Hair Loss

Signs and symptoms Hair Loss Diagnosis
Hair Loss Causes Hair Loss Tretment
When to seek Medical Advice Hair Loss Prevention
Coping Skills

Your hair loss may have started with a few extra hairs in the sink or in your comb. But now you can’t look in the mirror without seeing more of your scalp.

Baldness typically refers to excessive hair loss from your scalp and can be the result of heredity, certain medications or an underlying medical condition. Anyone — men, women and children — can experience hair loss.

Some people prefer to let their baldness run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the medications and surgical procedures that are available to treat hair loss. Before pursuing any of these treatment options, talk with your doctor about the cause of and best possible treatments for your hair loss.

Signs and symptoms

The medical term for hair loss is alopecia. Pattern baldness (androgenetic alopecia), the most common type of alopecia, affects roughly one-third of men and women. It’s typically permanent. Other types of alopecia are temporary, including alopecia areata. It can involve hair loss on your scalp or other parts of your body.

Permanent hair loss

  • Male-pattern baldness (androgenetic alopecia). For men, pattern baldness can begin very early, even in the teens or early 20s. It’s typically characterized by a receding hairline at the temples and balding at the top of the head. The end result may be partial or complete baldness.
  • Female-pattern baldness (androgenetic alopecia). Women with permanent hair loss usually have hair loss limited to thinning at the front, sides or crown. Women usually maintain their frontal hairline and rarely experience complete baldness.
  • Cicatricial (scarring) alopecia. This rare condition occurs when inflammation damages and scars the hair follicle, causing permanent hair loss. Sometimes the patchy hair loss is associated with slight itching or pain.

Temporary hair loss

  • Alopecia areata. Hair loss usually occurs in small, round, smooth patches about the size of a quarter. Usually the disease doesn’t extend beyond a few bare patches on the scalp, but it can cause patchy hair loss on any area that has hair, including eyebrows, eyelashes and beard. In rare cases, it can progress to cause hair loss over the entire body. If the hair loss includes your entire scalp, the condition is called alopecia totalis. If it involves your whole body, it’s called alopecia universalis. Soreness and itching may precede the hair loss.
  • Telogen effluvium. This type of temporary hair loss occurs suddenly. Handfuls of hair may come out when combing or washing your hair or may fall out after gentle tugging. This type of hair loss usually causes overall hair thinning and not bald patches.
  • Traction alopecia. Bald patches can occur if you regularly wear certain hairstyles, such as pigtails, braids or cornrows, or if you use tight rollers. Hair loss typically occurs between the rows or at the part where hair is pulled tightly.

Causes

Your hair goes through a cycle of growth and rest. The course of each cycle varies by individual. But in general, the growth phase of scalp hair, known as anagen, typically lasts two to three years. During this time, your hair grows about 1 centimeter (just less than 1/2 inch) a month. The resting phase is called telogen. This phase typically lasts three to four months. At the end of the resting phase, the hair strand falls out and a new one begins to grow in its place. Once a hair is shed, the growth stage begins again.

Most people normally shed 50 to 100 hairs a day. But with about 100,000 hairs in the scalp, this amount of hair loss shouldn’t cause noticeable thinning of the scalp hair.

Gradual thinning is a normal part of aging. However, hair loss may lead to baldness when the rate of shedding exceeds the rate of regrowth, when new hair is thinner than the hair shed or when hair comes out in patches.

Causes of specific types of hair loss

  • Pattern baldness (androgenetic alopecia). In male- and female-pattern baldness, the time of growth shortens, and the hairs are not as thick or sturdy. With each growth cycle, the hairs become rooted more superficially and more easily fall out. Heredity likely plays a key role. A history of androgenetic alopecia on either side of your family increases your risk of balding. Heredity also affects the age at which you begin to lose hair and the developmental speed, pattern and extent of your baldness.
  • Cicatricial (scarring) alopecia. This type of permanent hair loss occurs when inflammation damages and scars the hair follicle. This prevents new hair from growing. This condition can be seen in several skin conditions, including lupus erythematosus or lichen planus. It’s not known what triggers or causes this inflammation.
  • Alopecia areata. This is classified as an autoimmune disease, but the cause is unknown. People who develop alopecia areata are generally in good health. A few people may have other autoimmune disorders including thyroid disease. Some scientists believe that some people are genetically predisposed to develop alopecia areata and that a trigger, such as a virus or something else in the environment, sets off the condition. A family history of alopecia areata makes you more likely to develop it. With alopecia areata, your hair generally grows back, but you may lose and regrow your hair a number of times.
  • Telogen effluvium. This type of hair loss is usually due to a change in your normal hair cycle. It may occur when some type of shock to your system — emotional or physical — causes hair roots to be pushed prematurely into the resting state. The affected growing hairs from these hair roots fall out. In a month or two, the hair follicles become active again and new hair starts to grow. Telogen effluvium may follow emotional distress, such as a death in the family, or after a physiological stress, such as a high fever, sudden or excessive weight loss, nutritional deficiencies, surgery, or metabolic disturbances. Hair typically grows back once the condition that caused it corrects itself, but it usually take months.
  • Traction alopecia. Excessive hairstyling or hairstyles that pull your hair too tightly cause traction alopecia. If the pulling is stopped before there’s scarring of your scalp and permanent damage to the root, hair usually grows back normally.

Other causes of hair loss

  • Poor nutrition. Having inadequate protein or iron in your diet or poor nourishment in other ways can cause you to experience hair loss. Fad diets, crash diets and certain illnesses, such as eating disorders, can cause poor nutrition.
  • Medications. Certain drugs used to treat gout, arthritis, depression, heart problems and high blood pressure may cause hair loss in some people. Taking birth control pills also may result in hair loss for some women.
  • Disease. Diabetes and lupus can cause hair loss.
  • Medical treatments. Undergoing chemotherapy or radiation therapy may cause you to develop alopecia. Under these conditions, healthy, growing (anagen) hairs can be affected. After your treatment ends, your hair typically begins to regrow.
  • Hormonal changes. Hormonal changes and imbalances can cause temporary hair loss. This could be due to pregnancy, having a baby, discontinuing birth control pills, beginning menopause, or an overactive or underactive thyroid gland. The hair loss may be delayed by three months following a hormonal change, and it’ll take another three months for new hair to grow back. During pregnancy, it’s normal to have thicker, more luxuriant hair. It’s also common to lose more hair than normal about three months after delivery. If a hormonal imbalance is associated with an overproduction of testosterone, there may be a thinning of hair over the crown of the scalp. Correcting hormonal imbalances may stop hair loss.
  • Hair treatments. Chemicals used for dying, tinting, bleaching, straightening or permanent waves can cause hair to become damaged and break off if they are overused or used incorrectly. Overstyling and excessive brushing also can cause hair to fall out if the hair shaft becomes damaged.
  • Scalp infection. Infections, such as ringworm, can invade the hair and skin of your scalp, leading to hair loss. Once infections are treated, hair generally grows back. Ringworm, a fungal infection, can usually be treated with a topical or oral antifungal medication.
  • Trichotillomania (hair-pulling disorder). Trichotillomania is a type of mental illness in which people have an irresistible urge to pull out their hair, whether it’s from their scalp, their eyebrows or other areas of their body. Hair pulling from the scalp often leaves them with patchy bald spots on their head, which they may go to great lengths to disguise. Causes of trichotillomania are still being researched, and no specific cause has yet been found.

When to seek medical advice

Talk to your doctor if you notice sudden or patchy hair loss or more than usual hair loss when combing or washing your hair. Sudden hair loss can signal an underlying medical condition and may require medical treatment.

No cure is available for permanent hair loss or baldness. However, you can talk to your doctor about medical treatments to slow the rate of hair loss or to hide hair loss.

Screening and diagnosis

A complete medical history, family history and physical examination can help in a diagnosis. The pattern and rate of hair loss, the appearance of nearby hairs (for example, if hairs are broken off), and accompanying symptoms are considered when making the diagnosis.

Tests may be necessary if the cause isn’t apparent after the examination. These include:

  • Pull test. This is when several dozen hairs are gently pulled to see how many come out. This helps determine the stage of the shedding process and can help diagnose or rule out telogen effluvium.
  • Skin scrapings. Samples taken from the skin or from a few hairs plucked from the scalp can help verify whether an infection is causing hair loss.
  • Punch biopsy. When a diagnosis is difficult to confirm, especially in the case of alopecia areata or scarring alopecia, your doctor may perform a punch biopsy. During this test, the doctor uses a circular tool to remove a small section of your skin’s deeper layers.
  • Screening tests for related diseases. Your doctor may perform tests to determine if you have a medical condition that causes hair loss, such as thyroid disease, diabetes or lupus. Your doctor may also ask questions about the types of medications you’re taking. Sometimes hair loss is a side effect of certain drugs, such as those that treat gout, arthritis, depression, heart problems and high blood pressure.

Treatment

Baldness, whether permanent or temporary, can’t be cured. But hair loss treatments are available to help promote hair growth or hide hair loss. For some types of alopecia, hair may resume growth without any treatment.

Medication

The effectiveness of medications used to treat alopecia depends on the cause of hair loss, extent of the loss and individual response. Generally, treatment is less effective for more extensive cases of hair loss.

The types of drugs for treatment of alopecia that are approved by the Food and Drug Administration include:

  • Minoxidil (Rogaine). This over-the-counter (nonprescription) medication is approved for the treatment of androgenetic alopecia and alopecia areata. Minoxidil is a liquid or foam that you rub into your scalp twice daily to grow hair and to prevent further loss. Some people experience some hair regrowth or a slower rate of hair loss or both. Minoxidil is available in a 2 percent solution and in a 5 percent solution.New hair resulting from minoxidil use may be thinner and shorter than previous hair. But there can be enough hair growth for some people to hide their bald spots and have them blend with existing hair. New hair stops growing soon after you discontinue the use of minoxidil. It may take 12 weeks for new hair to start growing. If you experience minimal results within six months, your doctor may recommend discontinuing use. Side effects can include irritation of the scalp.
  • Finasteride (Propecia). This prescription medication to treat male-pattern baldness is taken daily in pill form. Many men taking finasteride experience a slowing of hair loss, and some may show some new hair growth. Positive results may take several months. Finasteride works by stopping the conversion of testosterone into dihydrotestosterone (DHT), a hormone that shrinks hair follicles and is an important factor in male hair loss. Rare side effects of finasteride include diminished sex drive and sexual function. As with minoxidil, the benefits of finasteride stop if you stop using it.Finasteride is not approved for use by women. In fact, it poses significant danger to women of childbearing age. If you’re a pregnant woman, don’t even handle crushed or broken finasteride tablets because absorption of the drug may cause serious birth defects in male fetuses.
  • Corticosteroids. Injections of cortisone into the scalp can treat alopecia areata. Treatment is usually repeated monthly. Doctors sometimes prescribe corticosteroid pills for extensive hair loss due to alopecia areata. New hair may be visible four weeks after the injection. Ointments and creams also can be used, but they may be less effective than injections.
  • Anthralin (Dritho-Scalp). Available as either a cream or an ointment, anthralin is a synthetic, tarry substance that you apply to your scalp and wash off daily. It’s typically used to treat psoriasis, but doctors can prescribe it to treat other skin conditions. Anthralin may stimulate new hair growth for cases of alopecia areata. It may take up to 12 weeks for new hair to appear.

Surgery

Hair transplants and scalp reduction surgery are available to treat androgenetic alopecia when more conservative measures have failed. During transplantation a dermatologist or cosmetic surgeon takes tiny plugs of skin, each containing one to several hairs, from the back or side of your scalp. The plugs are then implanted into the bald sections. Several transplant sessions may be needed, as hereditary hair loss progresses with time.

Scalp reduction, as the name implies, means decreasing the area of bald skin on your head. Your scalp and the top part of your head may seem to have a snug fit. But the skin can become flexible and stretched enough for some of it to be surgically removed. After hairless scalp is removed, the space is closed with hair-covered scalp. Doctors can also fold hair-bearing skin over an area of bald skin in a scalp reduction technique called a flap. Scalp reduction can be combined with hair transplantation to fashion a natural-looking hairline in those with more extensive hair loss.

Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring. It will take six to eight months before the quality of the new hair can be properly evaluated.

If you’re interested in these procedures, consider only board-certified dermatologists, plastic surgeons or cosmetic surgeons, and check local and state medical boards for a record of patient complaints before choosing a doctor. Consult with this doctor to confirm the cause of your hair loss and review all treatment options, including nonsurgical ones, before proceeding with plans for surgery.

Wigs and hairpieces

If you would like an alternative to medical treatment for your baldness or if you don’t respond to treatment, you may want to consider wearing a wig or hairpiece. They can be used to cover either permanent or temporary hair loss. Quality, natural-looking wigs and hairpieces are available.

Prevention

The following tips can help keep your hair healthy and may minimize the appearance of hair loss:

  • Eat a nutritionally balanced diet.
  • Handle your hair gently. Whenever possible, allow your hair to air-dry naturally.
  • Avoid tight hairstyles, such as braids, buns or ponytails.
  • Avoid compulsively twisting, rubbing or pulling your hair.
  • Check with hair care experts about hairpieces or styling techniques that help minimize the effects of balding.
  • The over-the-counter (nonprescription) medication minoxidil (Rogaine) promotes new hair growth and prevents further hair loss in a small percentage of people. Other over-the-counter hair growth products have no proven benefit.

Coping skills

Chances are that the greatest challenge of losing your hair is coping with the change in your appearance. You may be frustrated or upset by other people’s reactions or after trying various treatments with little success. If you’re having difficulty coping with baldness caused by heredity, a medical condition or medical treatments, you may find some of the following suggestions helpful:

  • Learn about the cause of your baldness and treatment options. Be wary of alternative treatments that have no proven track record or may cause dangerous or unpleasant side effects.
  • Educate those near to you. Your family and friends can be more sympathetic if they understand the cause of your baldness or your concerns about your looks. You may also learn that they are less concerned about changes in your appearance than you are.
  • Consider joining a support group. While support groups aren’t for everyone, they can be sources of information and comfort. Talking with people who experience the same challenges or medical conditions and learning how they cope can be reassuring.