Quiz
Hair loss – 14 cases

Diffuse hair loss

This quiz will test your diagnostic skills in diagnosing hair loss.

Diffuse hair loss from the scalp may present as an acute or subacute process without scarring, accompanied by shedding of telogen (bulb) or anagen (tapered) hairs, or more slowly as chronic thinning. In most cases, a careful history and examination reveals the cause. Where none is obvious, look for iron deficiency and thyroid disease.

Localised hair loss

A patient may present reporting one or more bald areas. This may or may not be accompanied by an inflammatory process with varying degrees of irritation, soreness, erythema, scaling and pustules and can be followed by permanent scarring (cicatricial alopecia). If scaling is present, a scraping should be arranged for mycology. It is often helpful to obtain one or more scalp biopsies from the active inflammatory edge. Refer to a dermatologist for specific diagnosis and management.

For each of the fourteen cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.

When you finish the quiz, you can download a certificate.

Case 4

Make a diagnosis

Diffuse alopecia (drug-induced)

Outline the clinical features

Drug-induced alopecia may be partial or complete but should be reversible once the drug is withdrawn. The interruption in hair growth may cause telogen or anagen shedding, diffusely from the entire scalp. The patient illustrated lost her hair completely within a few weeks of commencing acitretin; it regrew completely over a year or so once it was stopped.
Although medications such as beta-blockers, some antihyperlipemic drugs, non-steroidal anti-inflammatory drugs, anticoagulants and oral contraceptives have been linked to telogen effluvium, there are currently no controlled studies available on drugs causing this condition. Cytotoxics are the most common reason for anagen effluvium.

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