Hair loss, also known as Alopecia or Baldness, refers to a loss of hair from part of the body. Hair loss can affect just your scalp or your entire body. Hair loss without scarring of the scalp is a very common condition and affects most people at some time in their lives. It’s normal to lose between 50 and 100 hairs a day. With about 100,000 hairs on your head, that small loss isn’t noticeable. New hair normally replaces the lost hair, but this doesn’t always happen. Hair loss can develop gradually over years or happen abruptly. Hair loss can be permanent or temporary.
Types of Hair Loss
There are many types of hair loss:
Androgenic alopecia is a genetic condition that can affect both men and women. Men with this condition, called male pattern baldness, can begin suffering hair loss as early as their teens or early 20s. It’s characterized by a receding hairline and gradual disappearance of hair from the crown and frontal scalp. Women with this condition, called female pattern baldness, don’t experience noticeable thinning until their 40s or later. Women experience a general thinning over the entire scalp, with the most extensive hair loss at the crown.
Telogen effluvium is temporary hair thinning over the scalp that occurs because of changes in the growth cycle of hair. A large number of hairs enter the resting phase at the same time, causing hair shedding and subsequent thinning.
Involutional alopecia is a natural condition in which the hair gradually thins with age. More hair follicles go into the resting phase, and the remaining hairs become shorter and fewer in number.
Alopecia areata often starts suddenly and causes patchy hair loss in children and young adults. This condition may result in complete baldness (alopecia totalis). But in about 90% of people with the condition, the hair returns within a few years.
Alopecia universalis causes all body hair to fall out, including the eyebrows, eyelashes, and pubic hair.
Scarring alopecia result in permanent loss of hair. Inflammatory skin conditions (cellulitis, folliculitis, acne), and other skin disorders (such as some forms of lupus and lichen planus) often result in scars that destroy the ability of the hair to regenerate. Hot combs and hair too tightly woven and pulled can also result in permanent hair loss.
Causes of Hair Loss
Hair loss is related to one or more of the following factors:
Family history: The most common cause of hair loss is a hereditary condition that happens with aging. This condition is called androgenic alopecia, male-pattern baldness and female-pattern baldness. It usually occurs gradually and in predictable patterns a receding hairline and bald spots in men and thinning hair along the crown of the scalp in women.
Hormonal changes: A variety of conditions can cause permanent or temporary hair loss, including hormonal changes due to pregnancy, childbirth, menopause and thyroid problems. Medical conditions include alopecia areata, which is immune system related and causes patchy hair loss, scalp infections such as ringworm, and a hair-pulling disorder called trichotillomania.
Infections: Several infections like Dissecting cellulitis, tinea capitis, Folliculitis and Secondary syphilis can cause hair loss.
Traumas: A physical or emotional trauma may trigger noticeable hair loss. Traumas such as childbirth, major surgery, poisoning, and severe stress may cause a hair loss condition known as telogen effluvium, in which a large number of hairs enter the resting phase at the same time, causing shedding and subsequent thinning.
Drugs: Temporary or permanent hair loss can be caused by several medications, including those for blood pressure problems, diabetes, heart disease and cholesterol. Any that affect the body’s hormone balance can have a pronounced effect: these include the contraceptive pill, hormone replacement therapy, steroids and acne medications.
Radiation therapy: The radiation therapy causes hair loss and hair may not grow back the same as it was before.
Stress: Many people experience a general thinning of hair several months after a physical or emotional shock. This type of hair loss is temporary.
Hairstyles and treatments: Excessive hairstyling or hairstyles that pull your hair tight, such as pigtails or cornrows, can cause a type of hair loss called traction alopecia. Hot-oil hair treatments and permanents also can cause hair to fall out. If scarring occurs, hair loss could be permanent. Traction alopecia is most commonly found in people with ponytails or cornrows who pull on their hair with excessive force. In addition, rigorous brushing and heat styling, rough scalp massage can damage the cuticle, the hard outer casing of the hair. This causes individual strands to become weak and break off, reducing overall hair volume.
Poor nutrition: A diet lacking in protein, iron, and other nutrients can also lead to thinning hair.
Doctor will likely give you a physical exam and ask about your diet, your hair care routine, and your medical and family history. You might also have tests, such as the following:
Blood test. This might help uncover medical conditions that can cause hair loss.
Pull test. Your doctor gently pulls several dozen hairs to see how many come out. This helps determine the stage of the shedding process.
Scalp biopsy. Your doctor scrapes samples from the skin or from a few hairs plucked from the scalp to examine the hair roots under a microscope. This can help determine whether an infection is causing hair loss.
Light microscopy. Your doctor uses a special instrument to examine hairs trimmed at their bases. Microscopy helps uncover possible disorders of the hair shaft.
Effective treatments for some types of hair loss are available. You might be able to reverse hair loss, or at least slow it. Treatments for hair loss include medications and surgery.
If your hair loss is caused by an underlying disease, treatment for that disease will be necessary. If a certain medication is causing the hair loss, your doctor may advise you to stop using it for a few months.
Minoxidil. Over-the-counter minoxidil comes in liquid, foam and shampoo forms. To be most effective, apply the product to the scalp skin once daily for women and twice daily for men. Many people prefer the foam applied when the hair is wet. It’ll take at least six months of treatment to prevent further hair loss and to start hair regrowth. Possible side effects include scalp irritation and unwanted hair growth on the adjacent skin of the face and hands.
Finasteride. This is a prescription drug for men. You take it daily as a pill. Many men taking finasteride experience a slowing of hair loss, and some may show new hair growth. Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer. Women who are or may be pregnant need to avoid touching crushed or broken tablets.
Corticosteroids injections into the scalp can be used to treat alopecia areata. This type of treatment is repeated on a monthly basis. Oral pills for extensive hair loss may be used for alopecia areata. Results may take up to a month to be seen.
Hormonal modulators (oral contraceptives or antiandrogens such as spironolactone and flutamide) can be used for female-pattern hair loss associated with hyperandrogenemia.
Hair transplant surgery
In the most common type of permanent hair loss, only the top of the head is affected. Hair transplant, or restoration surgery, can make the most of the hair you have left. During a hair transplant procedure, a dermatologist or cosmetic surgeon removes hair from a part of the head that has hair and transplants it to a bald spot. Each patch of hair has one to several hairs (micrografts and minigrafts). Sometimes a larger strip of skin containing multiple hair groupings is taken. This procedure doesn’t require hospitalization, but it is painful so you’ll be given anesthesia to ease any discomfort. Possible risks include bleeding, bruising, swelling and infection. You may need more than one surgery to get the effect you want. Hereditary hair loss will eventually progress despite surgery.
There are things you can do to prevent further hair loss.
- Don’t wear tight hairstyles like braids, ponytails, or buns that put too much pressure on your hair.
- Try not to pull, twist, or rub your hair.
- Make sure you’re eating a balanced diet that includes adequate amounts of iron and protein.
- If you’re currently losing hair, use a gentle baby shampoo to wash your hair.
- Unless you have extremely oily hair, consider washing your hair only every other day. Always pat the hair dry and avoid rubbing your hair.