Nursing Guide to Alopecia: Nursing Diagnosis, Interventions, & Care Plans

Alopecia is the medical term for hair loss, which can affect the scalp or other areas of the body. It may be temporary or permanent, depending on the cause.  

Alopecia can manifest in various forms, including alopecia areata (autoimmune-related), androgenetic alopecia (genetic hair loss), and traction alopecia (due to repetitive tension on hair). Though alopecia is not life-threatening, it can have significant psychological impacts due to changes in appearance. 

Etiology and epidemiology 

Alopecia can be caused by a variety of factors, including genetics, autoimmune disorders, hormonal imbalances, infections, medications, or mechanical trauma to hair follicles. The most common forms are: 

• Androgenetic alopecia (male or female pattern baldness) is the most prevalent, affecting up to 50% of men and women by age 50.
• Alopecia areata is an autoimmune disorder affecting approximately 2% of the population at some point in their lifetime.
• Other forms include traction alopecia, telogen effluvium (temporary hair shedding), and scarring alopecia (permanent hair loss due to skin conditions). 

Alopecia can occur at any age, but androgenetic alopecia typically begins after puberty, while alopecia areata can develop suddenly at any age. 

Alopecia ICD-10 code 

• L63.9: Alopecia areata, unspecified
• L64.9: Androgenic alopecia, unspecified
• L65.9: Nonscarring hair loss, unspecified 

Source: ICD10data.com (https://www.icd10data.com/ICD10CM/Codes/L00-L99/L60-L75/L66-/L66.9) 

Alopecia Diagnosis 

Diagnosis of alopecia is based on medical history, clinical examination, and sometimes additional tests: 

• Medical history: Includes a review of family history, recent illnesses, medications, stress, and cosmetic practices (e.g., hair styling, chemical treatments).
• Physical examination: Focuses on the scalp and pattern of hair loss. Common signs include hair thinning, patchy bald spots, or hair shedding.
• Laboratory tests: These may be ordered to rule out systemic conditions such as thyroid disease, iron deficiency, or autoimmune disorders. Tests may include complete blood count (CBC), thyroid function tests, and ferritin levels.
• Biopsy: In certain cases, a scalp biopsy may be performed to confirm or differentiate between types of alopecia, especially scarring forms.
• Trichoscopy: A non-invasive procedure using a dermoscope to magnify hair and scalp structures for detailed examination. 

Management 

Treatment for alopecia depends on the underlying cause and the type of alopecia: 

Medications: 

• Topical treatments: Minoxidil (Rogaine) is used for androgenetic alopecia to stimulate hair regrowth.
• Oral medications: Finasteride (Propecia) or spironolactone are prescribed for androgenetic alopecia to reduce hair loss by inhibiting androgen effects.
• Corticosteroids: Topical or intralesional injections are used to treat autoimmune alopecia areata.
• Immunosuppressants: Methotrexate or biologic agents can be used in severe alopecia areata cases.
• Platelet-rich plasma (PRP) therapy: Involves injecting concentrated platelets into the scalp to stimulate hair growth.
• Surgical options: Hair transplantation may be considered for patients with permanent alopecia.
• Wigs or hairpieces: Used for cosmetic purposes when medical treatments are ineffective or not desired. 

Alopecia nursing care plan 

Nursing considerations 

Nurses play a vital role in educating and supporting patients with alopecia. Psychological effects, including depression and anxiety related to hair loss, should be addressed alongside medical management. 

Assessment 

• Assess the patient's hair loss pattern, scalp condition, and any associated symptoms such as itching, burning, or inflammation. 
• Take a detailed history of hair care practices, medications, and any recent illnesses or life changes (e.g., stress, weight loss). 
• Evaluate the patient’s emotional well-being, body image, and coping strategies. 

Nursing diagnosis/risk for 

• Disturbed body image related to visible hair loss and changes in appearance. 
• Risk for ineffective coping due to the emotional and social impacts of alopecia. 
• Risk for impaired skin integrity related to scalp irritation from treatments or traction alopecia. 

Interventions 

• Educate the patient about treatment options, including realistic expectations for outcomes and potential side effects. 
• Offer emotional support and refer patients to counseling or support groups if needed. 
• Provide guidance on protective hair care practices, such as avoiding excessive heat, tight hairstyles, and harsh chemicals. 
• For patients using medications like minoxidil, teach correct application techniques and monitor for adverse reactions. 
• Encourage the use of scarves, hats, or wigs if desired, and assist in exploring resources for obtaining high-quality hairpieces. 

Expected outcomes 

• Patient will demonstrate understanding of alopecia and its management 
• Patient will develop coping strategies to address the psychological effects of hair loss 
• Hair loss will be reduced or stabilized based on the treatment regimen 
• Patient will maintain scalp integrity and follow hair care recommendations 

Individual/caregiver education 

• Explain the natural hair growth cycle and why hair shedding occurs in conditions like telogen effluvium. 
• Discuss the importance of medication adherence and the timeframe for visible results (e.g., minoxidil may take 4-6 months for improvement). 
• Inform patients that some types of alopecia, such as androgenetic alopecia, may require ongoing treatment to prevent further hair loss. 
• Encourage healthy lifestyle practices that support hair health, including a balanced diet, stress management, and good scalp care. 
• Instruct caregivers on how to provide emotional support to individuals struggling with alopecia’s psychological impact. 

References 

1. National Alopecia Areata Foundation: https://www.naaf.org/ 
2. American Academy of Dermatology: https://www.aad.org/ 
3. Alopecia - StatPearls - NCBI Bookshelf (nih.gov) 

Resources 

• National Alopecia Areata Foundation: Provides support and information on alopecia areata. Website: https://www.naaf.org/ 
• American Academy of Dermatology: Offers resources on hair loss and treatment options. Website: https://www.aad.org/ 
• Alopecia UK: A charity offering support and resources for individuals living with alopecia. Website: https://www.alopecia.org.uk/