Hair loss can affect just your scalp or your entire body. It can be the result of heredity, hormonal changes, medical conditions or medications. Anyone can experience hair loss.
Baldness is excessive hair loss from your scalp. Hereditary hair loss with age is the most common cause of baldness. Some people prefer to let their hair loss run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. Others choose one of the treatments available to prevent further hair loss and to restore growth.
Before pursuing any hair loss treatment, talk with your doctor about the cause of your hair loss and treatment options.
Types of Hair Loss
- Patchy hair loss (alopecia areata)
Hair loss can appear in many different ways, depending on what’s causing it. It can come on suddenly or gradually. It can affect just your scalp or your whole body. Some types of hair loss are temporary, and others are permanent.
Signs and symptoms of hair loss may include:
- Gradual thinning on top of head.
- The most common type of hair loss, affecting both men and women as they age. In men, hair begins to recede from the forehead in a line that resembles the letter M. Women typically retain the hairline on the forehead but have a broadening of the part in their hair.
- Circular or patchy bald spots.
- Generally smooth, coin-sized bald spots. This type of hair loss usually affects just the scalp, but it also can occur in beards or eyebrows. In some cases, your skin may become itchy or painful before the hair falls out.
- Sudden loosening of hair.
- Physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing – or even after gentle tugging. This type of hair loss usually causes overall hair thinning and not bald patches.
- Full-body hair loss.
- Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over your body. The hair usually grows back.
- Patches of scaling that spread over the scalp.
- Often a sign of ringworm. It may be accompanied by broken hair, redness, swelling and, at times, oozing.
When to see a doctor
See your doctor if you are distressed by hair loss and want to pursue treatment. Also 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 that requires treatment.
People typically lose about 100 hairs a day. This usually doesn’t cause noticeable thinning of scalp hair because new hair grows in at the same time. Hair loss occurs when this cycle of hair growth and shedding is disrupted or when the hair follicle is destroyed and replaced with scar tissue.
Hair loss is typically related to one or more of the following factors:
- Family history (heredity).
- The most common cause of hair loss is hereditary – referred to as male-pattern baldness or female-pattern baldness. It usually occurs gradually with aging and in predictable patterns — a receding hairline and bald spots in men and thinning hair in women.
- Hormonal changes and medical conditions.
- 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 causes patchy hair loss, scalp infections such as ringworm and a hair-pulling disorder called trichotillomania.
- Medications and supplements.
- Hair loss can be a side effect of certain drugs, such as those used for cancer, arthritis, depression, heart problems, gout and high blood pressure.
- Radiation therapy to the head.
- The hair may not grow back the same as it was before.
- A very stressful event.
- Many people experience a general thinning of hair several months after physical or emotional stress. This type of hair loss is temporary.
- Certain 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 can cause inflammation of hair follicles that leads to hair loss. If scarring occurs, hair loss could be permanent.
A number of factors can increase your risk of hair loss, including:
- Family history of balding, in either of your parent’s families
- Significant weight loss
- Medical conditions, such as diabetes and lupus
Most baldness is caused by genetics (male-pattern baldness and female-pattern baldness). This type of hair loss is not preventable.
A variety of tips may help you avoid preventable types of hair loss:
- Avoid tight hairstyles, such as braids, buns or ponytails.
- Avoid compulsively twisting, rubbing or pulling your hair.
- Treat your hair gently when washing and brushing. A wide-toothed comb may help prevent pulling out hair.
- Avoid harsh treatments such as hot rollers, curling irons, hot oil treatments and permanents.
- Avoid medications and supplements that could cause hair loss.
- Protect your hair from sunlight and other sources of ultraviolet light.
- Stop smoking. Some studies show an association between smoking and baldness in men.
- If you are being treated with chemotherapy, ask your doctor about a cooling cap. This cap can reduce your risk of losing hair during chemotherapy.
Before a diagnosis can be made, you will often need a physical exam. You may also be asked about your medical history and family history. Additional tests may also be needed:
- Blood test. This may help uncover medical conditions related to hair loss.
- Pull test. Your provider will gently puls several dozen hairs to see how many come out. This helps determine the stage of the shedding process.
- Scalp biopsy. Taking samples from the skin or from a few hairs plucked from the scalp to examine the hair roots. This can help determine whether an infection is causing hair loss.
- Light microscopy. A special instrument may be used 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 further thinning. With some conditions, such as patchy hair loss (alopecia areata), hair may regrow without treatment.
Treatments for hair loss include medications, surgery to promote hair growth and slow hair loss.
If your hair loss is caused by an underlying disease, treatment for that disease will be necessary. This may include drugs to reduce inflammation and suppress your immune system, such as prednisone.
If a certain medication is causing the hair loss, your doctor may advise you to stop using it for at least three months.
Medications are available to treat pattern (hereditary) baldness. Options include:
- Minoxidil (Rogaine).
- This is an over-the-counter medication approved for men and women. It comes as a liquid or foam that you rub into your scalp daily. At first it may cause you to shed hair as hair follicles. New hair may be shorter and thinner than previous hair. At least six months of treatment is required to prevent further hair loss and to start hair regrowth. Possible side effects include scalp irritation, unwanted hair growth on the adjacent skin of the face and hands, and rapid heart rate (tachycardia).
- Finasteride (Propecia).
- This is a prescription drug. Many patients using finasteride experience a slowing of hair loss, and some may show some new hair growth. Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer.
- Other medications.
- For men, the oral medication dutasteride is an option. For women, treatment may include oral contraceptives and spironolactone. There are also a variety of over-the-counter supplements that both men and women can try.
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 tiny patches of skin, each containing one to several hairs, from the back or side of your scalp. Sometimes a larger strip of skin containing multiple hair groupings is taken. He or she then implants the hair follicle by follicle into the bald sections. You may need more than one surgery to get the effect you want. Hereditary hair loss will eventually progress despite surgery.
Surgical procedures to treat baldness are expensive and can be painful. Possible risks include bleeding and scarring.
The Food and Drug Administration (FDA) has approved a low-level laser device as a treatment for hereditary hair loss in men and women. A few small studies have shown that it improves hair density. The long-term benefits are not yet known.
Lifestyle and home remedies
You may want to try shaving, other styling techniques and products, scarves, a wig, or a hairpiece. Talk with a hair stylist for ideas. These nonmedical solutions can be used to cover permanent or temporary hair loss.
If your hair loss is due to a medical condition, the cost of a wig may be covered by insurance.
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