Hair plays a vital role in self-esteem and self-image. People often turn to hairdressers or pharmacists for advice when abnormalities are noticed. However, it is essential to consult a dermatologist to receive appropriate treatment and determine if there is an underlying pathology causing hair loss.

When to Seek a Trichological Examination?

It is essential to schedule a trichological examination with a dermatologist when the following signs of hair issues are observed:

  • Increased hair loss;
  • Flaky scalp or intense itching;
  • Thinning and dull hair;
  • Family history of androgenetic alopecia (baldness).

A dermatologist can investigate the causes of hair and scalp abnormalities and determine if there is a genetic predisposition to androgenetic alopecia. 

Individuals with a family history of baldness should consider an examination at 18 to 20, as signs of androgenetic alopecia, particularly male pattern baldness, may begin to appear. 

Temporary disorders like seborrheic dermatitis (dandruff) should also prompt a visit to the specialist.

How Does the Trichological Examination Work?

The trichological examination involves three stages: history, objective examination, and dermatoscopy.

  • History: The dermatologist collects relevant patient data, including hereditary factors, lifestyle, stress levels, medication use, recent illnesses or surgeries, and postpartum experiences.
  • Objective Examination: The scalp is inspected for redness, flakiness, and the condition of the hair (shiny, dull, or broken). A pull test is performed by gently tugging hair strands from the frontal, parietal, and occipital areas. If more than six hairs are shed, it is considered a positive test indicating abnormal hair loss. Dermoscopy is then conducted using a specific lens to examine the scalp, enabling the dermatologist to identify various pathologies and disorders such as androgenetic alopecia (miniaturization of hair follicles), perifollicular keratosis (scaling around the hair follicle), alopecia areata (patches of hair loss).
  • Diagnostic Tests: If hair loss is the only symptom without signs of underlying scalp pathology, the dermatologist may request blood tests, including a complete blood count (CBC), to check for anemia or iron deficiency (sideremia and ferritin). Other tests, such as thyroid-stimulating hormone (TSH) assay and anti thyroperoxidase antibodies, may be conducted to rule out hypothyroidism as a cause. Additionally, liver and kidney function tests may be recommended for older individuals or those with underlying medical conditions.

Causes of Hair Loss at 40 to 50 Years of Age

Around 40 and 50, the hair bulb naturally ages, possibly leading to reduced hair volume even without any pathology. Factors such as inadequate sleep, poor diet, and stress can exacerbate this tendency. In such cases, along with lifestyle modifications, a dermatologist may suggest scalp biostimulation with hyaluronic acid to rejuvenate the hair bulb. The use of lotions and supplements may complement this treatment.

Furthermore, abnormal hair loss can be attributed to stressful experiences such as:

  • Childbirth
  • General anesthesia
  • High-dose antibiotic therapies
  • Covid-19 

Hair loss tends to resolve independently in the above mentioned cases and when no underlying pathology is present.