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JAMA Insights
Clinical Update
March 2, 2021

Diagnosis and Treatment of Nonscarring Hair Loss in Primary Care in 2021

Author Affiliations
  • 1Department of Dermatology, University of California, San Francisco
  • 2Department of Dermatology, The Permanente Medical Group, Vallejo, California
  • 3Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
JAMA. 2021;325(9):878-879. doi:10.1001/jama.2020.19313

The first step in diagnosing hair loss (alopecia) is to determine whether the process is nonscarring or scarring. This review focuses on nonscarring alopecia, the category of hair loss most frequently encountered in primary care. Scarring alopecia, characterized by permanent destruction of follicular structures, presents with pruritus, pain, erythema, scale, and/or crust and obliteration of follicular pore markings leading to an abnormally smooth appearance of the skin. These patients may require scalp biopsy for diagnosis and referral for specialty care. Once hair loss has been categorized as nonscarring, the next step is to determine the distribution of loss on the scalp as patterned, diffuse, or focal (Figure). Diagnosis and management of the most common nonscarring disorders in each of these categories will be discussed.