Vol. 7, Issue 1, Part A (2025)

Hair loss is one of the most prevalent dermatological conditions encountered in clinical practice, with significant implications for patients' psychological well-being, self-esteem, and overall quality of life. Despite its non-life-threatening nature, alopecia can lead to considerable distress, particularly when it affects visible areas such as the scalp. Non-scarring alopecia, which includes androgenetic alopecia, telogen effluvium, alopecia areata, and anagen effluvium, accounts for the majority of cases seen in outpatient settings.
Accurate diagnosis is a key factor in determining a successful hair loss management strategy. Misclassification of alopecias can lead to the wrong treatment being applied which can result in less than optimal outcome for the patient and potential dissatisfaction. Therefore a full range of clinical assessment, dermoscopy, laboratory testing, and histopathological evaluation will assist in determining the underlying cause and appropriate therapy. 
This prospective observational study examined the clinical features, hormonal profiles and associated conditions, histopathological findings and response to treatment in 200 adult patients with non-scarring alopecia. Each patient was followed for six months and received standardized treatment protocols based on the type of alopecia.
There were two treatment groups, Group a received monotherapy only with topical minoxidil 5% and Group B received combination therapy based on each alopecia subtype. For androgenetic alopecia oral finasteride was used, intralesional corticosteroids were for alopecia areata, and the PRP was available as an adjunctive treatment for all types of alopecia.
The long-term results from the severity of alopecia tool (SALT) used to evaluate disease severity and monitor treatment response demonstrated that accurate classification improved treatment efficacy. In all cases the improvement in SALT scores was significantly greater for patients who are managed within a combination therapy approach than those who received minoxidil only. The histopathological evaluation also provided strong evidence of the very obvious features required for diagnosis including, but not limited to, miniaturization of the hair in androgenetic alopecia and lymphocytic infiltration of the peri-follicles in alopecia areata. 
The implications of this report show the necessity for a systematic and individualized diagnostic and management approach to non-scarring alopecia. The amalgamation of clinical, laboratory and pathology evaluations can lead to more accurate diagnoses and assist in targeted and effective treatment planning, as well as significantly improve patient and clinician reported outcomes.