Alopecia laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Ogechukwu Hannah Nnabude, MD

Some causes of alopecia may present with abnormal laboratory findings. For example, thyroid stimulating hormone levels may be elevated in hypothyroidism. In syphilis, patients may have an elevated rapid plasma reagin level. Hence, laboratory investigations may help narrow down the cause of alopecia.

The following laboratory tests can be completed in cases of a patient presenting with alopecia.

• Antinuclear antibodies (ANA) which would be elevated in autoimmune diseases such as systemic lupus erythematosus
• Dehydroepiandrosterone-sulfate (DHEA-S) ^[1]
• Erythrocyte sedimentation rate (ESR) which is an inflammatory marker ^[2]
• Iron studies ^[3]
• Prolactin ^[4]
• Rapid plasma reagin (RPR) which may be seen in syphilis ^[5]
• Testosterone
• Thyroid function tests which would be abnormal in hypothyroidism and hyperthyroidism ^[6]
• Viral and bacterial cultures

There are other tests available in cases in which there are other symptoms associated with alopecia.

• KOH prep if patchy alopecia with scaling or inflammation. This is used to investigate fungal causes of hair loss
• Medical illness suspected: CBC, TSH, possibly ferritin
• RPR if patchy or unexplained loss

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