DDx
Diagnostic Considerations
Also consider the following:
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Lichen planopilaris
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Traction alopecia
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Hypothyroidism
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Hyperthyroidism
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Iron deficiency anemia
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Medication-induced hair loss (most commonly from chemotherapeutic agents, gout medications, vitamin A, oral contraceptives, and antidepressants)
A strongly positive and painless hair-pull test may represent alopecia areata or loose anagen hair syndrome, the latter diagnosed with a hair mount of the proximal ends of extracted hair, not cut hair, demonstrating misshapen anagen hair bulbs, absent inner root sheath, and the cuticle distal to the bulbs resembling a fallen sock. [21] Normal values for the hair pull test have been suggested as two or fewer hairs. [22]
Loose anagen hair may occasionally be seen with other ectodermal or developmental anomalies. [23]
Differential Diagnoses
Media Gallery
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Thinning, dull, lackluster blonde hair with matting over the occipital region.
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Microscopic view of easily plucked hair demonstrating a distorted anagen bulb lacking inner and outer root sheaths, and a ruffled, sawtooth, baggy-stocking appearance of the cuticle (original magnification X100).
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