Hair Loss
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. 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.
Treatments and drugs
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. Sources: 1. Mayo Clinic 2. The American Hair Loss Council 3. American Hair Loss
Association
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