Dr. Rachita Dhurat reviews:

• When the hair fall or thinning began
• Whether the problem is shedding, reduced density or both
• Pattern and rate of progression
• Menstrual, hormonal and pregnancy history where relevant
• Recent illness, surgery, weight loss, stress or medication
• Diet and possible nutritional deficiencies
• Family history of hair loss
• Hair-care practices and chemical procedures
• Previous treatments and response
• Associated itching, scaling, pain or scalp inflammation

This detailed history helps distinguish temporary shedding from progressive follicular miniaturisation and inflammatory or scarring hair disorders.

The assessment may include:

• Pattern and distribution of hair loss
• Hair density and shaft calibre
• Hair-pull and bedside hair tests
• Signs of follicular miniaturisation
• Scalp scaling, redness or inflammation
• Hair-shaft breakage
• Examination of the frontal hairline, pony thickness and part width
• Assessment for scarring and loss of follicular openings

Trichoscopy is a non-invasive, magnified examination of the scalp and hair follicles. At RD Clinic, advanced digital trichoscopy using the FotoFinder system helps visualise and document features that may not be evident to the unaided eye. FotoFinder Systems GmbH is a German medical-imaging technology company, headquartered in Bad Birnbach, Bavaria, Germany.

It can help assess:

• Hair density and variation in shaft diameter
• Follicular miniaturisation
• Empty follicles and regrowing hairs
• Broken or damaged hair shafts
• Scalp scaling and vascular patterns
• Signs of alopecia areata
• Features suggesting scarring alopecia
• Treatment response during follow-up

Digital photographs also provide an objective baseline for future comparison.

Not every patient with hair loss requires an extensive blood-test package.

Laboratory investigations are selected according to the history and examination and may include evaluation for anaemia, iron deficiency, thyroid disease, nutritional deficiencies or hormonal abnormalities.

If clinical signs or an elevated androgen level suggest an underlying hormonal disorder, additional investigations may then be advised. A scalp biopsy or fungal examination is recommended only when necessary to confirm a difficult diagnosis.

Following the assessment, Dr. Rachita Dhurat explains:

• The most likely diagnosis
• Whether the condition is active or stable
• Whether the follicles are miniaturised, inflamed or scarred
• Possible contributing factors
• Realistic expectations and treatment duration
• Medical, procedural and supportive treatment options
• The recommended follow-up and monitoring plan

Treatment is selected according to the diagnosis—not according to a standard clinic package.

This assessment is particularly useful for patients with:

• Persistent or excessive hair shedding
• Progressive widening of the hair part
• Receding hairline or thinning crown
• Patchy hair loss
• Hair loss after pregnancy, illness or weight reduction
• Hair breakage or altered hair texture
• Persistent dandruff, itching or scalp pain
• Suspected scarring hair loss
• Hair loss that has not responded to previous treatment
• Uncertainty about whether treatment is working