Hair Loss Overview
Hair loss facts
- Hair loss without scarring of the scalp is a very common condition and affects most people at some time in their lives.
- Medical professionals should distinguish hair loss from breakage of the hair shaft from hair loss due to decreased hair growth.
- Common balding (androgenetic alopecia) occurs in men and women and is due to the effect of testosterone metabolites in genetically susceptible hair follicles.
- Thyroid disease, anemia, protein deficiency, secondary syphilis, chemotherapy, and low vitamin levels may cause hair loss.
- Alopecia areata is a form of hair loss produced by the autoimmune destruction of hair follicles in localized areas of skin.
- Medications indicated for hair regrowth include minoxidil and finasteride.
- Prevention of hair loss includes good hair hygiene, regular shampooing, and good nutrition.
- Medical health screening for hair loss may include blood tests such as complete blood count (CBC), iron level, vitamin B, thyroid function tests (TFT), and a biopsy of the scalp.
What are causes and risk factors for hair loss?
Because there are many types of hair loss, finding the cause can be challenging. This review will cover the most common causes of hair loss occurring on normal unscarred scalp skin. The medical term for hair loss is alopecia.
Most hair loss is not associated with systemic or internal disease, nor is poor diet a frequent factor. Hair may simply thin as a result of predetermined genetic factors and the overall aging process. Many men and women may notice mild physiologic thinning of hair starting in their 30s and 40s. Life vicissitudes, including illness, emotional trauma, protein deprivation (during strict dieting), and hormonal changes like those in pregnancy, puberty, and menopause may cause hair loss.
Several health conditions, including thyroid disease, iron deficiency anemia, and secondary syphilis, can cause hair loss. While thyroid blood tests and other lab tests, including a complete blood count (CBC), on people who have ordinary hair loss are usually normal, it is important to exclude treatable causes of hair loss.
What types of doctors treat hair loss?
A family physician, internist, or gynecologist can perform a basic health screening. Dermatologists are doctors who specialize in problems of skin, hair, and nails and may provide more advanced diagnosis and treatment of hair thinning and loss. Sometimes a scalp biopsy may be necessary.
Although many medications list "hair loss" among their potential side effects, most drugs are not likely to induce hair loss. On the other hand, cancer treatment (for example, chemotherapy or radiation therapy) and immunosuppressive medications commonly produce hair loss. Complete hair loss after chemotherapy usually regrows after six to 12 months.
How do physicians classify hair loss?
There are numerous ways to categorize hair loss. If the scalp appears perfectly normal with plenty of empty hair follicles, this is called non-scarring hair loss. On the other hand, cicatricial alopecia permanently destroys the follicles. Non-scarring hair loss also happens in situations where there is physical or chemical damage to the hair shaft, resulting in breakage. Occasionally, it may be necessary to do a biopsy of the scalp to distinguish these conditions. Sometimes, a physician may pull a hair to examine the appearance of the hair shaft as well as the percentage of growing hairs (anagen phase). This article will concentrate on the non-scarring types of hair loss.
Patchy hair loss
Some conditions produce small areas of hair loss, while others affect large areas of the scalp. Common causes of patchy hair loss are:
- alopecia areata (small circular or coin size bald patches on the scalp that usually grow back within months),
- traction alopecia (thinning from tight braids or ponytails),
- trichotillomania (the habit of twisting or pulling hair out),
- tinea capitis (fungal infection), and
- secondary syphilis.
Diffuse hair loss
Some common causes of diffuse hair loss are:
- pattern alopecia,
- drug-induced alopecia,
- protein malnutrition, and
- systemic disease-induced alopecia (cancer, endocrine disease, and telogen effluvium).
What is androgenetic or androgenic alopecia ("male-pattern baldness," "female-pattern baldness")?
This type of alopecia is often attributed to genetic predisposition and family history. Androgenic alopecia appears in both men and women. The hair loss in men is often faster, earlier onset, and more extensive.
Male-pattern baldness
Even men who never "go bald" thin out somewhat over the years. Unlike those with reversible telogen shedding, those with common male-pattern hair loss don't notice much hair coming out; they just see that it's not there anymore.
Some "myths" about male-pattern baldness
- People inherit baldness through their mother's male relatives. Actually, genes from both the mother and the father determine baldness. Looking at one's family can give someone at best an educated guess about how he or she will turn out. Studies are ongoing in this field, and current research has been inconclusive about the inheritance patterns.
- Longer hair puts a strain on roots. It doesn't. And hats don't choke off the circulation to the scalp to cause hair loss either.
- Shampooing does not accelerate balding.
- "Poor circulation" does not cause hair loss, and massaging doesn't stop it.
What treatment is there for hair loss in men?
There are few scientifically proven and FDA-approved treatments for hair loss. There are thousands of unproven claims and products to help with hair regrowth. Many conditioners, shampoos, vitamins, and other products claim to help hair grow in some unspecified way. To slow down hair loss, there are at least four potentially effective, basic options. These include medications like Minoxidil, and Propecia, which are for long-term use. Stopping these drugs does not seem to worsen or exacerbate the prior hair loss. The patient will simply revert to the state he would have been in had he never started treatment.
What other options do people have for hair loss?
There are many options and alternative cosmetic treatments for hair loss. Some of these are listed here and include hair-fiber powders, hairpieces, synthetic wigs, human hair wigs, hair extensions, hair weaves, laser, and surgery.
- Hair-fiber powders: Colored, powdery fiber sprinkles are commercially available and may work to camouflage balding areas. These colored sprinkles have special properties that help them attach to hair and give a fuller appearance. Toppik is one manufacturer of these products and can be found online. These cosmetic products are available without a prescription, are fairly inexpensive ($20-$40 range), and quite safe with minimal risk. Often these may be used in addition to medical treatments like Rogaine, Propecia, and hair transplants, and they are a great temporary measure to tide one over for special occasions.
- Hairpieces: Among the time-honored ways to add hair temporarily are hairpieces or hair weaving, in which a mesh is attached to the remaining hair and artificial or human hair of similar color and texture is woven with existing hair. Quality varies considerably with price; also, hairpieces and weaves may stretch, oxidize, and loosen.
- Surgery or hair transplants: Surgical hair restoration approaches include various versions of hair transplantation (taking hair from the back and putting it near the front) or scalp reduction (cutting away bald areas and stitching the rest together). Transplant procedures have improved greatly in recent years. They can produce much more attractive and natural-looking results than older methods that sometimes leave a "checkerboard" or hair plug look. Many transplant patients now take Propecia to maintain or keep what they've transplanted. When considering a hair transplant, check the surgeon's credentials and experience carefully. Micrografts are some of the newest techniques whereby surgeons transplant single one to two hair follicles. Hair transplants may be very expensive and time-consuming procedures ranging widely anywhere from $1,000-$20,000, depending on the number of hair grafts transplanted. Typically, 500 or more hairs may be transplanted in a session.
- Low level laser devices approved by the FDA are promoted for use in male pattern hair loss. These devices are used at home without a physician's prescription and vary in cost from $50 to over $1,000. They come in the form of combs, helmets, and hats. Limited studies are moderately persuasive that they stimulate hair growth.
- Platelet rich plasma obtained from the processed whole blood of male patients with pattern hair loss and then reinjected into their own scalp has been suggested as an adjuvant treatment. The efficacy of this form of therapy is currently under investigation.
Is hair loss in women different than men?
Female-pattern baldness
Women lose hair on an inherited (genetic) basis, too, but female pattern hair loss tends to be more diffuse, with less likelihood of the crown and frontal hairline being lost. Although some women may notice hair thinning as early as their 20s, the pace of hair loss tends to be gradual, often taking years to become obvious to others. There seems to be a normal physiologic thinning that comes with age and occurs in many women in their early to mid-30s. More women have underlying causes of hair loss than men. These include treatable conditions like anemia and thyroid disease and polycystic ovary syndrome (PCOS). These conditions are diagnosed by blood tests along with a historical and physical evidence. Although a few studies have suggested that baldness may be inherited through the mother's family genes, these theories require further testing. Current studies are inconclusive. Although not indicated for female pattern balding, spironolactone (Aldactone) has had some success in treating this condition.
While stories about hats choking off follicles or long hair pulling on the roots may be more folklore, repeat hair trauma like tightly woven hair pulled back and consistent friction can potentially worsen or cause localized hair loss in some individuals. Individuals who pull their hair tightly back in a rubber band can develop a localized hair loss at the front of the scalp.
Hair loss "myths" of special concern to women:
- Longer hair does not necessarily put a strain on roots.
- Shampooing does not accelerate hair loss; it just removes those that were ready to fall out anyway.
- Coloring, perming, and conditioning the hair do not usually cause hair loss.
What about pregnancy hair loss?
Pregnancy may cause many changes in the scalp hair. As the hormones fluctuate during pregnancy, a large number of women feel their hair thickens and becomes fuller. This may be related to change in the number of hairs cycling in the growth phase of hair growth, but the exact reason is unknown. Quite often, there may be a loss of hair (telogen effluvium) after delivery or a few months later which will eventually normalize.
What specific treatments are there for hair loss in women?
Female hair loss treatments include minoxidil (Rogaine), hair transplants, hair-powder fibers like Toppik, wigs, hair extensions, and weaves.
- Minoxidil is available over the counter and available in 2%, 4%, and 5% concentrations. It may be something of a nuisance to apply twice daily, but it has been shown to help conserve hair and may even grow some. Minoxidil tends to grow very fine small hairs wherever it is applied. It is important to avoid running the liquid onto the face or neck where it can also grow hair. Surgical procedures like hair transplants can be useful for some women as well as men to "fill in" thinned-out areas.
What vitamins are good for hair loss? Are there home remedies for hair loss?
A good daily multivitamin containing zinc, vitamin B, folate, iron, and calcium is a reasonable choice, although there is no good evidence that vitamins for men or women or supplements for hair have any meaningful benefit in alopecia. Newer studies suggest that vitamin D may be somewhat helpful and worth considering (if there is vitamin D deficiency). Specific vitamin and mineral deficiencies like iron or vitamin B12 may be diagnosed by blood tests and treated (because deficiency might cause hair loss).
Can itchy scalp cause hair loss?
Itchy scalp may be a symptom of a scalp disease that could produce hair loss. Causes may include seborrheic dermatitis (dandruff) and psoriasis. Treatments may include medicated shampoos like ketoconazole, OTC dandruff shampoos, and topical steroid creams and lotions to help decrease itching.
What is the prognosis for hair loss?
The prognosis for androgenic non-scarring hair loss is guarded due to the fact that there is no cure for the problem. Medications must be taken indefinitely. Other types of hair loss have a good chance of spontaneously resolving.
How do people prevent hair loss?
Hair-loss prevention depends on the underlying cause. Good hair hygiene with regular shampooing is a basic step but is probably of little benefit. Good nutrition, especially adequate levels of iron and vitamin B, is helpful. Treatment of underlying medical conditions like thyroid disease, anemia, and hormonal imbalances may useful in prevention.
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