Phillips T Grant, Slomiany W Paul, Allison Robert
Washington Health Systems Family Medicine Residency, Washington, PA, USA.
Am Fam Physician. 2017 Sep 15;96(6):371-378.
Hair loss is often distressing and can have a significant effect on the patient's quality of life. Patients may present to their family physician first with diffuse or patchy hair loss. Scarring alopecia is best evaluated by a dermatologist. Nonscarring alopecias can be readily diagnosed and treated in the family physician's office. Androgenetic alopecia can be diagnosed clinically and treated with minoxidil. Alopecia areata is diagnosed by typical patches of hair loss and is self-limited. Tinea capitis causes patches of alopecia that may be erythematous and scaly and must be treated systemically. Telogen effluvium is a nonscarring, noninflammatory alopecia of relatively sudden onset caused by physiologic or emotional stress. Once the precipitating cause is removed, the hair typically will regrow. Trichotillomania is an impulse-control disorder; treatment is aimed at controlling the underlying psychiatric condition. Trichorrhexis nodosa occurs when hairs break secondary to trauma and is often a result of hair styling or overuse of hair products. Anagen effluvium is the abnormal diffuse loss of hair during the growth phase caused by an event that impairs the mitotic activity of the hair follicle, most commonly chemotherapy. Physician support is especially important for patients in this situation.
脱发常常令人苦恼，并且会对患者的生活质量产生重大影响。患者可能首先会因弥漫性或斑片状脱发去看家庭医生。瘢痕性脱发最好由皮肤科医生进行评估。非瘢痕性脱发在家庭医生办公室就可以很容易地得到诊断和治疗。雄激素性脱发可通过临床诊断，并用米诺地尔进行治疗。斑秃通过典型的脱发斑进行诊断，且具有自限性。头癣会导致脱发斑，可能伴有红斑和鳞屑，必须进行全身治疗。休止期脱发是一种由生理或情绪压力引起的相对突然发作的非瘢痕性、非炎症性脱发。一旦去除诱发原因，头发通常会重新生长。拔毛癖是一种冲动控制障碍；治疗旨在控制潜在的精神疾病。结节性脆发病是毛发因外伤而断裂，通常是发型设计或过度使用美发产品所致。生长期脱发是在生长阶段由损害毛囊有丝分裂活性的事件导致的异常弥漫性脱发，最常见的原因是化疗。在这种情况下，医生的支持对患者尤为重要。
