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Hair loss history and lifestyle
Dermatologists will ask a number of questions depending on what they suspect you have. A dermatologist first needs to decide whether the hair loss is congenital (present from birth) or acquired (hair loss developed later in life). So the most obvious question will be how long have you had the hair loss?
If the hair loss seems congenital then the dermatologist may ask if other members of your family have similar hair loss and what genetic relationship they are to you. They may ask about other hereditary diseases in your family. They may ask if you had any physical or emotional trauma during or shortly after birth. Using these and other questions the dermatologist is trying to find out whether the hair loss is based on genetics or on an environmental influence.
If the hair loss seems to be acquired later in life then the dermatologist may ask a whole series of questions about the nature of the hair loss.
Does the hair progressively expand over time or does it wax and wane?
Does your family have a history of this type of hair loss?
What do you do to your hair?
How do you style your hair?
Questioning may expand to include other areas of your health and lifestyle not directly connected with your hair.
What other physical complaints are you being treated for?
Do you feel healthy, depressed, fatigued?
Do you have gastrointestinal problems?
Any hormonal complications?
Are you taking vitamin or mineral supplements?
The questioning may become quite detailed if the dermatologist suspects an uncommon diagnosis.
Visual examination
Many people expect a long and detailed examination as they are used to for other complaints. However, hair and hair loss is clearly visible. A dermatologist can gain all the information required by examining the scalp for a minute or two.
The dermatologist first looks at the pattern of hair loss.
Is it a limited focal patchy type of hair loss?
Is it a diffuse pattern? Is the hair loss all over?
Is hair loss limited to the top of the scalp, temples, occipital area?
Is it asymmetrical or symmetrical in appearance?
Next the dermatologist looks at the form of the hair loss.
Does the hair loss involve inflammation?
Is there any scar tissue?
Is there any crusting or scaling of the skin?
Are there any lumps and bumps in the skin?
What does the hair look like?
Is it healthy and shiny?
Is it lackluster, thin?, straight, curly, kinked?
If the dermatologist suspects a fungal infection he/she may look at your hair using a special light source called a wood’s lamp. Under this light fungal material fluoresces and can be clearly identified. As well as examining your hair the dermatologist may also examine and ask you about the quality of your nails, teeth, and eyes. These structures are all related to the hair follicle structure and can occasionally be affected in some hair conditions.
Hair Pull test
The dermatologist may conduct a hair pull test. The dermatologist gently tugs on a few strands of hair to see if the fibers pull out easily or if they are firmly anchored in the hair follicle. Note. If you suspect your dermatologist will physically examine your hair the morning of a consultation you should not wash your hair! When you wash your hair you remove many of the loose hairs. This means that when a dermatologist does a hair pull test he/she may obtain a false result. Not washing your hair will allow a more accurate hair pull test to be made.
Hair analysis
Sometimes a dermatologist may take a few hair fibers for microscopic analysis. Usually the hairs have to be pulled or plucked out rather than cut so that the dermatologist can examine the roots of the fiber as well as the shaft. The hairs are placed on a microscope slide and examined under the microscope.
Typically the dermatologist is asking himself/herself;
Is the hair shaft straight and uniform thickness?
Are there cracks, constrictions, or bulges along the length of the hair fiber?
Is the cuticle intact or deformed?
Is the fiber twisted, knotted, kinked?
Is the fiber cross section round, oval, grooved?
Is the hair root healthy or malformed?
Is the exposed end of the hair cut, frayed, broken?
Are there any particles on the fiber that are not part of the skin or hair structure?
Are there mites, fungal structures?
Using polarized light, does the hair fiber have a tiger stripe look to it?
Sometimes a dermatologist may send the hair fiber away for further analysis using a scanning electron microscope. These microscopes provide very highly magnified images and the hair fiber can be processed so that the surface of the fiber and the internal structure can be looked at. Very occasionally hair fiber may be sent to a laboratory for chemical analysis. Usually the most important analysis is to identify the concentration of sulfur compounds in the hair fiber. Sulfur compounds are important for strength and flexibility in the hair fiber. Hair may also be used to look for concentrations of lead, zinc, copper, and various chemical compounds.
Skin scrapings and scalp biopsies
If the dermatologist suspects the hair condition may be the result of bacteria, yeast, or fungi, he/she will take scrapings of skin from the affected area. Some of these scrapings will be covered with special staining chemicals that bind to certain types of bacteria and fungi. Other scrapings may be used to culture any bacteria or fungi that may be present. This will help define any particular pathogenic strain that may be involved.
Sometimes a dermatologist needs to take a scalp biopsy. A biopsy is a small piece of skin taken from the affected area. Typically, a dermatologist will use a sterile, disposable biopsy punch. This is simply a miniature cookie cutter that is pushed into the skin and withdrawn pulling out a small piece of skin. The diameter of the biopsy can be anywhere between 2 and 6 millimeters.
The piece of skin is then placed in a liquid that fixes and preserves the material (usually a formaldehyde solution). The skin is then sent to a histologist who cuts the biopsy into thin sections and lays them on a microscope slide. The skin sections can be stained in different ways depending on what the dermatologist wants to look at.
The microscope slide may be examined by the dermatologist and also by a pathologist. They look at the shape of the hair follicles in the skin, their size and whether they are in a healthy state. They also look for signs of inflammation, scarring, or infection in the skin and around the hair follicles.
Blood samples
Hair loss or excess hair growth can be a symptom of internal body dysfunction. A dermatologist may suspect hormones or the immune system to be involved in your hair condition. In this case he/she may take a blood sample or ask you to see an endocrinologist/immunologist for further testing.
With blood samples the dermatologist is considering such questions as;
What levels of estrogen and progesterone are present?
What is the androgen concentration?
What are the concentrations of thyroid hormones?
What is the iron or copper concentration?
How many lymphocyte cells or red blood cells are in the plasma?
Are there any autoantibodies present and if so what do they target?
While the questioning and examination are straight forward and do not take long, they do provide enough information from which a dermatologist can provide a diagnosis. With a diagnosis you can then progress to considering any options for treatment.
Help your dermatologist help you
The typical doctor/dermatologist appointment lasts no more than seven minutes. That is not a lot of time for the dermatologist to find out what the problem is and determine the future course of action to take. The dermatologist’s priority is to diagnose the problem and see the next patient. While you might want more consultation time, frankly it is not going to happen especially if you are in a country with a national health system. This means that you have to be prepared and make sure you get the most out of the appointment.
First, make sure you keep the appointment! If you cannot then please have the courtesy to inform the clinic. It is frustrating when patients do not turn up. Your appointment could be used by someone else rather than waste the time. It is also a waste of money, ultimately your money through insurance and national health charges!
Write down a list of the medications you are using including alternative medicines. Ideally, take the original packaging with you in case the dermatologist needs more information about the products.
Make sure the clinic has details on other conditions you may have and tell them about other doctors you are consulting with.
If you have questions make sure you write them down and be ready to ask. Take a pen and notepad to write down the answers the dermatologist gives you in case you forget.
Realize that with such a limited amount of time that the dermatologist can only give you brief replies to your questions. Books and websites like this one will give you more information.
Realize not all questions can be answered. Hair research is actually quite limited. We do not know the cause or mechanisms of many hair diseases.
Source of article...
http://www.ukmedix.co.uk/news.cfm/id/43 ... 0condition
Dermatologists will ask a number of questions depending on what they suspect you have. A dermatologist first needs to decide whether the hair loss is congenital (present from birth) or acquired (hair loss developed later in life). So the most obvious question will be how long have you had the hair loss?
If the hair loss seems congenital then the dermatologist may ask if other members of your family have similar hair loss and what genetic relationship they are to you. They may ask about other hereditary diseases in your family. They may ask if you had any physical or emotional trauma during or shortly after birth. Using these and other questions the dermatologist is trying to find out whether the hair loss is based on genetics or on an environmental influence.
If the hair loss seems to be acquired later in life then the dermatologist may ask a whole series of questions about the nature of the hair loss.
Does the hair progressively expand over time or does it wax and wane?
Does your family have a history of this type of hair loss?
What do you do to your hair?
How do you style your hair?
Questioning may expand to include other areas of your health and lifestyle not directly connected with your hair.
What other physical complaints are you being treated for?
Do you feel healthy, depressed, fatigued?
Do you have gastrointestinal problems?
Any hormonal complications?
Are you taking vitamin or mineral supplements?
The questioning may become quite detailed if the dermatologist suspects an uncommon diagnosis.
Visual examination
Many people expect a long and detailed examination as they are used to for other complaints. However, hair and hair loss is clearly visible. A dermatologist can gain all the information required by examining the scalp for a minute or two.
The dermatologist first looks at the pattern of hair loss.
Is it a limited focal patchy type of hair loss?
Is it a diffuse pattern? Is the hair loss all over?
Is hair loss limited to the top of the scalp, temples, occipital area?
Is it asymmetrical or symmetrical in appearance?
Next the dermatologist looks at the form of the hair loss.
Does the hair loss involve inflammation?
Is there any scar tissue?
Is there any crusting or scaling of the skin?
Are there any lumps and bumps in the skin?
What does the hair look like?
Is it healthy and shiny?
Is it lackluster, thin?, straight, curly, kinked?
If the dermatologist suspects a fungal infection he/she may look at your hair using a special light source called a wood’s lamp. Under this light fungal material fluoresces and can be clearly identified. As well as examining your hair the dermatologist may also examine and ask you about the quality of your nails, teeth, and eyes. These structures are all related to the hair follicle structure and can occasionally be affected in some hair conditions.
Hair Pull test
The dermatologist may conduct a hair pull test. The dermatologist gently tugs on a few strands of hair to see if the fibers pull out easily or if they are firmly anchored in the hair follicle. Note. If you suspect your dermatologist will physically examine your hair the morning of a consultation you should not wash your hair! When you wash your hair you remove many of the loose hairs. This means that when a dermatologist does a hair pull test he/she may obtain a false result. Not washing your hair will allow a more accurate hair pull test to be made.
Hair analysis
Sometimes a dermatologist may take a few hair fibers for microscopic analysis. Usually the hairs have to be pulled or plucked out rather than cut so that the dermatologist can examine the roots of the fiber as well as the shaft. The hairs are placed on a microscope slide and examined under the microscope.
Typically the dermatologist is asking himself/herself;
Is the hair shaft straight and uniform thickness?
Are there cracks, constrictions, or bulges along the length of the hair fiber?
Is the cuticle intact or deformed?
Is the fiber twisted, knotted, kinked?
Is the fiber cross section round, oval, grooved?
Is the hair root healthy or malformed?
Is the exposed end of the hair cut, frayed, broken?
Are there any particles on the fiber that are not part of the skin or hair structure?
Are there mites, fungal structures?
Using polarized light, does the hair fiber have a tiger stripe look to it?
Sometimes a dermatologist may send the hair fiber away for further analysis using a scanning electron microscope. These microscopes provide very highly magnified images and the hair fiber can be processed so that the surface of the fiber and the internal structure can be looked at. Very occasionally hair fiber may be sent to a laboratory for chemical analysis. Usually the most important analysis is to identify the concentration of sulfur compounds in the hair fiber. Sulfur compounds are important for strength and flexibility in the hair fiber. Hair may also be used to look for concentrations of lead, zinc, copper, and various chemical compounds.
Skin scrapings and scalp biopsies
If the dermatologist suspects the hair condition may be the result of bacteria, yeast, or fungi, he/she will take scrapings of skin from the affected area. Some of these scrapings will be covered with special staining chemicals that bind to certain types of bacteria and fungi. Other scrapings may be used to culture any bacteria or fungi that may be present. This will help define any particular pathogenic strain that may be involved.
Sometimes a dermatologist needs to take a scalp biopsy. A biopsy is a small piece of skin taken from the affected area. Typically, a dermatologist will use a sterile, disposable biopsy punch. This is simply a miniature cookie cutter that is pushed into the skin and withdrawn pulling out a small piece of skin. The diameter of the biopsy can be anywhere between 2 and 6 millimeters.
The piece of skin is then placed in a liquid that fixes and preserves the material (usually a formaldehyde solution). The skin is then sent to a histologist who cuts the biopsy into thin sections and lays them on a microscope slide. The skin sections can be stained in different ways depending on what the dermatologist wants to look at.
The microscope slide may be examined by the dermatologist and also by a pathologist. They look at the shape of the hair follicles in the skin, their size and whether they are in a healthy state. They also look for signs of inflammation, scarring, or infection in the skin and around the hair follicles.
Blood samples
Hair loss or excess hair growth can be a symptom of internal body dysfunction. A dermatologist may suspect hormones or the immune system to be involved in your hair condition. In this case he/she may take a blood sample or ask you to see an endocrinologist/immunologist for further testing.
With blood samples the dermatologist is considering such questions as;
What levels of estrogen and progesterone are present?
What is the androgen concentration?
What are the concentrations of thyroid hormones?
What is the iron or copper concentration?
How many lymphocyte cells or red blood cells are in the plasma?
Are there any autoantibodies present and if so what do they target?
While the questioning and examination are straight forward and do not take long, they do provide enough information from which a dermatologist can provide a diagnosis. With a diagnosis you can then progress to considering any options for treatment.
Help your dermatologist help you
The typical doctor/dermatologist appointment lasts no more than seven minutes. That is not a lot of time for the dermatologist to find out what the problem is and determine the future course of action to take. The dermatologist’s priority is to diagnose the problem and see the next patient. While you might want more consultation time, frankly it is not going to happen especially if you are in a country with a national health system. This means that you have to be prepared and make sure you get the most out of the appointment.
First, make sure you keep the appointment! If you cannot then please have the courtesy to inform the clinic. It is frustrating when patients do not turn up. Your appointment could be used by someone else rather than waste the time. It is also a waste of money, ultimately your money through insurance and national health charges!
Write down a list of the medications you are using including alternative medicines. Ideally, take the original packaging with you in case the dermatologist needs more information about the products.
Make sure the clinic has details on other conditions you may have and tell them about other doctors you are consulting with.
If you have questions make sure you write them down and be ready to ask. Take a pen and notepad to write down the answers the dermatologist gives you in case you forget.
Realize that with such a limited amount of time that the dermatologist can only give you brief replies to your questions. Books and websites like this one will give you more information.
Realize not all questions can be answered. Hair research is actually quite limited. We do not know the cause or mechanisms of many hair diseases.
Source of article...
http://www.ukmedix.co.uk/news.cfm/id/43 ... 0condition
