Hair loss: A systematic approach to evaluation, diagnosis, and management.

Clay W Walker, Daniel Champigny, Thomas Hartman, Brittney Hulsey, Cambrei Hoffart

Journal: JAAPA : official journal of the American Academy of Physician Assistants 2026;39(9):27-34

PMID: 42647672

Abstract

Hair loss (alopecia) is a common presentation in both primary care and dermatology. It often signals underlying inflammation or abnormalities in hair cycling or hair shaft structure, requiring a thorough and systematic evaluation. Clinical guidelines emphasize pattern recognition, trigger identification, and targeted interventions. This article equips physician associates (PAs) with an evidence-based approach to assessing patient history, conducting physical examinations, selecting appropriate diagnostics, and implementing treatment strategies for alopecia. History and scalp inspection guide diagnosis, with the differential including such conditions as telogen effluvium (diffuse), alopecia areata (focal), and androgenetic alopecia (patterned). Recommended laboratory tests include thyroid-stimulating hormone, complete blood cell count, and iron studies, while scalp biopsy is used to confirm scarring. Treatments address causes, with avoidance of triggers central to effluvium, intralesional steroids or baricitinib for alopecia areata, minoxidil-based therapy for androgenetic alopecia, and antifungals for tinea capitis. By integrating trichoscopy, selective testing, and etiology-specific care, PAs can enhance diagnostic accuracy and optimize outcomes for patients with hair loss.

Address: Clay W. Walker is an assistant professor of PA studies and director of didactic education in the PA program at A.T. Still University in Mesa, AZ, and an assistant professor of family medicine at Mayo Clinic in Phoenix, AZ. Daniel Champigny is director of student affairs and academic success in the Department of Physician Assistant Studies at Frostburg State University in Hagerstown, MD, as well as a PA in urgent care for Penn State Health in Mechanicsburg, PA. Thomas Hartman is an assistant professor in the Department of Physician Assistant Studies and director of student progression and retention for the PA program at A.T. Still University. Brittney Hulsey is an associate professor of PA studies and director of the PA program at A.T. Still University, as well as a PA in family medicine at Village Medical in Phoenix, AZ. Cambrei Hoffart is a student in the PA program at A.T. Still University. C. Walker discloses service as an external clinical expert on the GlaxoSmithKline UTI Consultancy Panel and service as a medical consultant and advisor for Cosmas Health's Pyrls. The authors have disclosed no other potential conflicts of interest, financial or otherwise.

DOI: 10.1097/01.JAA.0000000000000405

MeSH Terms: Humans, Alopecia, Diagnosis, Differential, Minoxidil, Alopecia Areata, Biopsy, Physical Examination, Scalp, Practice Guidelines as Topic, Antifungal Agents, Primary Health Care