Questions First
First, the trichologist would gather some personal information including your health history. She would pay particular attention to any health issues you had experienced within the last 2-3 months including: illnesses, beginning or ending medications, childbirth, breastfeeding, diet, stress, and regular menstrual cycles. She would also ask about your family’s health history and whether your relatives experienced any significant hair loss. Next, the trichologist would ask how you care for her hair: what types of products you use and how often, whether you chemically process your hair, swim regularly, or wear your hair in any tight hairstyles.
Physical Exam
The tricholgost would then physically examine your hair and scalp to look for any signs of patchy hair loss, scaling, swelling or redness. Once she had ruled out those symptoms, she would begin to examine you for a condition called diffuse hair loss - thinning caused by hair loss from all over your head.
The trichologist would run her hands over your hair to check for signs of thinning. She would then gently pull on your hair in several different areas to see if it indeed came out easily and in quantity. At the same time, she would ask when you last washed or brushed your hair and explain that it’s perfectly normal to lose up to 150 hairs a day, many of them while shampooing or grooming. The trichologist would save the hairs she gathered in an envelope marked with the your name while explaining that she would examine them under a microscope after the appointment. She would then take several digital photos of your hair to upload to her computer.
At the end of the initial appointment, the trichologist would explain that she suspected diffuse hair loss (telogen effluvium). She would set you at ease by explaining that you would not go bald with the problem and that she may be able to correct the cause and restore your hair’s thickness. She would schedule a follow-up appointment at which time she would report her findings.
Making The Diagnosis
When examining the hairs under a microscope, the trichologist would look to see if there were white bulbs at the ends, indicating telogen hairs (hairs in the "fall out" phase). She would also check for small anagen bulbs (hair in the active growth phase) without root sheaths, which would indicate a condition called loose anagen syndrome. Lastly, she would look for signs of breakage, which could indicate anagen effluvium, or chemical or mechanical damage to the hair.
If the trichologist determined that you were suffering from breakage and appeared to have no outstanding health or nutritional problems, she would recommend gentle care of your hair at home and in the salon, as well as protecting it from UVA/UVB rays.
Breakage due to signs of fungal infection or inherited defects would require further investigation and a gentle explanation that there is no treatment.
If the hairs appeared to have fallen out in the active growth stage ("anagen") and you had undergone cancer treatment (radiation, chemotherapy), or may have been exposed to toxins, the trichologist would tell you that the hair loss should stop 2-3 months after either the treatments stopped or your doctor treated you for toxicity.
If the microscopic evidence suggested loose anagen syndrome (anagen bulbs with no root sheaths), she would treat it by suggesting mineral supplements of silicon dioxide and calcium fluoride. The trichologist would examine you in another two months to see if the hair loss and thinning was responding to the treatment.
If telogen effluvium was her diagnosis, the trichologist would take another look at your health history. If you recently had a baby, fever, operation, started or stopped medication, or had a nutritional deficiency from crash dieting, she would explain that you should expect the hair loss to cease 2 or 3 months after the problem had been corrected and that your hair should fully return to normal after about 6 months.
Doctor Referral
If it appeared that you were experiencing an undue amount of stress in your life, she would explain that handling the stress would put an end to the hair loss. The trichologist would then tactfully refer you to a medical doctor for evaluation and possible medication.
If the trichologist suspected any of the following, she would refer you to your physician for a blood test and a complete medical check-up:
- a hormonal imbalance (hypo or hyperthyroid, Polycystic Ovarian Syndrome)
- diabetes
- anemia
- systemic lupus erythematosus (butterfly rash on face)
- poisoning (X-rays, pesticides, lead, mercury)
- thrush
- kidney or liver problems
