.
Throughout this blog, we will discuss several critical personal history aspects that you may need to examine when assessing your alopecia conditions. Also, it can provide a good checklist for you before your doctor's visit.
It is vital to have a detailed description of what kind of symptoms you are experiencing if you want to diagnose the problem correctly. The reason is that symptoms are rarely severe and significantly disproportionate to what is found during examination or scalp biopsy.
Pruritus (itchy skin) is among the more frequent complaints when it comes to scalp symptoms, but it can manifest itself in pain and even burning sensations. It is best to describe what kind of severity you experience these sensations, how often it occurs, and for how long it last, along with any potential triggers you have noticed.
Hair Care Routine
A thorough depiction of hair care provides valuable information in exploring possible causes of alopecia, especially for those experimenting with a wide variety of styles and treatments.
A good starting point would be exploring the hair cleansing habit, the hair care products used, and the chemical treatments employed. Those who use chemical treatments for their locks (e.g., relaxers, permanent perm) should also consider where they go for this treatment at home or in a salon. The application of caustic chemicals should be done in a salon due to the complication and their intensive effects on hair characteristics.
There are a few other types of styling habits that should also be considered when assessing for the onset of alopecia, such as the use of hair extensions. Were they braids with human or artificial hair added? Were they glued or sewn in? These factors are critical because mounting research suggests these tight hairstyles may play a significant role in the development of centrifugal cicatricial alopecia.
Past Medical History
Certain specific aspects of the past medical history may need to be included when assessing your current medical condition.
This includes knowledge about menstruation (if applicable), illnesses linked to hair loss, previous hospitalizations or other traumatic events that could trigger acute telogen effluvium, and medications used (including birth control pills if relevant).
Women may need to contemplate whether they have experienced irregular cycles, menopause, or postpartum. Hormonal changes brought on by these occurrences can often lead to sudden hair loss. Many people who suffer from anaemia due to irregular periods are also prone to developing iron deficiency, which may result in hair loss.
In addition, you will want to document information on a history of thyroid disorder or lupus erythematosus in detail too.
Many often ask whether their medication is causing their hair loss, but this information is hard to procure.
Alopecia has been listed as a side effect of many medications - but its occurrence is somewhat rare. It is almost always best to try and figure out what other triggers for hair shedding might be before you look at changing your medications or starting new ones.
Whenever possible, make sure to talk with your doctor about all the different types of treatments you are taking, including medications and dietary supplements.
Oral contraceptives with androgenic progestagens are known for causing some cases of hair loss. Besides that, recent or frequent starting and stopping of other hormone supplements can also increase the likelihood of telogen effluvium.
Regarding dietary supplements, they often contain a great deal of variation in their content. Taking multiple supplements could result in much more than the recommended daily requirement. While this is not an issue for water-soluble vitamins, it can lead to toxicity for fat-soluble ones. For instance, studies have proved that getting too much preformed vitamin A can lead to hair loss apart from other side effects.
On another note, it is as crucial to consider the discontinuation of medications as it is about medications being taken. It is especially true for oral contraceptives, as stopping a birth control pill can cause acute telogen effluvium. Other causes of diffuse hair loss include high fever, the postpartum state, and severe calorie/protein deprivation.
When searching for stressful events that could lead to sudden hair loss, it may not be as easy as asking the simple question: “Are you stressed out?”
Rarely are people living completely stress-free lives. More often than not, it will prove more beneficial to think of a recent highly stressful event - the one that stands out from those on a day-to-day basis.
Did you know that when you are under the influence of stress, your hair stops growing after only one month and starts to shed after three months? Not until five months later that new hair strands emerge, but they are much thinner and weaker.
A thorough family history of alopecia is critical. One way to obtain this information is to openly ask your family: “Do we have any family history of hair loss?”
Because everyone has different ideas about what constitutes hair loss (receding hairline, thin on top, etc.), it is best to ask specifically about each immediate family member. This also allows you to think about each family member’s hair instead of just looking at the whole family in general.
Gaining specific information about every member can also reveal gaps in your knowledge of the family history. You may not know many members from a certain side of the family, so there are more blank spots in what you know instead of negative information.
The information we provide is not intended to mitigate, prevent, treat, cure or diagnose any disease or condition. If you have any concerns about your health, please consult your doctor.
Hair and Scalp Disorders: Medical, Surgical, and Cosmetic Treatments, Second Edition. Edited by Amy J. McMichael, MD, and Maria K. Hordinsky, MD.