Synopsis
Distinguish patterned follicular miniaturisation from reactive diffuse shedding, investigate only supported causes, and counsel accurately on minoxidil, finasteride, recovery times and safety.
- Androgenetic alopecia is gradual patterned miniaturisation: frontal and vertex recession is typical in male-pattern loss, while female-pattern loss often widens the central part with relative frontal-hairline preservation.
- Telogen effluvium is diffuse shedding after many follicles synchronously enter rest, often two to three months after fever, surgery, childbirth, major psychological stress, dietary restriction or a medicine change.
- Pattern loss and telogen effluvium can coexist; a shedding episode may reveal previously subtle miniaturisation rather than creating permanent follicle destruction.
Key red flags
Loss of follicular openings, scalp pain or scale, pustules, rapid virilisation, a scalp mass, systemic illness, profound nutritional compromise or hair loss in a child requires an alternative and sometimes urgent specialist pathway.
Smooth patches, broken hairs of uneven length, perifollicular scale, pustules or missing openings require alopecia areata, trauma, fungus or scar assessment.
Investigation priorities
Identify distribution, shaft miniaturisation, regrowth and inflammatory or scarring signs.
Management branches
Hair is shedding from the whole scalp without obvious scar or focal inflammation.
- Map onset against illness, operation, childbirth, medicines, menstruation, dietary restriction and psychological stress during the preceding two to four months.
- Examine for patterned miniaturisation and regrowth, then request full blood count, ferritin, thyroid or other tests only where history creates a plausible corrective action.