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Tips for Treating Hair Loss, With Luiza Kalil, MD
At New Wave Derm 2025, Kalil shared expert tips on evaluating and diagnosing scarring vs non-scarring hair loss using clinical tools.
HCPLive spoke with Luiza Kalil, MD, assistant professor at Yale School of Medicine at the 2025 New Wave Dermatology meeting in Aventura, Florida, on May 16, 2025, regarding her session, “The Experts Guide to Hair Loss.”
In her presentation, she discussed how to systematically evaluate patients with hair loss using clinical examination and tracheoscopy, when to use laboratory tests to differentiate various types of hair loss, and how to distinguish between scarring and non-scarring alopecia.
“[A] hair loss appointment [is] sometimes different from the general dermatology appointment,” Kalil told HCPLive. “We use [hair loss appointments] because it takes longer…you have to be really meticulous when you're talking to your patient regarding the clinical history and their hair evaluation. It’s really helpful if you have the medical history, a family history, and then you do the trichoscopy and… making sure you're diagnosing scarring or non-scarring.”
Hair loss can be scarring (lichen planopilaris, frontal fibrosing alopecia) or non-scarring (telogen effluvium, androgenetic alopecia, and alopecia areata). Kalil explained that there is no standardization when it comes to using laboratory tests to differentiate different types of hair loss.
“I usually do [lab tests] when I need to check if the patient has any nutritional deficiencies,” Kalil said.
In laboratory tests, dermatologists could look for CBC, CMP, TSH, iron and ferritin, 25-hydroxyvitamin D, Zinc and B12, ANA, hemoglobin A1C, immunoglobulin E, and TB screening plus hepatitis/HIV if considering a JAK inhibitor. If there are hyperandrogenism signs, patients could get lab tests for SDHEA and testosterone.
Dermatologists should evaluate hair loss by asking patients about their hair loss duration and rate of progression, symptoms, hair care practices, medical history, and family history. They should also assess the location, pattern, and extent of hair loss.
Some of Kalil’s patients hope vitamin supplements will help with hair loss, though the cause may be unrelated. Still, checking for vitamin deficiency can be a helpful step.
Hair loss can progress from catagen, telogen, and exgoen. A shift from catagen to telogen could be caused by a fever, drugs, surgery, stress, nutritional deficiencies, diet and weight loss, thyroid deregulations, systemic lupus, COVID-19, and scalp diseases.
The telogen category, defined by shedding, reduction in scalp hair density, and no scale, inflammation, pustules, or scarring, can be identified by the hair pull test with > 5 hairs in a single pull or > 15 in 3 pulls. Helpful vitamins may be vitamin D, zinc, biotin, and vitamin B12; they may also have too much vitamin A and selenium.
Kalil said that a patient might need a biopsy—1 vertical and 1 with transverse sections— if she wants to confirm the diagnosis or look for scarring. Biopsies should take place at the peripheral margin of the alopecia area, which is active and with hair.
Dermatologists can identify non-scarring hair loss by specific tracheoscopy features. For instance, alopecia areata features constrictions of broken hairs, black dots and exclamation marks, and yellow dots. AgA features hair diameter diversity and miniaturized hair. Telogen effluvium features short regrowing hairs.
The absence of follicular ostia indicates scarring. Lichen planopilaris features perifollicular scaling, perifollicular erythema, and blue-gray dots. Frontal fibrosing alopecia features perifollicular scaling, perifollicular erythema, and loss of vellus hairs.
“There are a lot of different research coming, and it's really exciting because [there is] a lot of new data for scarring alopecia and also [for] scarring alopecia,” Kalil said, “It’s really good [for hair loss treatment] because there are so much going on, but we really need to make sure we are doing the best for our patients. So read about safety data and read about efficacy before [starting] to do anything.”
Kalil has no relevant disclosures.
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