The clinician faced with a patient with hair loss must decide whether it is focal or diffuse. If it is focal, one should determine whether there is a rash in the area of hair loss. If there is a rash, one should consider conditions such as tinea capitis, lupus erythematosus, psoriasis, and seborrheic dermatitis. If there is no rash, one should consider alopecia areata, syphilis, burns, and other injuries to the skin.
If the area of hair loss is diffuse, one must consider that it might be male pattern baldness, as well as female pattern baldness in later years. If it is not typically a male pattern baldness, then one must consider that it might be due to a systemic disease myxedema, hyperpituitarism, hyperthyroidism, anticoagulant drug therapy, or cancer chemotherapy.
If you are looking for pyoderma or a fungal infection, then a smear and culture of the scrapings for bacteria and fungi should be done. If these are negative, a skin biopsy should be performed. The skin biopsy will help identify lupus erythematosus, psoriasis, and alopecia areata. Systemic disorders may need to be ruled out with thyroid function tests, antinuclear antibody (ANA) assay, VDRL test, CBC, and serum iron and ferritin. A dermatologist should be consulted in difficult cases.
Read excerpts from these other book chapters related to Patchy hair loss:
Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.
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Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9 
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