An alopecia areata diagnosis depends mostly on the history of hair loss and the symptoms. The most obvious alopecia areata symptom is hair loss, but how the hair loss presents (looks) is different according to the type. You may see: Small, round or oval patches of hair loss on the: Scalp Beard area of the face Other areas of the body with hair Hair loss and regrowth at the same time in different areas of the body Significant hair loss in a very short period Hair loss that’s mostly on one side of the scalp instead of both sides Hair loss can be anywhere and in more than one place: Scalp, up to 95% of the time Beard (males), 28% of the time Eyebrows, 3.8% of the time Extremities, 1.3% of the time There are some other alopecia areata symptoms that you might experience: Burning or itching in the areas where you lost hair (up to 14% of people with the disease experience this.) Gray or white hairs that remain in the spots where most of the hair is gone Hair loss that occurs during colder winter months (fewer flare-ups during warmer months) “Exclamation point” hairs – hair that started regrowing but broke off after just a few millimeters of growth Stippling or pitting (rows of tiny dents) on the fingernails. There can also be trachyonychia, rough ridges going lengthwise down the nails. These nail changes can cause pain. Although more commonly associated with severe alopecia areata, up to 30% of all people with alopecia areata have nail changes. Tingling, itching, or burning sensation in the areas just before losing the hair. Looking for a Diagnosis (What to Expect When You See a Dermatologist) Dermatologists are doctors who specialize in diseases and conditions that affect the skin. To diagnose and treat alopecia areata, look for a board-certified dermatologist. They have proven, in-depth knowledge and training in their field and must stay updated to renew their certification every few years. In addition, some nurse practitioners and physician assistants have completed additional dermatology training and have experience treating alopecia areata. You can use the NAAF Doctor Finder to identify a healthcare provider with expertise in alopecia areata. Preparing for Your First Visit Doctor visits can be stressful. However, you can take steps to prepare for the exam, which can help the appointment go smoothly. Ensure that your scalp (or your child's) is in a position allowing easy inspection. Remove hair pieces or hairstyles that might make it difficult to see the skin. If you regularly wear a wig, ensure you can easily remove it. If not, wear a head covering for the visit instead. Remove artificial nails or nail polish. Your doctor will want to examine your nails. One of the symptoms of alopecia areata is ridging or pitting of the nails. Do not apply false eyelashes or make up to your brows. This would make it difficult for your doctor to examine those areas thoroughly. Set aside enough time for your visit. An initial visit with a dermatologist is usually longer than follow-up visits. When you confirm your appointment, ask how long it will be. Bring: Gather your family’s medical history and see if anyone in your family has alopecia areata or another type of autoimmune disease. This includes biological parents, siblings, aunts, uncles, and first cousins. Alopecia areata is genetic, and about 20% of those with the disease have relatives with it or another autoimmune disease. If your primary care physician referred you, ask for a copy of your medical records and the referral. You'll want this even if it was sent to the dermatologist’s office already. Print out or make a list of all medications you currently take. This includes over-the-counter drugs, as well as vitamins and dietary supplements. Make a list (or take photos) of all hair and scalp products you (or your child) use and bring with you. Download this Healthcare Visit Worksheet to help you prepare. During your visit Information gathering: The first part of your doctor’s visit is usually for information gathering. Some questions can seem unrelated, but your answers may help your doctor diagnose you. Your doctor will ask about the patient's: Reason for your visit Medical history Family’s medical history Diet Whether the patient recently had a baby If the patient is stressed Examination: Your doctor will examine your scalp, face, hair (and hair-growing areas), and nails. The examination is to look for: Redness Scarring Swelling Sores Any patterns made by the hair loss What the remaining hair looks like Pitting or ridges on your nails Your doctor may want to photograph your hair to track loss or regrowth. Testing: Your doctor may also conduct or recommend certain tests during your exam, such as: Pull test: This test checks different parts of your scalp for active (current) hair loss. Your doctor will gently pull on some hair – about 40 strands. If more than six strands come out, this is active hair loss. Tug test: The doctor gently tugs a few strands of hair to check for broken strands. Card test: Your doctor holds a felt card against your skin while parting your hair. The card will help show the tiniest of hairs or broken strands that you might not be see otherwise. Blood tests: While blood tests don't indicate if a person has alopecia areata, they can show if a disease is present that is causing hair loss. These include too little iron in the blood or thyroid disease, for example. Cultures: Cultures (taking a swab or sample) check for infections. Fungal infections like tinea capitus (scalp ringworm) are not uncommon. Scalp biopsy: If your doctor isn’t sure about the diagnosis, you may have a biopsy. A small section of skin from your scalp skin is removed and sent to a laboratory for testing. Trichoscopy: Your doctor might use a tool called a dermatoscope, which is used to view the scalp and hair at a high magnification level. This lets your doctor look for certain signs that appear with alopecia areata. Alopecia Areata Diagnosis Once your doctor determines that you or your child have alopecia areata, they will characterize the severity of the disease. Is it mild, moderate or severe? The distinction is important because it may affect treatment recommendations. What is shared decision-making? Choosing treatment (or not) is a personal decision—with any disease or disorder. Your doctor has the expertise. However, only the patient knows how alopecia areata makes them feel, so working with your healthcare provider is crucial. You must find the best course of action for your (or your child's) alopecia areata. Shared decision-making involves the patient and provider weighing all factors. Then, together, they decide what is best for the patient's health and well-being. The patient is engaged, informed, and included in the decision-making process. Studies show that patients who share treatment decisions with their providers have less regret about their choices. Confidence in your decision may improve your treatment adherence and boost your satisfaction with your alopecia areata treatment. How can you ensure a positive working relationship with your provider? Educate yourself. If you’re uncertain about treatments, ask. Learn all you can about available treatments from reliable sources, such as NAAF, your healthcare provider, or peer-reviewed journal articles. Know their pros and cons, efficacy, side effects, cost, and duration. Consider all of these factors when weighing treatment options. Keep records. Accurate medical records and notes about your talks with your doctor will help you. They will let you evaluate what has worked and when to try something new. Discuss honestly. Be open and honest about your alopecia areata journey. What treatments have you tried? How has the disease affected your (or your child’s) quality of life? What does the evidence show about the treatment you are considering? Work with your physician to make a decision that feels right for you and that your provider supports. Learn more: How dermatologists determine disease severity. Read about types of alopecia areata.
