Hair Loss (Alopecia): Medical History

Medical history (history of the patient) represents an important component in the diagnosis of alopecia (hair loss). Family history

• Are there clustered family members in your family who have hair loss?

Social history

• Is there any evidence of psychosocial stress or strain due to your family situation?

Current medical history/systemic history (somatic and psychological complaints).

• How long has the hair loss been present?
  • Slow and increasing?
  • Suddenly?
• Does the hair loss exist only on the head or does the entire body hair fall out?
• Is it circular hair loss or does the hair fall out diffusely?
• Do you have other symptoms such as dandruff or redness of the scalp?
• When, at what age, did you first notice hair loss?
• How do you care for your hair?

Vegetative anamnesis including nutritional anamnesis.

• Please tell us your body weight (in kg) and height (in cm).
• Have you lost weight?
• Do you eat a balanced diet?
• Do you smoke? If so, how many cigarettes, cigars or pipes per day?
• Do you use drugs? If yes, what drugs (amphetamines) and how often per day or per week?
• Woman: when did menopause begin?

Self history including medication history.

• Pre-existing conditions (autoimmune diseases; hormonal diseases).
• Operations
• Allergies

Medications that can cause hair loss; hair loss typically occurs 2 to 3 months after starting the medication

• ACE inhibitors (captopril, enalapril).
• Analgesics/antirheumatics – ibuprofen, naproxen, piroxicam.
• Anthelmintics (albendazole, mebendazole).
• Antiarrhythmic drugs – Amiodarone
• Antidepressants
  • Lithium (e.g., quoilinonum)
  • Selective serotonin reuptake inhibitors (SSRIs) – fluoxetine, sertraline.
  • Tetracyclic antidepressants
  • Tricyclic antidepressants (TCAs) – amitriptyline, desipramine, imipramine.
• Antiepileptic drugs – carbamazepine, gabapentin, valproate, valproic acid.
• Angiogenesis inhibitors (sorafenib, sunitinib).
• Anticoagulants
  • Coumarin derivatives – indandiones, phenprocoumon (product names: Marcumar, Falithrom), warfarin.
  • Heparin (enoxaparin)
  • Low-molecular-weight heparins (NMH) (certoparin, dalteparin, enoxaparin, nadroparin, reviparin, tinzaparin).
  • Synthetic. Heparin analogue (Fondaparinux).
• Antimalarials – e.g. chloroquine
• Antifungals
  • Azoles (voriconazole)
  • Triazole derivatives (fluconazole)
• Antipsychotics (neuroleptics) – haloperidol.
• Antiretroviral drugs – e.g., indinavir
• Beta-blockers – e.g., metoprolol, propranolol; also for topical beta-receptor blockers: pindolol.
• Biologicals (adalimumab)
• Coumarins
• Gout remedy – colchicine
• Guanethidine
• H2 blockers – e.g., ranitidine, cimetidine
• Heparin
• Hormones
  • Anabolic steroids
  • Androgens (testosterone, testosterone antate, testosterone undecanoate).
  • Progestins
  • Hormone antagonists
    • Aldosterone antagonists (e.g., spironolactone).
    • Aromatase inhibitors (anastrozole, testolactone) → alopecia androgenetica in women undergoing mammary carcinoma (breast cancer) therapy.
    • Estrogen antagonists (antiestrogens) – tamoxifen → alopecia androgenetica in women under breast carcinoma therapy.
    • Octreotide
    • Prolactin antagonist (bromocriptine)
    • Thyrostatic agents (carbimazole, propylthiouracil).
  • Estrogens
• Immunosuppressants
  • Azathioprine
  • Ciclosporin (cyclosporin A)
  • Interferons (Interferon-α)
• Immunotherapeutics (fingolimod).
• Lipid-lowering agents
  • Fibrates
  • HMG-CoA reductase inhibitors (statins) – atorvastatin, cerivastatin, fluvastatin, lovastatin, mevastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin.
  • Nicotinic acid
• Mesalazine
• Metals
  • Gold
  • Arsenic
• Metal binder – D-penicillamine (chelating agent).
• Monoclonal antibodies – pertuzumab
• Proton pump inhibitors (PPI; acid blockers) – esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole.
• Uricosurics (benzbromarone, probenecid).
• Antivirals
• Vitamins and their derivatives
  • Vitamin A
  • Vitamin A derivatives: retinoids (acitretin, isotretinoin).
• Cytostatics
  • Alkylants (busulfan* * , carmustine* , chlorambucil, cycophosphamide* * * , dacarbazine* , ifosfamide, melphalan* , procarbazine, thiotepa* ).
  • Anthracyclines (adriamycin* * * , daunorubicin* * * , daunorubicin, epirubicin).
  • Antimetabolites (cytarabine* , fluorouracil* , mercaptopurine* , methotrexate (MTX)* * ).
  • Mitomycins (Mitomycin C* * )
  • Platinum derivatives (carboplatin, cisplatin* , oxaliplatin).
  • Purine analogues (thioguanine* )
  • Taxanes (paclitaxel, taxoids* * * )
  • Topoisomerase inhibitors (mitoxanthrones).
  • Other cytostatic drugs (actinomycin* * , bleomycin* , camptothecin* * , capecitabine, cytarabine, estramustine, etoposide* * * , floxuridine* * , hexamethylmelamine* , Hydroxyurea* , Ifosfamide* * * , L-asparaginase* , Nitrogen mustard* * , Mitomycins, Streptozotocin* , Teniposide* * , Vincristine* * * , Vinblastine* * * , Vindesine* * * ).

* Mild alopecia* * Moderate alopecia* * * Strong alopecia.

X-rays

• Radiotherapy (radiotherapy, radiatio).

Environmental pollution – intoxications (poisonings).

• Air pollutants: particulate matter (PM10) and diesel exhaust (→ decrease in the concentration of the protein beta-catenin in hair follicles; beta-catenin is required for hair growth).