- Sudden loss of one or more patches of hair.
- Sometimes develops after stress.
- More common in Down’s syndrome.
- May affect more than one member of a family.
- In the active phase, exclamation mark hairs may be seen at the edge of the bald patch.
- There is no cure but there is hope of regrowth.
- Counsel the patient and offer psychological support — offer a wig if the patient is concerned.
- Treatment options include intralesional steroids for patchy loss; contact immunotherapy for more extensive loss (diphenylcyclopropenone); potent topical steroids are sometimes tried; pulsed systemic steroids and PUVA.
- Self-induced hair loss due to twisting, pulling or cutting the hair.
- More common in women.
- Patient usually denies causing the problem.
- Patient may display other forms of self-harm.
- Uneven loss with diffuse or bare patches.
- Broken or cut hairs seen in the scalp.
- If the pulled hair is eaten it may cause intestinal obstruction.
- Biopsy to exclude other causes, if necessary.
- Offer support or behavioural therapy.
Contributed by Dr Jean Watkins, a GP in Ringwood, Hampshire