The Curbsiders Internal Medicine Podcast #492 Hair and Nails with Helena Pasieka MD MS
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Jul 21, 2025 
Helena Pasieka, a dual board certified internist and dermatologist specializing in complex dermatology, shares valuable insights on hair and nail health. She discusses the psychosocial impact of hair loss, emphasizing compassionate communication and effective coping strategies. The conversation covers assessment methods, treatment options for conditions like alopecia and psoriasis, and highlights the importance of cultural practices in hair care. Helena also sheds light on common myths and the emotional toll of hair loss, promoting individualized patient counseling.
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Thoughtful Hair Exam Approach
- Start hair assessment with a handshake and examine nails for pitting or ridging.
- Ask permission before examining scalp and consider cultural hair practices and patient comfort.
Key History Points for Hair Loss
- Distinguish between hair shedding from root versus hair breakage or fragility.
- Focus history on diet, hormonal changes, stress, and styling practices to guide diagnosis of hair loss.
Essentials of Hair Loss Testing
- Order CBC with ferritin and vitamin D to evaluate hair loss causes.
- Avoid ANA testing as initial screen due to low yield and false positives.