Hair: There are several concerns that might come up with hair in teens. One that is not uncommon and requires a good history is demonstrated by the following case.
A teen comes in complaining of hair loss. He denies any current symptoms and is feeling well. Your examination is completely negative and fails to show any focal signs and his hair appears normal. What is the important history to take from this teen.
The important information is the history of medical problems 6 weeks or several months before. This teen may likely have telogen effluvium (hair loss of telogen phase). Hair is divided between growing anagen hair and telogen (resting hair) (see diagram below). After the telogen phase, the hair falls out. If a teen has a major intercurrent health issue such as hepatitis, mono, acute HIV infection, pregnancy, many of the teen's hairs may go into the telogen phase. This does not cause a problem. However, when the teen recovers, hair starts to grow and the telogen hair is pushed out. The teen may describe that he wakes up and there is a lot of hair on his/her pillow or that s/he notices a lot of hair in the shower. This condition resolves over several months or occasionally longer as the telogen hair is replaced. If one gently pulls on a group of hair (hair pluck test), one usually gets about 0-3 hairs. In these individuals, one may get 5-10 hairs or more.
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Another problem that occurs is hair loss in a patch or alopecia areata.
Above are two examples of alopecia areata. One also has to consider local scalp disease such as a fungal infection or a possible collagen vascular disease. Lupus may present with alopecia.
The teen on the right has several bad prognostic signs. He has hair loss in band like distribution and by history he had this hair loss several years before, recovered and then the condition returned.
This teen also had some other signs that suggest idiopathic or immune alopecia. The first is the "exclamation point" hairs on the edge of the area of alopecia seen below.
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The second finding suggesting immune alopecia is the #12 unknown and the second condition with pitting of the nails. This is an example of the nails found in this teen.
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Some teens may have total hair loss on their head, alopecia totalis or total body hair loss, alopecia universalis. In these conditions it is important to not only check for a collagen vascular disease but to be aware that this may be associated with other immune processes such as thyroid disease, Addison's disease, pernicious anemia and diabetes mellitus.
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