Derm Cases · Dermatology / Trichology
OSCE — patterned hair loss: AGA diagnosis, minoxidil, finasteride teratogenicity
An 8-minute OSCE on androgenetic alopecia pattern diagnosis, trichoscopy anisotrichosis, male vs female therapy, and absolute avoidance of 5α-reductase inhibitors in pregnancy.
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Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE on androgenetic alopecia pattern diagnosis, trichoscopy anisotrichosis, male vs female therapy, and absolute avoidance of 5α-reductase inhibitors in pregnancy.
Brief (to candidate)
A 28-year-old man has progressive frontotemporal recession; a 32-year-old woman has crown widening with irregular menses and acne. You have 8 minutes to diagnose AGA, use trichoscopy, prescribe evidence-based therapy, and screen the woman for hyperandrogenism while protecting against teratogens.
Candidate instructions
- Diagnose male/female pattern AGA and list key differentials.
- Use trichoscopy: hair diameter diversity >20%, preserved ostia.
- Prescribe minoxidil (topical/oral concepts) and finasteride for appropriate males.
- Screen woman for PCOS/hyperandrogenism; choose anti-androgen options safely.
- State absolute teratogenicity of finasteride/dutasteride.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Pattern recognition | Male Hamilton–Norwood frontotemporal/vertex; female Ludwig/Sinclair crown widening with frontal fringe often preserved; gradual onset months–years[2] |
| Trichoscopy | Anisotrichosis / hair diameter diversity >20%, miniaturisation, preserved follicular ostia (non-scarring)[2] |
| Male therapy | Topical minoxidil 5%; oral finasteride 1 mg daily (or dutasteride in selected refractory); counsel sexual/side-effect and lifelong need; LDOM emerging option under specialist shared care[1][5][6] |
| Female pathway | Topical minoxidil first-line; investigate irregular menses/acne/hirsutism for PCOS; anti-androgens (e.g. spironolactone) when appropriate; never finasteride/dutasteride in pregnancy or unprotected childbearing potential[1][3] |
| Differentials | Telogen effluvium (diffuse, trigger, uniform shafts), AA (patchy), scarring alopecia (lost ostia), traction, nutritional/thyroid/iron |
| Expectations | Stabilisation/regrowth over 6–12 months; stop → lose gains; transplant only stable donor/recipient planning |
| Safety | Minoxidil hypertrichosis/shedding initial; finasteride PSA effect/sexual side effects counselling; blood pressure if oral minoxidil |
Model key actions
- Confirm non-scarring pattern loss with anisotrichosis on trichoscopy.[2]
- Male: minoxidil ± finasteride 1 mg; female: minoxidil ± anti-androgen after endocrine screen.[1][5]
- Contraindicate 5α-reductase inhibitors in pregnancy risk.
Common errors
- Prescribing finasteride to a woman planning pregnancy.
- Missing PCOS screen in hyperandrogenic female AGA.
- Diagnosing scarring alopecia without trichoscopy of ostia.
- Promising permanent cure after short minoxidil course.
References5ShowHide
- [1]Devjani S, et al. Androgenetic Alopecia: Therapy Update. Drugs, 2023.PMID 37166619
- [2]Oiwoh SO, Enitan AO, Adegbosin OT, et al. Androgenetic Alopecia: A Review. Skin Appendage Disord, 2024.PMID 38826011
- [3]Nestor MS, et al. Treatment options for androgenetic alopecia: Efficacy, side effects, compliance. J Cosmet Dermatol, 2021.PMID 34741573
- [5]Gupta AK, et al. Comparison of oral minoxidil, finasteride, and dutasteride for treating androgenetic alopecia. J Dermatolog Treat, 2022.PMID 35920739
- [6]Gupta AK, et al. Minoxidil: a comprehensive review. J Dermatolog Treat, 2022.PMID 34159872