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Hair Loss  
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Definition  

Alopecia refers to hair loss in areas of skin that normally have hair. There are two forms of alopecia: scarring and non-scarring.

Scarring is the loss of hair follicles. This form causes permanent hair loss. The most prevalent forms of scarring alopecia are:

  • Cutaneous lupus erythematous
  • Central centrifugal cicatricial alopecia
  • Fungal kerions

In the case of non-scarring alopecia, the hair shaft is gone, but the follicles are still present. This form is often reversible. It can also develop into scarring alopecia. Non-scarring types include:

  • Androgenetic (hereditary) alopecia
  • Telogen effluvium
  • Alopecia areata is an autoimmune process; the cause is unknown
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Causes  

Many things can cause alopecia, including:

  • Stress that prompts growing hairs to rest and shed
    • Illness or surgery
    • Vitamin and nutrient deficiencies
    • Prolonged fever
    • Childbirth
    • Emotional/psychological stress
    • Crash dieting
  • Hormonal problems
  • Medications
    • Blood thinners
    • Drugs for gout
    • Chemotherapy for cancer treatment
    • Vitamin A
    • Birth control pills
    • Antidepressants
    • Blood pressure and heart medications
  • Allergic reaction to medications
  • Radiation therapy
  • Infections
  • Autoimmune disorders
  • Systemic and discoid lupus erythematosus
  • Anemia
  • Hair pulled too tightly by:
    • Hair rollers
    • Pigtails
    • Cornrows
  • Hot comb and oil treatments (can inflame the hair follicle and cause scarring)
  • Twisting and pulling hair out due to psychiatric problems
  • Genes
    • Male and female pattern baldness—Usually inherited
    • Congenital disorders—Can include problems with the hair shaft
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Risk Factors  

Factors that increase your chance of alopecia include:

  • Family history of baldness or hair loss
  • Increased age (for male- and female-pattern baldness only)
  • Pregnancy
  • Stress
  • Poor nutrition
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Symptoms  

Alopecia symptoms depend on the type of hair loss. Some of the more common symptoms include:

Male-pattern baldness:

  • Hair recedes
  • Hair falls out at the top of the head
  • Affects men and women

Female-pattern baldness:

  • Hair thins over the entire head
  • Hair comes out when brushing

Alopecia areata:

  • Rapid hair loss
  • Round or oval patches of hair loss
  • Sometimes tiny hairs are visible in the patches
  • Fingernails and toenails with pits

Stress-related:

  • Gradual shedding
  • Hairs come out with gentle pulling

Fungal infections:

  • Patches of hair loss
  • Black dots in the patches
  • Itching
  • Scaling
  • Inflammation (such as redness)
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Diagnosis  

The doctor will ask about your symptoms and medical history and perform a physical exam. The doctor will examine the location of hair loss, noting the pattern of hair loss and condition of the scalp.

This physical exam may include:

  • Gentle pulling on the hair
  • Taking samples of scalp areas with inflammation to examine under a microscope
  • Analyzing samples of hair
  • Checking for hair loss on other parts of the body

The doctor will ask questions about:

  • Diet
  • Hair care
  • Medication use
  • Your personal and family medical history
  • Pregnancies, menopause, and monthly menstrual cycles

Other tests may include:

  • Blood tests
  • Biopsy of the scalp
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Treatment  

Treatment will depend on the cause of the condition. Treatments include:

Medications  

To treat related conditions:

  • Drugs to correct a hormonal imbalance or deficiency
  • Changing medication that may be causing the hair loss
  • Antifungal shampoos and pills—To treat fungal infections

Direct treatment for baldness:

  • For men—A prescription drug (finasteride)
    • Note: Pregnant women should not handle this medication. Even a small amount absorbed through the skin of the hands can cause birth defects in baby boys.
  • Over-the-counter medication (minoxidil)—Applied to the scalp daily (must be used on a regular basis)
    • Note: If you have heart problems, discuss this drug with your doctor before using it.
  • Steroid injection into your scalp to help speed-up hair re-growth in alopecia areata

Alternative Treatments  

  • Topical immunotherapy—Apply an allergen to the scalp that causes local reaction like redness, itching, and also induces hair growth; done if other efforts do not work
  • Phototherapy—Potential treatment for patients with alopecia areata; usually done over 4-6 months

Lifestyle Changes  

Be gentle with your hair. Avoid pulling it tightly. If pulled over a long period of time, scarring can occur. Permanent hair loss is also possible.

If treatment does not correct the hair loss, you may opt for a wig, hairpiece, or hair weaving.

If emotional stress is the cause, learn and practice stress-management techniques.

Surgery  

This can involve:

  • Hair transplant—Taking hair from the back and sides of the head and transplanting it in bald areas. As many as 300 grafts may be needed. You must return multiple times for the grafts.
  • Scalp reduction with flaps—Cutting the scalp and pulling the areas with hair closer together.

Chemotherapy Induced  

  • It could be minimal, moderate, or severe.
  • It is transient and completely reversible after chemotherapy is done.
  • Currently, there are no medications available that were shown to reduce the risk of alopecia associated with cancer treatments.
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Prevention  

There are no prevention guidelines for the most common type of hair loss: male-pattern baldness. However, the following tips may help you avoid other types of hair loss:

  • Do not pull your hair tightly into a ponytail, cornrows, or curlers.
  • Learn and practice stress-management techniques.
  • Obtain medical care for acute illnesses and to manage chronic conditions.
  • Eat healthy, well-balanced meals.