Please see guidelines on: http://www.pcds.org.uk/clinical-guidance/alopecia-an-overview
- Look for evidence of perifollicular inflammation + scarring e.g. shiny, smooth scalp with loss of follicular ostia.
- Refer routinely having organized FBC, UE, LFT, ferritin, TFT, ANA please
- Blood screen in primary care: FBC, UE, LFT, ferritin, TFT, ANA (ferritin and ANA depending on clinical judgement)
- If small patches advise spontaneous remission in up to 80% of people within 1 year and even those with under 50% hair loss can be advised simple watchful waiting.
- TOPICAL STEROIDS – those small patches can be offered a limited trial of super potent topical steroid (e.g. dermovate for up to 3/12 to small patches with 6/52 on, then break for 5/7). Avoid hairline/face areas. Larger areas can use a less potent topical steroid.
- Dermatologists can trial intralesional steroids for smaller patches. However, benefit is only demonstrated in 1 in 4 patients and does not prevent new patches developing.
Referrals for physiological androgenic alopecia are not routinely funded
Please refer the patient via the Advice and Guidance service and the dermatologists will refer to the wig service from there.