When sitting with a patient with hair loss, it is important to accept the emotional pressure associated with such a loss, says Matt L. Leavitt, DO, FAOCD, FISHRS. The 2021 Fall Clinical Dermatology Conference for PAs and NPs, November 12-14, in Orlando, Florida and Virtual.

Levit is the Founder and CEO of Advanced Dermatology and Cosmetic Surgery, Founder of Medical Hair Repair, Senior Consultant of Bosley Hair Rehabilitation and Transplant, Chairperson of KCU / ADCS Orlando Dermatologist and Associate Clinical Professor at Nova Southeast University College. Osteopathic Medicine, KCUM, Orlando, Florida.

Provides 3-way approach to communicate with these patients

  1. Ask permission to examine the patient’s missing area. This establishes an initial contact with the patient and shows that the clinician understands the emotional impact of hair loss.
  2. Give the patient stability. He realizes how important this loss is to the patient.
  3. Conduct the initial review. During the examination, Levitt described the overall brightness and size of the hair, the health of the scalp, whether the damage was localized, patterned or irregular, and whether there were any scars or scars.

In his description, he listed pearls to diagnose both cervical and scarless alopecia.

Cystic alopecia is divided into follicular ostia, follicle extinction during hematoxylin and eosin (H&E) staining, hair follicle inflammation, fibrous tissue replacement, and persistent hair loss.

Types of scar alopecia include:


  • Chronic skin disease Discotic lupus erythematosus
  • Lichen planopilaris
  • Classic pseudopelade (Brock)
  • Central centrifugal cicatricial alopecia
  • Alzheimer’s mucinosa
  • Keratosis follicularis spinulosa decalvans


  • Folliculitis decalvans
  • Disruption of cellulite / folliculitis


  • Folliculitis keloidalis
  • Folliculitis (acne) necrotic
  • Erosive pustular dermatosis

Not unique

In addition, it has provided unique diagnostic features for specific types of alopecia.

According to Lichin Planopilaris (LPP), it is most common in women between the ages of 40 and 60 years. Although etiology is unknown, it may be associated with antigenic stimulation.

Levit described the types of injuries in LPP.

  • Perifollicular erythematous / violaceous papules and spinous / follicular keratotic papules
  • Atrophic, soft glossy surface
  • Multiple areas / scattered areas in the entire skull
  • Disease activity is limited to the hair follicles
  • Hair loss is a gradual disease that can lead to large areas

Another scar highlighted in the presentation is alopecia-type facial fibrosis alopecia. Anterior fibrosis alopecia is characterized by a unique LPP. It is a clinical difference that affects the facial hairline, Levit said. This type of hair loss usually affects women and men over the age of 40 after menopause. Known as progressive alopecia, the skull is 3 to 8 cm wide and forms a band-like area with photo-damaged skin. Axillary hair loss has been reported and keratosis pilaris is seen as papules on the forehead and temples.

It was another type of scar that he talked about. This type of hair loss, which is caused by excessive stress on the hair follicles, is very common in black patients. It is divided into hair follicles and baldness, which can include erythema, sclerosis and pimples. Toxic alopecia is usually in the frontal or temporal lobe areas and can be expressed in the persistence of short hairs on the anterior margin. Levit explained that prolonged dragging scars can cause scarring.

Levit’s discussion of scar alopecia also discusses the differences in scarring.


  • Fractures are caused by anaphylaxis, hair loss, physical or chemical processes.
  • The flow of telogen
  • Androgenetic alopecia (women)
  • Alpsia Aretata, Totatis or Universalis
  • Loose Analysis Syndrome Focal


  • Infection
  • Horrible
  • Alopecia areata
  • Hair breakage
  • Androgenetic alopecia (men and women)
  • Developmental

Increasing the risk of hair loss by 10% to 30% to 50% telogen per day (150 to 700 hairs per day) highlights the appearance of scar tissue and rapid growth. These hairs are easy to comb. The telogen leak will delay the trigger for up to three months, explained Levit.

Causes of telogen leakage include:

  • Acute stress (bleeding)
  • Childbirth (Postpartum)
  • Chronic genital warts: cancer, leukemia, Hodgkin’s disease, tuberculosis, cirrhosis.
  • Malnutrition
  • Chronic iron deficiency
  • Psychological stress
  • Thyroid disease
  • Drugs Depression-Allopurinol (Zyloprim; Casper Pharma, LLC), Clofibrate (Atromid-S; Ayerst Laboratories), Cocaine, Warfin (Comadin), Heparin, Oral contraceptives and propylthiouracil.
  • Fever
  • Influenza
  • Lobar pneumonia
  • Pertussis
  • Red fever
  • Kovid-19

The most common cause of telogen influenza is called postpartum telogen gravidorum. According to Levit, about 1/3 to one-half of postpartum people experience mild to moderate hair loss without a doctor’s intervention within 6 to 18 months. However, he said, if hair loss continues for more than six months, it is considered chronic.

Women between the ages of 40 and 60 may have latent telogen fluids in the occlusal area and are as short as variability, normal vision density, and angina.

Recognizing the subtle differences in alopecia, he said, will help clinicians better diagnose and treat patients.

Adam Levit, MD, described Matt TL’s son Tricoscopy as an important diagnostic tool that helped him complete his presentation for the conference.

“Tricoscopy has become an important tool for the diagnosis of both scarring and non-scarred alopecia,” said Adam Levitt, a specialist in alopecia and hair restoration surgery, at Advanced Dermatology and Cosmetic Surgery, Orlando, Florida. “In many cases, trichoscopy can replace the need for a scalp biopsy, and trichoscopic findings are well established and protected regardless of gender, hair type, or race.”

He cited many examples of trichoshopic findings that can be used to diagnose different types of hair loss.

“The tricoscopic findings of androgenic alopecia have reduced the number of small follicles and the follicular unit,” he said. “Tricoscopic findings of alopecia areata include exaggerated hairs and peripheral yellow globes. Trichospecific findings for lycopene planophilaris and facial fibrosing alopecia include peripheral erythema, peripheral scales, and milk red / white areas. The central centrifugal cervical alpine tricoscopic findings include the peripheral gray-white halo. In Tina Capitis we can see cork hairs and broken hairs of different lengths in Tricotomymania.

For more coverage of PAs and NPs, visit the 2021 Fall Clinical Dermatology Conference Dermatology Times®.


Levit is on the advisory board for Eli Lily and the company and receives royalties from AZ Surgical.


Levit, M.L. Diagnosis and treatment approach for hair loss. 2021 Fall Clinical Dermatology Conference for PA & NPs; November 12-14, 2021 Orlando, Florida and Virtual.