Hair Loss

Also called alopecia

Everyone loses hair. It is normal to lose about 50-100 hairs every day. If you see bald patches or lots of thinning, you may be experiencing hair loss.

There are many causes of hair loss. Women may notice hair loss after giving birth. People under a lot of stress can see noticeable hair loss. Some diseases and medical treatments can cause hair loss.

The most common cause of hair loss is a medical condition called hereditary hair loss. Other names for this type of hair loss are:

Male-pattern baldness.
Female-pattern baldness.
Androgenetic alopecia.

Luckily, most causes of hair loss can be stopped or treated. Anyone troubled by hair loss should see an expert dermatologist.

Who experiences hair loss?

Millions of people experience hair loss. Some people see their hair re-grow without doing anything. Others need treatment for their hair to re-grow. Sometimes, hair will not re-grow.

To find out what is possible, you should see a dermatologist. These doctors specialize in treating diseases that affect the skin, hair, and nails.

What causes hair loss?

The reasons for hair loss are many. When hair loss begins suddenly, the cause may be due to illness, diet, medicine, or childbirth. If hair loss is gradual and becomes more noticeable with each passing year, a person may have hereditary hair loss. Certain hair care practices also can cause noticeable hair loss.

The following describes some of the many things that cause hair loss:

Hair disorders

Hereditary thinning or baldness (also called androgenetic alopecia): This is the most common cause of hair loss. It affects men and women.
When men have hereditary hair loss, they often get a receding hairline. Many men see bald patches, especially on the top of the head. Women, on the other hand, tend to keep their hairline. They see noticeably thinning hair. The first sign of hair loss for many women is a widening part. In rare cases, men see noticeably thinning hair. And in rare cases, women can see a receding hairline or bald patches. The reasons for this are unknown.
Alopecia areata: Researchers believe that this is an autoimmune disease. Autoimmune means the body attacks itself. In this case, the body attacks its own hair. This causes smooth, round patches of hair loss on the scalp and other areas of the body. People with alopecia areata are often in excellent health. Most people see their hair re-grow. Dermatologists treat people with this disorder to help the hair re-grow more quickly.
Cicatricial (scarring) alopecia: This rare disease develops in otherwise healthy people. The disease destroys a person’s hair follicles. Scar tissue forms where the follicles once were, so the hair cannot regrow. Treatment tries to stop the inflammation, which destroys the hair follicles.

Disease

Underlying medical condition: Hair loss can be the first sign of a disease. About 30 diseases, including thyroid disease and anemia, cause hair loss. By treating the disease, hair loss often can be stopped or reversed.
Illness: Significant hair loss can occur after an illness. A major surgery, high fever, severe infection, or even the flu can cause hair loss. Your dermatologist may call this type of hair loss telogen effluvium.
Some cancer treatments: Radiation therapy and chemotherapy can cause hair loss. This hair loss is often temporary, but it can cause great distress.
Ringworm of the scalp: This disease is contagious and common in children. Without effective treatment, ringworm can cause balding.
Trichotillomania: This medical disorder causes people to repeatedly pull out their own hair. They often feel a constant urge to pull out the hair on the scalp. Some sufferers say they feel compelled to pull out their eyelashes, nose hairs, eyebrows, and other hairs on their bodies.

Hormones and stress

Giving birth: After giving birth, some women have noticeable hair loss. Falling estrogen levels cause this type of hair loss. The hair loss is temporary. In a few months, women see their hair re-grow.
Menopause: Hair loss is common during menopause. This loss is often temporary. Hair re-grows with time. If a woman is 40 years of age or older, she should not expect her hair to have the fullness that it did when she was younger.
Stress: Experiencing a traumatic event (e.g., death of a loved one or divorce) can cause hair loss.

Dieting and poor nutrition

Weight loss: Some people see hair loss after losing more than 15 pounds. The hair loss often appears 3 to 6 months after losing the weight. This hair loss is common. The hair re-grows without help.
Vitamin A: Too much vitamin A can cause hair loss. People can get too much of this vitamin through vitamin supplements or medicines. Once the body stops getting too much vitamin A, normal hair growth resumes.
Protein: When the body does not get enough protein, it rations the protein it does get. One way the body can ration protein is to shut down hair growth. About 2 to 3 months after a person does not eat enough protein, you can see the hair loss. Eating more protein will stop the hair loss. Meats, eggs, and fish are good sources of protein. Vegetarians can get more protein by adding nuts, seeds, and beans to their diet.
Iron: Not getting enough iron can lead to hair loss. Good vegetarian sources of iron are iron-fortified cereals, soybeans, pumpkin seeds, white beans, lentils, and spinach. Clams, oysters, and organ meats top the list of good animal sources of iron.
Eating disorder: When a person has an eating disorder, hair loss is common. Anorexia (not eating enough) and bulimia (vomiting after eating) can cause hair loss.

Medicine

Some prescription medicines can cause hair loss. These include:

Blood thinners.
High-dose vitamin A.
Medicines that treat arthritis, depression, gout, heart problems, and high blood pressure.
Birth control pills: Some women who take the pill see hair loss. Sometimes, the hair loss begins when a women stops taking the pill. Women who get this hair loss often have hereditary hair loss.
Anabolic steroids (steroids taken to build muscle and improve athletic performance) may cause hair loss.

Hair care

Your hairstyle and even some of the products you use on your hair can cause hair loss.

Products: Frequent bleaching or permanents can cause the hair to break. Regular or improper use of dyes, gels, relaxers, and hair sprays also can cause hair breakage. Dermatologists recommend limiting use of these hair products. Less use often means less hair breakage.
Blow dryers, flat irons, and other devices: Frequent use of a blow dryer tends to damage hair. The high heat from a blow dryer can boil the water in the hair shaft leaving the hair brittle and prone to breakage. Dermatologists recommend that you allow your hair to air dry. Then style your hair when it is dry. Dermatologists also recommend limiting the use of flat irons (these straighten hair by using high heat) and curling irons.
Hairpins, clips, and rubber bands: When used to hold hair tightly, hairpins, clips, and rubber bands can break hair. Here are dermatologists’ tips for choosing these:
Hairpins: Use hairpins that have a smooth, ball-tipped surface.
Hair clips: These should have spongy rubber padding where they touch the hair.
Rubber bands: Try scrunchies made of fabric instead. Rubber bands often cause the hair to break. Scrunchies should fit loosely. To prevent hair loss, you should wear them in different areas of the scalp. This can prevent lots of hair breakage in one area.

Hairstyles

Years of wearing hair in a style that pulls on the hair such as a ponytail, cornrows, or braids can cause a type of hair loss known as traction alopecia.

Improper washing, drying, and combing The following practices often cause the hair to break:

Too much shampooing, combing, or brushing (100 strokes or more a day).
Rubbing wet hair dry with a towel.
Brushing or combing wet hair (especially people who are Asian or Caucasian).

For many people, hair is more elastic when wet. This means it breaks off more easily than dry hair. When hair breakage occurs, the hair appears shaggy or too thin. For people who are of African descent, their hair is not more elastic when wet.

Diagnosing hair loss?

Because so many things can cause hair loss, a dermatologist acts like a detective. A dermatologist may begin by asking questions. The dermatologist will want to know whether the hair loss happened suddenly or gradually. Knowing this helps to eliminate causes.

A dermatologist also will ask what medicines you take, what allergies you have, and whether you have been dieting. It is important to give the dermatologist accurate information. Women may be asked about their periods, pregnancies, and menopause.

The dermatologist also will carefully look at your scalp and hair. During an exam, the dermatologist may pull on your hair. Sometimes a dermatologist needs to pull out a hair to get the necessary evidence. And sometimes a dermatologist needs to look at the hair on the rest of your body to see whether there is too little or too much hair in other areas.

Sometimes the evidence lies in your scalp. The dermatologist may remove a small piece of the scalp. This is called a scalp biopsy. A dermatologist can quickly and safely perform a scalp biopsy during an office visit. A scalp biopsy can be essential to solving the case. Sometimes, a blood test is necessary.

Treatment

Treatment for hair loss helps many people feel better. Hair loss, especially in women, can cause low self-esteem. Many women feel unattractive and embarrassed. A dermatologist can offer solutions to help you feel and look your best

Just as there are many causes, there are many treatments for hair loss. Dermatologists recommend treating hair loss early. Early means before you lose a lot of hair. Hair loss is harder to treat when a person has a lot of hair loss.

One or more of the following treatments may be part of your treatment plan.

Minoxidil: This medicine is applied to the scalp. It can stop hairs from getting thinner and stimulate hair growth on the top of the scalp. It is the only hair re-growth product approved for men and women. A dermatologist may combine minoxidil with another treatment.
Laser devices: Brushes, combs, and other hand-held devices that emit laser light might stimulate hair growth. These devices might make hair look more youthful in some people. Because the FDA classifies these products as medical devices, the products do not undergo the rigorous testing that medicines undergo. The long-term effectiveness and safety for these devices are not known.
Finasteride: The FDA approved this medicine to treat men with hair loss. It comes in pill form and helps slow hair loss in most (about 88%) men. It helps stimulate hair re-growth in many (about 66%) men. Finasteride works by stopping the body from making a male hormone, dihydrotestosterone (DHT).
Corticosteroid: If your hair loss is caused by inflammation in your body, a dermatologist may inject a medicine called a corticosteroid into your scalp. This can help stop the inflammation that happens when a person has alopecia areata. A corticosteroid is different from an anabolic steroid.

Procedures

The type of procedure that a dermatologist recommends will depend on how much hair you have lost. To achieve the best results, a dermatologist may use one or more of the following procedures:

Hair transplantation:Skin on the scalp that has good hair growth is removed and transplanted to areas of the scalp that need hair.
Scalp reduction:Bald scalp is surgically removed and hair-bearing scalp is brought closer together to reduce balding. Scalp reduction surgery can be performed alone or in conjunction with a hair transplant.
Scalp expansion:Devices are inserted under the scalp for about 3 to 4 weeks to stretch the skin. This procedure may be performed before a scalp reduction to make the scalp more lax. It also can be performed solely to stretch hair-bearing areas, which reduces balding.
Scalp flaps: A hair-bearing segment of scalp is surgically moved and placed where hair is needed.

Good Hair Care: Tips for Patients

In our quest for beautiful hair, we often do things that damage our hair. Many people are surprised to learn that a hairstyle or even the way they wash and dry their hair has contributed to their hair loss. Damaged hair is fragile, so it tends to break. Hair breakage can leave us with frizzy, unhealthy looking hair. If we continue to damage our hair, we may eventually see thinning hair or even bald spots. The good news is that simple changes can prevent further hair damage. By following tips that dermatologist give their patients, you can learn to stop damaging your hair.

1- Do not wash your hair by rubbing shampoo into the length of your hair
Changes that can help prevent hair damage:
2- Gently massage shampoo into your scalp.
3- When you rinse the shampoo from your scalp, let it flow through the length of your hair and resist the temptation to rub it into your hair.
4- Do not skip the conditioner
Changes that can help prevent hair damage:

Use conditioner after every shampoo.

5- Do not dry your hair by rubbing it with a towel
Changes that can help prevent hair damage:

Wrap your hair in a towel to absorb the water.
Let your hair air dry.

6- Do not brush your hair while it is wet
Changes that can help prevent hair damage:

Do you have straight hair? Let your hair dry a bit before you gently comb it with a wide-tooth comb.
Do you have textured hair or tight curls? Always comb your hair while it is damp, using a wide-tooth comb.

7- Avoid using a blow dryer, hot comb, or curling iron
Changes that can help prevent hair damage:

Let your hair air dry when possible.
Use the lowest heat setting.
Limit the time a hot comb or curling iron touches your hair.
Use these tools less frequently, aiming for once a week — or even less often.

8- Avoid applying styling products that offer long-lasting hold
Changes that can help prevent hair damage:

Try a hairstyle that does not require this product.

9- Avoid pulling your hair back tightly, such as in a ponytail, bun, or cornrows
Changes that can help prevent hair damage:

Wear hair loosely pulled back.
Use covered rubber bands made especially for styling hair.
Try a different hairstyle that does not pull on your hair.

10- Avoid wearing a weave or hair extensions
Changes that can help prevent hair damage:

Wear weaves and extensions that are light, so they do not pull.
Get weaves and hair extensions at a salon that specializes in these services.
Wear a professional weave or hair extension for 2 or 3 months at most.
Keep up your scalp hygiene when wearing a weave or hair extension.
Switch hairstyles, so you don’t always wear a weave or hair extensions.

11- Avoid coloring, perming, and relax your hair
Changes that can help prevent hair damage:

Try to add more time between touch-ups, especially when the air is dry. In the winter, try to stretch the time between touch-ups to every 8 to 10 weeks or longer.
Have only one service — a coloring, relaxer, or perm. If you want more than one service, perm or relax your hair first, and do it 2 weeks before you color your hair.
Use conditioner after each shampoo.
When in the sun, protect your hair by using a leave-in conditioner that contains zinc oxide or wearing a wide-brimmed hat.

12- Do not brush your hair 100 strokes a day or tugging on your hair to style it
Changes that can help prevent hair damage:

Brush and comb your hair only to style it. Hair never needs 100 brush strokes a day. That’s a myth.
Use a wide-tooth comb, and use it gently to comb your hair.
Avoid pulling and tugging on your hair as you brush, comb, or style it.
Remove tangles gently, using a moisturizing conditioner if necessary.