What Is It?
Hair loss can range from mild hair thinning to total baldness. Hair can fall out for many different reasons. Medically, hair loss falls into several categories, including:
We normally lose approximately 50 to 100 scalp hairs each day. If more than this is falling out, you may find unusually large amounts of hair in brushes, on clothing, and in the drains of sinks and tubs. You may also notice that your hair is generally thinner, that your part is wider, that your hairline has changed or that one or more bald patches have appeared.
When hair loss is the result of telogen effluvium or medication side effects, the hair loss usually is all over the head, while in tinea infections and alopecia areata, the hair loss occurs in small patches. Also, tinea infections can cause additional symptoms, such as scaling of the scalp or areas of broken hairs that look like black dots. In traumatic alopecia, the area of hair loss depends on the method of hair injury and follows the pattern inflicted by hot rollers, braiding or chemical treatments. In male-pattern baldness, the hairline usually begins to recede at the temples first, followed by thinning at the top of the head. Gradually, the crown area becomes totally bald, leaving a fringe of hair around the back and sides of the head.
Your doctor will diagnose the cause of your hair loss based on your medical history, the medications you take, your nutritional status, your hairdressing habits and a physical examination. If your doctor suspects a fungal infection of your scalp, he or she may take a hair sample for laboratory testing. Blood tests probably will be needed if your doctor suspects a medical illness (such as lupus) or a thyroid problem, iron deficiency or sex-hormone imbalance.
How long hair loss lasts depends on the cause. In telogen effluvium, for example, hair usually is lost over several weeks to months, but then grows back over the next several months. When hair loss is a side effect of a medication, hair growth usually returns to normal once the drug is stopped. If you are losing hair because of abusive hairdressing, the hair loss usually stops after you change to more natural styling, except in traction alopecia, which results from years of pulling the hair back in tight braids. In tinea scalp infection, the fungus that causes the problem must be treated for at least 6 to 12 weeks and hair regrowth may be slow. Early treatment is important in preventing possible permanent hair loss. Both male- and female-pattern baldness tend to get worse over time but can be treated.
Some forms of hair loss can be prevented by minimizing stress, eating a healthy diet and using sensible hairdressing techniques, and, if possible, switching to medications that do not cause hair loss. Hair loss from fungal infections can be prevented by keeping hair clean and by never sharing hats, combs or brushes with other people. Hair loss from hereditary-pattern baldness can sometimes be prevented by medication.
Hair loss resulting from telogen effluvium or drug side effects usually requires no treatment other than discontinuing the medication that is causing the problem. Limiting trauma or chemical exposure (such as use of a blow dryer, hair straightener, coloring or perms) may limit or stop hair loss. Hair loss from poor nutrition or medical illness usually stops with the adoption of a healthy diet and treatment of the underlying medical condition. Treatment of fungal scalp infection requires 6 to 12 weeks of oral medication, such as terbinafine (Lamisil) or itraconazole (Sporanox), with or without shampoos containing selenium sulfide (Selsun Blue, Head & Shoulders, others) or ketoconazole (Nizoral). Alopecia areata can be treated with a corticosteroid that is injected or applied to the skin. Other treatments for this condition include anthralin cream (Drithocreme, DrithoScalp, Psoriatec), minoxidil (Loniten, Rogain) or a combination of these therapies.
Many men and women with hereditary-pattern baldness do not seek treatment for hair loss. Those who do seek medical help can be treated with topical minoxidil (Rogaine) or (in men only) oral finasteride (Propecia, Proscar), or they can choose hair transplants or scalp-reduction surgery.
When to Call a Professional
Call your doctor whenever you are concerned about hair loss, especially if you are having other unexplained symptoms.
Many forms of hair loss are either self-limited (telogen effluvium or drug side effects) or respond to treatment with medication (tinea capitis). Even hereditary-pattern baldness tends to improve with treatment. However, treatment must continue indefinitely. In some conditions, hair loss cannot be reversed, especially if scarring has developed (as can happen in lupus-related scalp disease).
American Academy of Dermatology
P.O. Box 4014
Schaumburg, IL 60168-4014
American Society of Plastic Surgeons
444 E. Algonquin Road
Arlington Heights, IL 60005