Jun 9, 2026Hair and Nails
Hair Loss Exams: What to Look For Before You Diagnose
Hair loss can’t be evaluated well from the scalp alone. In this hair and scalp exam video, Garland James, PA-C, walks through a practical approach to evaluating hair loss in clinic, from taking a focused history and asking about styling practices to looking for signs of inflammatory and noninflammatory alopecia. She also emphasizes the parts of the exam that can easily be missed: asking permission before touching the hair, photographing the scalp for comparison, recognizing when biopsy may be needed, and building a treatment plan with the patient instead of around them. Use the accompanying Hair and Scalp Exam: A Practical Clinical Guide for PAs and NPs as a quick reference for assessing hair practices, tension patterns, density and distribution, dermoscopic clues, and care considerations in textured hair.
Question: In the video, James emphasizes that the clinical history can help guide the hair loss exam. Which of the following is most relevant to ask before examining the scalp?
Whether the patient prefers prescription or over-the-counter treatment
Current and recent hair care practices, including protective styles and duration of wear
Whether the patient has used cosmetic hair coloring in the past 10 years
Whether the patient is willing to stop all styling during treatment
Rationale: Rationale: Hair practices can help explain the pattern of hair loss and should be discussed before the exam. The accompanying guide also notes that hair practices often explain the pattern and recommends asking about recent styling changes, current routine, symptoms, and prior treatments.
document.querySelectorAll('.mcq-block').forEach(function(block) {
const correct = block.getAttribute('data-correct');
const form = block.querySelector('.mcq-form');
const feedback = block.querySelector('.mcq-feedback');
const resultText = block.querySelector('.mcq-result');
form.addEventListener('change', function(e) {
const selected = e.target.value;
// Log to console (optional)
console.log("Selected answer:", selected);
// Show feedback
feedback.style.display = 'block';
if (selected === correct) {
resultText.textContent = "Correct!";
resultText.style.color = "green";
} else {
resultText.textContent = "Incorrect";
resultText.style.color = "red";
}
});
});
.mcq-block {
padding: 1rem;
border: 1px solid #ddd;
border-radius: 10px;
margin: 1.5rem 0;
background: #fafafa;
}
.mcq-question {
margin-bottom: 0.75rem;
}
.mcq-feedback p {
margin: 0.3rem 0;
}
Question: During the exam, which finding would most strongly support considering biopsy for possible inflammatory or scarring alopecia?
Diffuse shedding without scalp symptoms
Mixed hair shaft diameters consistent with miniaturization
Perifollicular erythema or scaling with concern for scarring disease
Mild dandruff without tenderness or visible inflammation
Rationale: In the video, James notes that if the exam raises concern for an inflammatory component that could lead to scarring, biopsy should be strongly considered. She also cautions that biopsy location matters; avoid areas that are already fully scarred and sample near active inflammation when possible.
document.querySelectorAll('.mcq-block').forEach(function(block) {
const correct = block.getAttribute('data-correct');
const form = block.querySelector('.mcq-form');
const feedback = block.querySelector('.mcq-feedback');
const resultText = block.querySelector('.mcq-result');
form.addEventListener('change', function(e) {
const selected = e.target.value;
// Log to console (optional)
console.log("Selected answer:", selected);
// Show feedback
feedback.style.display = 'block';
if (selected === correct) {
resultText.textContent = "Correct!";
resultText.style.color = "green";
} else {
resultText.textContent = "Incorrect";
resultText.style.color = "red";
}
});
});
.mcq-block {
padding: 1rem;
border: 1px solid #ddd;
border-radius: 10px;
margin: 1.5rem 0;
background: #fafafa;
}
.mcq-question {
margin-bottom: 0.75rem;
}
.mcq-feedback p {
margin: 0.3rem 0;
}
