Nield et al listed criteria for when to refer a pediatric patient with alopecia to a dermatologist. The authors are from West Virginia University, University of Miami, Wayne State University and Children's Hospital of Michigan.
General indications to refer to a dermatologist:
(1) significant doubt or uncertainty about the diagnosis
(2) failure to respond as expected to therapy (treatment failure)
(3) need for scalp biopsy
(4) considering a therapy with a potential for significant complications, especially if unfamiliar with it
Alopecia-specific reasons to refer:
(1) tinea capitis with severe inflammation and/or kerion
(2) alopecia areata universalis or totalis
(3) telogen effluvium lasting more than 4 months
(4) scarring alopecia
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