Alopecia is loss of hair from head or body and is fairly common problem, especially among males. There are several causes of alopecia and several different types of alopecia, such as alopecia areata (loss of hairs from patches), alopecia totalis (complete baldness of head), alopecia universalis (loss of all body hairs), and androgenic alopecia (male pattern of hair loss) etc. Alopecia occurring females is usually more troubling (more psychological trouble than physical trouble) to the sufferer than alopecia or hair loss occurring in males and should be evaluated appropriately.
Clinical evaluation should be done to determine the cause of alopecia and some tests can be done to find out the cause of alopecia. Male pattern of baldness and female pattern of hair loss usually do not need testing as both are not associated with increased hair loss. Hair loss occurring without any family history should prompt the physicians to question about drug history.
The following tests can be done to evaluate alopecia:
The pluck test:
In this test, the individual is asked to pull hair out by the roots (plucking) and the pulled hair is examined under microscope to determine the phase of hair growth. Microscopic examination can diagnose a defect of telogen, anagen, or systemic disease.
Daily hair count:
This test is done if the pull test is negative (i.e. less than 10 hairs come out with every pull). The numbers of hair are collected after the morning combing and during washing for 14 days. The hairs are collected in a clear plastic bag and counted. More than 100 hairs per day are considered abnormal, except after shampooing, where hair counts may normally be 250.
Scalp biopsy is done when alopecia is present (by checking with other tests), but the diagnosis is not sure. Scalp biopsy can differentiate different types of alopecia.
The Pull test:
This test is done by gently pulling 40-60 hairs at a time from three to four different areas of scalp. If 10 or more hairs of approximately 10% of total hairs pulled comes out the Putt test is considered positive for diagnosis of alopecia.