{"id":3692,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/alopecia\/"},"modified":"2024-10-09T13:14:03","modified_gmt":"2024-10-09T12:14:03","slug":"alopecia","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dermatology\/alopecia\/","title":{"rendered":"Alopecia"},"content":{"rendered":"\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"641\" height=\"483\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Alopecia-Female-hair-loss-17-03-20.png\" alt=\"Dermatology Alopecia Female hair loss\" class=\"wp-image-1046\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Alopecia-Female-hair-loss-17-03-20.png 641w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Alopecia-Female-hair-loss-17-03-20-300x226.png 300w\" sizes=\"auto, (max-width: 641px) 100vw, 641px\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">DermNet (dermnetnz.org)<\/span> Female hair loss- <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=female%20hair%20loss\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<p>Diffuse Non &#8211;  Scarring Physiological: <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Normal ageing process. <\/li>\n\n\n\n<li>Female pattern hair loss (FPHL)- thinning over crown<\/li>\n\n\n\n<li>Telogen effluvium\/ excessive shedding occurs three\u2013four months after pregnancy\/ other major event<\/li>\n\n\n\n<li>May be component of polycystic ovarian disease in young women<\/li>\n\n\n\n<li>Consider any new medications<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"260\" height=\"271\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Alopecia-17-03-20-e1684151594735.png\" alt=\"Dermatology Alopecia\" class=\"wp-image-1044\" style=\"width:300px;height:313px\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">\u00a9 DermNet New Zealand<\/span> <em>Alopecia areata<\/em>&#8211; <a href=\"https:\/\/dermnetnz.org\/images\/alopecia-areata-images\">Alopecia Areata Images \u2014 DermNet (dermnetnz.org)<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<p>Localised Non-Scarring Alopecia areata Patchy hair loss with exclamation mark hair  <\/p>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"295\" height=\"225\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Alopecia-Scalp-psoriasis-01-04-20.png\" alt=\"Dermatology Alopecia Scalp psoriasis\" class=\"wp-image-1047\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">\u00a9 DermNet New Zealand<\/span> Scalp psoriasis- <a href=\"https:\/\/dermnetnz.org\/images\/alopecia-areata-images\">Alopecia Areata Images \u2014 DermNet (dermnetnz.org)<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<p>Diffuse inflamed non-scarring. <\/p>\n\n\n\n<p><br>Consider seborrhoeic dermatitis or psoriasis (may also rarely cause scarring)     <\/p>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:33.33%\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"295\" height=\"225\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Alapecia-Seborrhoeic-dermatitis-01-04-20.jpg\" alt=\"Dermatology Alapecia Seborrhoeic dermatitis\" class=\"wp-image-1043\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">\u00a9 DermNet New Zealand<\/span> Scalp Alopecia Seborrhoeic &#8211; <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=apecia%20seborrhoeic\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:66.66%\">\n<p>Localised inflamed non-scarring.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Consider&nbsp;<strong>tinea infection<\/strong>&nbsp;(may also cause scarring)<\/li>\n\n\n\n<li>Consider&nbsp;<strong>psoriasis<\/strong>&nbsp;or&nbsp;<strong>seborrhoeic dermatitis<\/strong><\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"241\" height=\"157\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Alopecia-scarring-17-03-20-e1684151081662.png\" alt=\"Dermatology Alopecia scarring\" class=\"wp-image-1048\" style=\"width:290px;height:189px\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">\u00a9 DermNet New Zealand<\/span> Scalp Discoid Lupus &#8211; <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=apecia%20seborrhoeic\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p><em>Scarring : no visible hair growth or follicles. Skin is atrophic or inflamed Loss of hair follicles with or without inflammation and accompanied by scarring local or diffuse causes include:&nbsp;<\/em><\/p>\n\n\n\n<p><strong>Lichen planuopilaris, folliculitis decalvans and frontal fibrosing alopec<\/strong><\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"641\" height=\"483\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Alopecia-Decalvans-follicultis-17-03-20.png\" alt=\"Dermatology Alopecia Decalvans follicultis\" class=\"wp-image-1045\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Alopecia-Decalvans-follicultis-17-03-20.png 641w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Dermatology-Alopecia-Decalvans-follicultis-17-03-20-300x226.png 300w\" sizes=\"auto, (max-width: 641px) 100vw, 641px\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">\u00a9 DermNet New Zealand<\/span> Scalp Folliculitis &#8211; <a href=\"https:\/\/dermnetnz.org\/#gsc.tab=1&amp;gsc.q=apecia%20seborrhoeic\">Search DermNet | DermNet (dermnetnz.org)<\/a><\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n<p><strong>R.C 18-05-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h3 class=\"wp-block-heading\">Dermatology Referral Criteria<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Inflammatory scarring alopecia<\/li>\n\n\n\n<li>Diagnostic uncertainty<\/li>\n\n\n\n<li>Persistent or extensive alopecia (scarring or non-scarring)<\/li>\n\n\n\n<li>Hairpiece or wig prescription for alopecia caused by trauma or disease resulting in psychological distress (if available)<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Investigations<\/h4>\n\n\n\n<p>In diffuse alopecia check FBC, ferritin and TFTs. Consider iron supplementation if ferritin at lower end of normal range or below. The need for any additional tests depends on the history \/ examination eg ANA \/ ENA for suspected lupus, VDRL for suspected syphilis&nbsp;<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Non-Scarring:<\/h4>\n\n\n\n<p><strong>Diffuse<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Inform patients with mild FPHL that condition is physiological. Topical Minoxidil 2% may prevent further hair loss and encourage hair growth but only during use. This is NOT available on the NHS.<\/li>\n\n\n\n<li>Reassure patients that Telogen effluvium will recover spontaneously and there is no specific treatment.<\/li>\n\n\n\n<li>Patients with severe widespread alopecia caused by disease can be considered for NHS wig prescription.<\/li>\n<\/ul>\n\n\n\n<p><strong>Localised<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Reassure patients with alopecia areata that spontaneous regrowth is likely, though less so if widespread and involving areas out with the scalp.<\/li>\n\n\n\n<li>Generally good outcome in patients with short history and limited extent.<\/li>\n\n\n\n<li>Consider trial of potent topical steroid lotion for three months when there is diagnostic certainty.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Diffuse inflamed<\/h4>\n\n\n\n<p><strong>Treatment:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Coal tar + salicylic acid ointment ( eg Cocois\/Sebco)<\/li>\n\n\n\n<li>Anti-fungal shampoo ( eg ketoconazole)<\/li>\n\n\n\n<li>Topical steroid lotion\/mousse\/foam.<\/li>\n<\/ul>\n\n\n\n<p><strong>Localised inflamed<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Send plucked hairs to mycology lab.<\/li>\n\n\n\n<li>If dermatophyte infection confirmed, treat with oral terbinafine.<\/li>\n\n\n\n<li>Treat as for diffuse inflamed non-scarring if psoriasis or seborrhoeic dermatitis<\/li>\n<\/ul>\n\n\n\n<p><strong>Scarring<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Refer to Dermatology<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">For Patients:<\/h4>\n\n\n\n<p><a href=\"https:\/\/www.alopecia.org.uk\/\">https:\/\/www.alopecia.org.uk\/<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">For Health Professionals<\/h4>\n\n\n\n<p><a href=\"http:\/\/www.pcds.org.uk\/clinical-guidance\/alopecia-an-overview\" target=\"_blank\" rel=\"noreferrer noopener\">Link to PCDS Alopecia guidance<\/a><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Diffuse Non &ndash; Scarring Physiological: Localised Non-Scarring Alopecia areata Patchy hair loss with exclamation mark hair Diffuse inflamed non-scarring. Consider seborrhoeic dermatitis or psoriasis (may also rarely cause scarring) Localised inflamed non-scarring. Scarring : no visible hair growth or follicles. Skin is atrophic or inflamed Loss of hair follicles with or without inflammation and accompanied<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3853,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[96],"class_list":["post-3692","page","type-page","status-publish","hentry","category-alopciea"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/dermatology\/alopciea\/\" rel=\"tag\">Alopecia<\/a>","rttpg_excerpt":"Diffuse Non &ndash; Scarring Physiological: Localised Non-Scarring Alopecia areata Patchy hair loss with exclamation mark hair Diffuse inflamed non-scarring. Consider seborrhoeic dermatitis or psoriasis (may also rarely cause scarring) Localised inflamed non-scarring. Scarring : no visible hair growth or follicles. Skin is atrophic or inflamed Loss of hair follicles with or without inflammation and accompanied","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3692","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3692"}],"version-history":[{"count":30,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3692\/revisions"}],"predecessor-version":[{"id":21160,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3692\/revisions\/21160"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3853"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3692"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3692"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}