Hair Loss

What are the types of hair loss?

Many conditions, diseases, and improper hair care result in excessive hair loss. People who notice their hair shedding in large amounts after combing or brushing, or whose hair becomes thinner or fall out, should consult a dermatologist. With a correct diagnosis, many people with hair loss can be helped.

The medical term for hair loss is alopecia. Pattern baldness (androgenetic alopecia), the most common type of alopecia, affects roughly one-third of men and women. It's typically permanent. Another type of alopecia, alopecia areata, can be temporary. It can involve hair loss on your scalp or other parts of your body.

Androgenetic alopecia

Having androgenetic alopecia may mean you experience hair loss as early as during your teen years. For men, this type of baldness is typically characterized by hair loss that begins at the temples and crown. The end result may be partial or complete baldness. Women with androgenetic alopecia usually have hair loss limited to thinning at the front, sides or crown. Complete baldness rarely occurs in women. Androgenetic alopecia is caused by heredity. Although it's most common among men, it can also affect women. A history of androgenetic alopecia on either side of your family increases your risk of balding. Heredity also affects the age at which you begin to lose hair and the developmental speed, pattern and extent of your baldness.

Alopecia areata

With alopecia areata, baldness usually occurs in small, round, smooth patches. You may lose only scalp hair, or you may lose body hair as well. Alopecia areata is classified as an autoimmune disease, but the cause is unknown. People who develop this type of baldness are generally in good health. Some scientists believe that some people are genetically predisposed to develop alopecia areata and that a trigger, such as a virus or something else in the environment, sets off the condition. A family history of alopecia areata makes you more likely to develop it. With alopecia areata, your hair generally grows back, but you may lose and regrow your hair a number of times.

What is normal hair growth?

About 90 percent of the hair on a person's scalp is growing at any one time. The growth phase lasts between two and six years. Ten percent of the hair in a resting are phase that lasts two to three months. At the end of its resting stage, the hair is shed. When hair is shed, new hair from the same follicle replaces it and the growing cycle starts again. Scalp hair grows about one-half inch a month. As people age, their rate of hair growth slows. Most hair shedding is due to the normal hair cycle, and losing 50 to 100 hairs per day is no cause for alarm. If you are concerned about excessive hair loss or dramatic thinning, consult your dermatologist.

What are the causes of hair loss?

1. Improper hair cosmetic use or improper hair care - Many men and women use chemical treatments on their hair, including dyes, tints, bleaches, straighteners and permanent waves. These treatments rarely damage hair if they are done correctly. However, the hair can become weak and break if any of these chemicals are used too often. Hair can also break if the solution is left on too long, if two procedures are done on the same day, or if bleach is applied to previously bleached hair. If hair becomes brittle from chemical treatments, it is best to stop until the hair has grown out.
   
2. Diseases like diabetes, lupus and thyroid disorders can cause hair loss. Both an over-active thyroid and an under-active thyroid can cause hair loss. Your doctor can diagnosis thyroid disease with laboratory tests. Hair loss associated with thyroid disease can be reversed with proper treatment.
   
3. Poor nutrition. Having inadequate protein or iron in your diet or poor nourishment in other ways can cause you to experience hair loss. Fad diets, crash diets and certain illnesses, such as eating disorders, can cause poor nutrition. Inadequate protein in diet - Some people who go on crash diets that are low in protein, or have abnormal eating habits, may develop protein malnutrition. The body will save protein by shifting growing hair into the resting phase. Massive hair shedding can occur two to three months later. Hair can then be pulled out from the roots fairly easily. This condition can be reversed and prevented by eating the proper amount of protein and, when dieting, maintaining adequate protein intake.
   
4. Medications. Certain drugs used to treat gout, arthritis, depression, heart problems and high blood pressure may cause hair loss in some people. Taking birth control pills also may result in hair loss for some women.
   
5. Medical treatments. Undergoing chemotherapy or radiation therapy may cause you to develop alopecia. After your treatment ends, your hair typically begins to regrow.
   
6. Recent high fever, severe flu or surgery. You may notice you have less hair three to four months after events such as an illness or surgery. These conditions cause hair to shift rapidly into a resting phase (telogen effluvium), meaning you'll see less new hair growth. A normal amount of hair typically will appear after the growth phase resumes.
   
7. Infancy. Newborns often lose hair during the first several months of life. This baby hair (vellus) is eventually replaced by more permanent hair. It's also common for babies to lose a patch of hair on the back of their heads from rubbing against mattresses, playpens and car seats. Hair will grow back once a baby begins to spend more time sitting up.
   
8. Hairstyles that pull on the hair, like ponytails and braids, should not be pulled tightly and should be alternated with looser hairstyles. Constant pull causes some hair loss, especially along the sides of the scalp.
   
9. Shampooing, combing and brushing too often can also damage hair, causing it to break. Using a cream rinse or conditioner after shampooing will make it easier to comb and more manageable. When hair is wet, it is more fragile, so vigorous rubbing with a towel, and rough combing and brushing should be avoided. Do not follow the old rule of 100 brush strokes a day that damages hair. Instead, use wide toothed combs and brushes with smooth tips.
   
10. Hereditary thinning or balding - Hereditary balding or thinning is the most common cause of hair loss. The tendency can be inherited from either the mother's or father's side of the family. Women with this trait develop thin hair, but do not become completely bald. The condition is called androgenetic alopecia and it can start in the teens, twenties or thirties.
    
11. Alopecia areata - In this type of hair loss, hair usually falls out, resulting in totally smooth, round patches about the size of a coin or larger. It can, rarely, result in complete loss of scalp and body hair. This disease may affect children or adults of any age. The cause of alopecia areata is unknown. Apart from the hair loss, affected persons are generally in excellent health. In most cases, the hair regrows by itself. Dermatologists can treat many people with this condition. Treatments include topical medications, a special kind of light treatment, or in some cases pills.
    
12. Childbirth - When a woman is pregnant, more of her hair will be growing. However, after a woman delivers her baby, many hair enter the resting phase of the hair cycle. Within two to three months, some women will notice large amounts of hair coming out in their brushes and combs. This can last one to six months, but resolves completely in most cases.
    
13. Cancer treatments - Some cancer treatments will cause hair cells to stop dividing. Hair become thin and break off as they exit the scalp. This occurs one to three weeks after the treatment. Patients can lose up to 90 percent of their scalp hair. The hair will regrow after treatment ends. Patients may want to get wigs before treatment.
    
14. Birth control pills - Women who lose hair while taking birth control pills usually have an inherited tendency for hair thinning. If hair thinning occurs, a woman can consult her gynaecologist about switching to another birth control pill. When a women stops using oral contraceptives, she may notice that her hair begins shedding two or three months later. This may continue for six months when it usually stops. This is similar to hair loss after the birth of a child.
    
15. Low serum iron - Iron deficiency occasionally produces hair loss. Some people do not have enough iron in their diets or may not fully absorb iron. Women who have heavy menstrual periods may develop iron deficiency. Low iron can be detected by laboratory tests and can be corrected by taking iron pills.
    
16. Major surgery/chronic illness - Anyone who has a major operation may notice increased hair shedding within one to three months afterwards. The condition reverses itself within a few months but people who have a severe chronic illness may shed hair indefinitely.
    
17. Fungus infection (Ringworm) of the scalp – This is caused by a fungus infection. Ringworm (which has nothing to do with worms) begins as small patches of scaling that can spread and result in broken hair, redness, swelling, and even oozing. This contagious disease is most common in children and oral medication will cure it.
    
18. Hair pulling (Trichotillomania) - Children and sometimes adults will twist or pull their hair, brows or lashes until they come out. In children especially, this is often just a bad habit that gets better when the harmful effects of that habit are explained. Sometimes hair pulling can be a coping response to unpleasant stresses and occasionally is a sign of a serious problem needing the help of a mental health professional.

How is the diagnosis confirmed?

Dermatologists, physicians who specialize in treating diseases of the hair and skin, will evaluate a patient's hair problem by asking questions about diet, medications including vitamins and health food taken in the last six months, family history of hair loss, recent illness and hair care habits. Hormonal effects may be evaluated in women by asking about menstrual cycles, pregnancies and menopause. After examining the scalp and hair, the dermatologist may check a few hair under the microscope. Sometimes blood tests or a scalp biopsy may be required for an accurate diagnosis. It is important to find the cause and whether or not the problem will respond to medical treatment.

What is the treatment?

For hair loss caused by illness such as fever, radiation therapy, or medication use, no treatment is necessary. The hair will usually grow back when illness has ended or therapy has stopped. A wig, hat, or other covering may be desired until the hair grows back.

Baldness, whether permanent or temporary, can't be cured. But treatments are available to help promote hair growth or hide hair loss. For some types of alopecia, hair may resume growth without any treatment.

Medications
The effectiveness of medications used to treat alopecia depends on the cause of hair loss, extent of the loss and individual response. Generally, treatment is less effective for more extensive cases of hair loss.
The types of drugs for treatment of alopecia include

Minoxidil: this is used for the treatment of androgenetic alopecia and alopecia areata. Minoxidil is a liquid that you rub into your scalp twice daily to regrow hair and to prevent further loss.
Finasteride: this prescription medication to treat male-pattern baldness is taken daily in pill form. Many people taking finasteride experience a slowing of hair loss, and some may show some new hair growth. This prescription medication to treat male-pattern baldness is taken daily in pill form. Finasteride is not approved for use by women.
Corticosteroids: injections of cortisone into the scalp can treat alopecia areata.

For hair loss caused by illness such as fever, radiation therapy, or medication use, no treatment is necessary. The hair will usually grow back when illness has ended or therapy has stopped. A wig, hat, or other covering may be desired until the hair grows back. As far as the environmental factors are concerned, diet plays a very important part. You should see to it that you take a diet rich in Vitamin B-complex and proteins. Too much of stress and pollution may also be a cause of your problem. You should see to it that your scalp is not kept dirty for long.

Surgical procedures

Hair transplants and scalp reduction surgery are available to treat androgenetic alopecia when more conservative measures have failed. During transplantation a dermatologist or cosmetic surgeon takes tiny plugs of skin, each containing one to several hairs, from the back or side of the scalp. The plugs are then implanted into the bald sections. Several transplant sessions may be needed as hereditary hair loss progresses with time.

Scalp reduction means decreasing the area of bald skin on the head. The scalp and the top part of the head may seem to have a snug fit. But the skin can become flexible and stretched enough for some of it to be surgically removed. After hairless scalp is removed, the space is closed with hair-covered scalp.

Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring.