I have the “S1 guideline for diagnostic evaluation in androgenetic alopecia (2010)†in my signature under the folder “Androgenetic Alopeciaâ€
These are some of the things in it that may be helpful to you.
diffuse effluvium can be a result of severe infection, iron deficiency, thyroid dysfunction, drugs, chronic deficient diet or rapid significant weight loss.
smoking and ultraviolet radiation (UVR) exposure in the history of the patient – both these can accelerate Androgenetic Alopecia
Nail check
Nail abnormalities are not typical for Androgenetic Alopecia, but occur in alopecia areata, certain deficiencies and lichen planus.
Pull test
The pull test is an examination that is easy to perform and to repeat, to roughly judge active hair shedding. Briefly, 50– 60 hairs are grasped by thumb, index and middle fingers. While the hairs are tugged away, the fingers slide along the hair shaft. The pull test is positive when more than 10% of the grasped hair can be pulled out
In patients with Androgenetic Alopecia the pull test is positive only in the active phase with increased telogen hairs in the affected area.
A diffuse positive pull test requires further diagnostic tests to exclude diffuse telogen effluvium.
The pull test is usually negative in Androgenetic Alopecia, except in active periods when there can be a moderate telogen hair shedding in a pattern distribution.
However, even with a diffusely positive pull test such as in telogen effluvium or diffuse alopecia areata, underlying Androgenetic Alopecia may be present.
The hair loss may be described as chronic, but the patients often report increased activity in autumn and winter.
In Androgenetic Alopecia increased hair diameter diversity and an increased number of vellus hairs can be seen. Less common are peripilar signs, reflecting the presence of perifollicular infiltrates, and yellow dots more prevalent in alopecia areata.
