She called me back promptly not during business hours.
I should recommend her any day!!
I found Pony Express online. Her quality of products is probably p you can get out there. What I liked about Linda’s site was it talked about the different conditions or behaviors someone stright away I felt more at ease. I called and left her a VM pleading in desperation for help. So pattern and distribution of the hair loss may also be instructive.
Alopecia areata could be random in distribution, whereas androgenetic alopecia will have a distinct and known pattern.
Evaluation of the hair shaft may also prove to be helpful to determine the caliber, fragility, length, and shape.
Using a contrast sheet of paper to evaluate the hair against a whitish background can also improve one’s ability to read the hair characteristics.
An attentive physical examination going to be undertaken of the scalp and hair, after a careful history is taken from the patient.
In non scarring alopecias, the position of hair loss will still maintain visible follicular units, whereas with scalp scarring this location of hair loss will have no follicular units and on p of that may have associated appearance of scarring, scaling, and associated redness.
Alopecia areata and telogen effluvium are characterized by active hair shedding, whereas androgenetic alopecia is typically a condition of progressive hair thinning. Now let me tell you something. Another important distinction concerns if the person is shedding hair or simply showing thinning of hair. Questions that could elicit a positive history of telogen effluvium would include a recent fever, recent anesthesia, pregnancy, crash diet, and similar For a female, So if the hair is simply thinning, other questions might be asked regarding thyroid abnormalities, irregular menses, or iron deficiency, if the hair is shedding.
Daily scalp counts can also be helpful.
The individual can determine progress or worsening of hair shedding since This process can be repeated at intervals.
Did you know that the shed hairs are collected from brushes, sinks, and the shower and placed daily into separate plastic bags. Normal, physiologic hair loss gonna be approximately 100 to 150 hairs per day. Loads of info can be found by going online. This process should span a 7 day period. Days in which showering occurs should’ve been noted, as increased shedding is expected on those days. Someone losing fewer than 100 hairs per day should be considered to have no active shedding. It is hairs shafts are hereafter cut 1 cm above the root, and the roots are evaluated on a slide side by side.
For these reasons, the trichogram is rarely used today.
a scalp biopsy provides a lot more information than a pluck test can afford.
Anagen hairs are distinguished from telogen hairs and anagen/telogen ratios are established. Forceful tug of the anagen hairs will surely show artefactual changes so that dystrophic or damaged anagen hairs shouldn’t be considered pathologic but a result of their forceful removal. Basically, a trichogram or pluck test requires the use of a hemostat with a rubberized end in which 60 to 80 hairs are firmly grasped and forcefully plucked, twisted, and lifted out of the scalp. You see, focal versus diffuse hair loss patterns may indicate different disease processes.
So a focal area of loss could point ward alopecia areata, a localized tinea capitis, or trichotillomania.
Understanding the pattern and duration of hair loss can be instructive.
Hair loss that began in childhood can be hereditary or have genetic influences that might be explored. Diffuse loss may point ward a telogen effluvium, anagen effluvium or androgenetic alopecia. Conversely, hair breakage could arise due to harsh chemical treatments/’hair care’ products or some anagen effluvium, like following chemotherapy for cancer. Hairs that fall out by the root might point ward telogen effluvium or androgenetic alopecia. On p of that, a further refining question my be if the hair is coming out by the roots or showing signs of abnormal breakage, I’d say in case the hair is shedding. Infections like tinea capitis and akin conditions that cause structural hair shaft defects can also lead to abnormal hair breakage. However, any virilizing signs in women including irregular menses, hirsutism, or acne may be evaluated with both free testosterone and dehydroepiandrosterone sulfate.
Associated laboratory work up can also be helpful just like serum ferritin to rule out iron deficiency anemia as a cause of hair loss, particularly in women with a diffuse patterned hair loss.
Thyroid function tests, specifically ‘thyroid stimulating’ hormone, should be required as part of a thorough work up.
Besides, a serum antinuclear antibody might be important, when lupus is suspected. Upper levels typically contain all telogen and anagen hairs as well as terminal and vellus hairs. Anagen/telogen ratios and terminal/vellus hair ratios can be calculated with horizontal sectioning. Originally, the biopsy was sectioned vertically to evaluate the longitudinal nature of every hair shaft but day the thought is that a transverse or horizontal section can be more informative regarding the how the hair shafts relate to each other and the anagen to telogen ratios can be better understood. Like the periphery of an active lesion of alopecia areata, a scalp biopsy can be a very informative procedure in which a biopsy of 4mm wide and 4 mm deep is undertaken in an area of active hair loss.