OSCE — Alopecia & Hair Disorders

Brief (to candidate)

You will assess a patient with a presentation consistent with Alopecia & Hair Disorders.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Hair loss (alopecia) is the single most psychologically charged dermatological presentation. The pivotal skill is the scarring vs non-scarring distinction: non-scarring (reversible — androgenetic, alopecia areata, telogen effluvium, anagen effluvium, traction, trichotillomania, tinea capitis) preserves the follicle and is potentially recoverable, whereas scarring (cicatricial) (lichen planopilaris, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, discoid lupus, folliculitis decalvans, pseudopelade) destroys follicular stem cells and is permanent and irreversible. Androgenetic alopecia (miniaturisation by dihydrotestosterone via 5-alpha-reductase type II) is graded by the Hamilton-Norwood scale in men and the Ludwig scale in women.

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]