When a doctor is consulted by a patient, especially a younger one, complaining of the sudden loss of hair, the most important part of the examination is taking the history.

In a young person the likely cause of patchy hair loss is alopecia areata, trichotillomania or the fracture of the hair shafts such as may be caused by braiding that has resulted in the hair being pulled to such an extent that it breaks off. Trichotillomania is the name given to the compulsion to play with the hair, often involving twisting and pulling, to such an extent that it comes out in chunks. It is a variation of the damage that can be done to hair by an over-zealous hairdresser braiding hair.

Alopecia areata is the term used to describe patches of baldness that can affect the hair of the scalp, eyebrows, eyelashes or body hair. Any hair-bearing area can be affected by alopecia areata. It is often precipitated by stress but although the patient has no obvious other symptoms of skin or general disease, many doctors think that it is likely that the underlying cause is one of the autoimmune conditions. Complete recovery may occur and the prognosis is much better if the bald patches are confined to a smaller area. When it is severe and generalised, as in this case, the problem is less likely to clear up.

This would seem to be a classic case of severe alopecia areata. It could be that it was triggered by the stress of the hair braiding but it would not be the basic cause. This condition needs treatment with psychotherapy, sometimes helped by a mild anti-depressant.