What should you know about hair loss in different spots?

Several smooth patches may be a presentation of alopecia areata, while diffuse thinning across the scalp can follow a body stressor and fit telogen effluvium. Thinning concentrated at the temples, crown, or part can reflect androgenetic or female pattern hair loss. Scale and broken hairs raise concern for scalp ringworm. Loss along areas exposed to braids, extensions, buns, or other repeated tension may fit traction alopecia. The locations alone cannot tell which condition is present, and different causes can occur together.

Map the affected areas with photographs taken from the front, sides, and top, and record whether each spot is smooth, scaly, sore, or broken rather than shed from the root. Note recent fever or illness, stress, dietary restriction, medication changes, chemical treatments, and hairstyle tension. Use gentle care and pause tight styling. A clinician may use magnification, a hair-pull assessment, or targeted tests; share all products and medicines so the plan is safe and specific.

Arrange an appointment when patches continue to enlarge, new areas appear, or shedding interferes with daily life. Seek prompt care for pain, warmth, pus, marked scale, fever, or a rapidly inflamed scalp. New eyebrow or eyelash loss, nail changes, or shiny skin over a patch also warrant assessment because they may change the diagnostic approach.

What does the distribution suggest, and could more than one process be involved? Do the hairs show breakage or shedding? Which examination or tests are needed? How will we measure progress, and what should I stop using meanwhile?