Hair Loss: What Tests Should You Consider for Diagnosis?

What tests should be done for hair loss?

Last March, I discovered a round patch of hair loss and applied the medication prescribed by a dermatologist, which helped my hair grow back.
However, I have now found another round bald spot in a different area.
I also experience hair shedding, leading to a decrease in hair volume, especially on the crown of my head.
I would like to know if I need to undergo blood tests or any other examinations.
Which hospitals and specialties should I consult?

Zai, 20~29 year old female. Ask Date: 2009/11/05

Dr. Du Zhiqiang reply Dermatology

Dear Zai,
Alopecia areata is more common in older adults and middle-aged individuals, with an unknown cause.
Many tests also yield no answers.
It is medically believed to be caused by immune system dysregulation, endocrine disorders, localized infections, or poor nutrition of the hair follicles.
If you wish to undergo related examinations, you can first visit an outpatient clinic for a physician's evaluation to rule out seborrheic dermatitis of the scalp or fungal and bacterial infections.
The tests should include thyroid function tests, immune antibodies, and biochemical tests for anemia, among others.
For more thorough investigations, you may go to a medical center for a scalp biopsy.
Generally, alopecia areata resolves on its own within three to four months without aggressive treatment.
However, if you prefer a more proactive approach, you can seek outpatient treatment for localized injection therapy.
Wishing you peace and health,
Dr.
Du Zhi-Liang
Department of Dermatology
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2009/11/05

More Info

When it comes to diagnosing hair loss, particularly conditions like alopecia areata (which is characterized by round patches of hair loss), it is essential to take a comprehensive approach. Your experience with a previous round patch of hair loss that responded to treatment suggests that you may be dealing with a similar issue again. However, the recurrence of hair loss in different areas raises the question of whether further investigation is necessary.

Diagnostic Tests for Hair Loss
1. Clinical Examination: The first step in diagnosing hair loss is a thorough clinical examination by a dermatologist. They will assess the pattern of hair loss, the condition of the scalp, and any other symptoms you may have. This is often sufficient to diagnose conditions like alopecia areata, androgenetic alopecia (male or female pattern baldness), or telogen effluvium.

2. Blood Tests: While not always necessary, blood tests can be helpful in ruling out underlying medical conditions that may contribute to hair loss. Common tests include:
- Thyroid Function Tests: To check for hypothyroidism or hyperthyroidism, both of which can cause hair loss.

- Complete Blood Count (CBC): To assess for anemia, which can lead to hair thinning.

- Hormonal Tests: Such as testosterone and DHEA-S levels, especially if there are signs of androgenetic alopecia.

- Nutritional Deficiencies: Tests for iron levels, vitamin D, and other essential nutrients can also be relevant.

3. Scalp Biopsy: In some cases, a dermatologist may recommend a scalp biopsy to examine the hair follicles and scalp tissue under a microscope. This can help differentiate between various types of hair loss.

4. Trichoscopy: This is a non-invasive technique that uses a dermatoscope to examine the scalp and hair follicles. It can provide valuable information about the hair growth cycle and the health of the follicles.

Where to Seek Help
You should consult a dermatologist, preferably one who specializes in hair disorders. You can find dermatology services in both private clinics and hospitals. If you are considering a hospital visit, look for a dermatology department that has experience in treating hair loss conditions.

Should You Get Blood Tests?
Given your history of alopecia areata and the new patches of hair loss, it may be prudent to have blood tests done, especially if you have not had them recently. While many cases of alopecia areata do not require extensive testing, ruling out other potential causes of hair loss can provide peace of mind and guide treatment options.

Conclusion
In summary, if you are experiencing new patches of hair loss, it is advisable to see a dermatologist for a thorough evaluation. They will determine whether blood tests or other diagnostic procedures are necessary based on your clinical presentation. Early intervention can often lead to better outcomes, especially in cases of alopecia areata, where timely treatment can promote hair regrowth. Avoid self-diagnosing or self-treating, as this can lead to further complications or ineffective treatments.

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