Feasibility of Clinical and Laboratory Diagnostic Approach to Chronic Female Diffuse Alopecia in Dermatologic Outpatient Clinic

Park, Jee Young; Lee, Jae Chul; Jung, Hong Dae; Kim, Byung Soo; Lee, Weon Ju; Lee, Seok Jong; Kim, Do Won

Abstract

BACKGROUND: Various kinds of disease can cause chronic diffuse hair loss in females such as female pattern hair loss and chronic telogen effluvium etc, but differential diagnosis between these diseases are so sophisticated that an easy and feasible diagnostic approach to chronic female diffuse alopecia has not yet been established.
OBJECTIVE
The purpose of this study is to differentiate chronic female diffuse alopecia through several clinical and laboratory methods, which, can be tried easily in a short time with little doctor and assistants input in the ordinary dermatologic outpatient clinic.
METHODS
We examined 187 female patients with a chief complaint of chronic diffuse hair loss and/or decreased hair density for more than 6 months. History taking, detailed patient's questionnaire, physical examination including hair pull test and hormonal test or skin biopsy were performed.
RESULTS
Common age of onset was 20~29 years (62 cases, 33.1%) and below 19 years old (41 cases, 21.9%). A family history of similar alopecia including female pattern hair loss was seen in 50% (91 cases) and the father was the most common relative (61 cases). Crash diet restriction for weight reduction was the most common aggravating factor (14 cases, 16.1%) of hair loss and seborrheic dermatitis was the most common associated disease (24 cases, 12.8%). The serum ferritin level was lower than normal in 61 cases (40.7%) and serum copper and zinc were decreased in 22 cases (14.7%) respectively. The result of presumptive diagnosis by our checklists were as follows: female pattern hair loss (149 cases, 83.2%), diffuse alopecia areata (13 cases, 7.3%), chronic telogen effluvium (6 cases, 3.4%), and polycystic ovarian syndrome (3 cases, 1.7%).
CONCLUSION
Female pattern hair loss might be the most common disease in chronic diffuse alopecia in females and a decrease of the serum ferritin level was most frequently observed. Further study about diagnostic methods such as transverse section of skin biopsy and phototrichogram will be needed for a more accurate final diagnosis.