Hair Loss: Diagnostic Strategies Rooted in Empathy

At Dermatology Week APP Day 2025, Dr Arash Mostaghimi took attendees on a diagnostic deep dive into hair loss disorders—an often frustrating and emotional concern for patients and providers alike—in his session, “Evaluating Hair Loss with a Diagnostic Lens.”

“Diagnosis,” he said, “is figuring things out and making people know that you care.”

This message echoed through the entire presentation, where Dr Mostaghimi emphasized a systematic yet deeply empathetic approach. From start to finish, the framework was clear: Look, listen, and never assume.

The foundation? Five diagnostic pillars: the scalp, the hair, the pattern, the history, and non-scalp hair. “Healthy hair starts at the root,” he reminded attendees, urging clinicians to get hands-on and always examine beyond the hairline, including eyebrows, eyelashes, and beard and body hair.

Dermatologic humility was another key theme. “Leave assumptions at the door,” he said, noting that many patients carry incorrect past diagnoses or were never truly examined. He urged providers to reevaluate prior treatments. “You’ll have a patient tell you, ‘Minoxidil didn’t work,’ and when you dig into it, they tried it for 3 weeks and stopped.”

Scalp inflammation, pattern misinterpretation, and overlapping diagnoses are frequent pitfalls. Psoriasis and lichen planopilaris, for instance, may masquerade as non-scarring alopecias. “When you see one diagnosis, put it aside and ask: Is there another?”

As for labs and biopsies? Be strategic. “Avoid ANA or an autoimmune workup unless you have a clear reason,” he said. Instead, biopsies can be more helpful, especially when the clinical picture is mixed or the treatment plan long term.

Finally, when it comes to treatment, set realistic expectations. “Hair is always slow,” he said. “Use real dates. Say, ‘We’ll know by Easter if it’s working.’ That timeline grounds people.” And above all, listen: “Connect the treatments with the underlying biology and the patient’s desires.”

For more meeting coverage, visit the Dermatology Week APP Day newsroom.

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Reference
Mostaghimi A. Evaluating hair loss with a diagnostic lens. Presented at: Dermatology Week; October 22–25, 2025; Virtual.