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. When looking for a doctor to diagnose and treat alopecia areata, look for a board-certified dermatologist. Any doctor can choose a specific area of medicine, like dermatology. Board-certified dermatologists have proven in-depth knowledge and training in their field. They must stay up to date with their knowledge to renew their certification every few years. It can be stressful going to any doctor but there are some steps you can take to prepare for the examination and help make the appointment go smoothly. Make sure your scalp is easily accessible so it can be inspected. Remove hair pieces or hairstyles that might make it difficult to see the skin. If you regularly wear a wig, ensure it is easily removed or wear a head covering for the visit instead. Remove artificial nails or nail polish. Your doctor will need to examine your nails. One of the symptoms of alopecia areata is ridging or pitting of the nails. Gather your family’s medical history to 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. If your primary care physician referred you, ask for a copy of your medical records along with a copy of the referral, even if one has been 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. The day of your visit An initial visit with a dermatologist is usually longer than follow-up visits. Be sure to set aside enough time so you’re not rushed. Bring your copy of the referral if you have it. Also bring any medical records you have. Your dermatologist may already have them, but having your own copy is helpful. Collect all hair and scalp products you use and bring them to your first visit. Your dermatologist may want to see them. Do not apply false eyelashes or highlight your eyebrows. This makes it difficult for the doctor to examine these areas properly. During your visit 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 come up with a diagnosis. You will be asked about things like: The reason for your visit Your medical history: Previous and current illnesses or treatments could give the doctor some important information. Your family’s medical history: Alopecia areata is genetic. People who have the disease often have relatives with either alopecia areata or other autoimmune diseases. Your diet Whether you recently had a baby If you’re stressed Your doctor will examine your scalp, face, other areas where hair usually grows, and your 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 A few tests your doctor may do include: 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: A few strands of hair are tugged gently. This is to check if any strands break. Card test: Your doctor holds a felt card against your skin in a parting your hair. The tiniest of hairs or broken strands, which might not be seen otherwise, will show against the felt. Other tests your doctor may recommend include: Blood tests: These don’t say if you have alopecia areata, but they can show if you have another disease or condition that causes hair loss. These include too little iron in the blood or thyroid disease. 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. Light microscopy: Your doctor can examine hair that has been trimmed from your scalp. Your doctor may also want to take photographs of your hair to monitor your hair loss or hair regrowth. Alopecia Areata Diagnosis The only way to be sure you have alopecia areata is with a doctor’s diagnosis, even if you seem to have alopecia areata symptoms. Once your doctor determines that you do have the disease, it will also mention if you have mild (limited), moderate, or severe disease because treatment is based on disease severity. Learn more: How dermatologists determine disease severity. Read about types of alopecia areata.
