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Hair loss

Loss of hair; Alopecia; Baldness; Scarring alopecia; Non-scarring alopecia

Partial or complete loss of hair is called alopecia.

Considerations

Hair loss usually develops gradually. It may be patchy or all over (diffuse). You lose roughly 100 hairs from your head every day. The scalp contains about 100,000 hairs.

Causes

HEREDITY

Both men and women tend to lose hair thickness and amount as they age. This type of baldness is not usually caused by a disease. It is related to aging, heredity, and changes in the hormone testosterone. Inherited, or pattern baldness, affects many more men than women. Male pattern baldness can occur anytime after puberty. About 80% of men show signs of male pattern baldness by age 70.

PHYSICAL OR EMOTIONAL STRESS

Physical or emotional stress may cause one-half to three-quarters of scalp hair to shed. This kind of hair loss is called telogen effluvium. Hair tends to come out in handfuls while you shampoo, comb, or run your hands through your hair. You may not notice this for weeks to months after the episode of stress. Hair shedding decreases over 6 to 8 months. Telogen effluvium is usually temporary. But it can become long-term (chronic).

Causes of this type of hair loss are:

  • High fever or severe infection
  • Childbirth
  • Major surgery, major illness, sudden blood loss
  • Severe emotional stress
  • Crash diets, especially those that do not contain enough protein
  • Drugs, including retinoids, birth control pills, beta-blockers, calcium channel blockers, certain antidepressants, NSAIDs (including ibuprofen).

Some women ages 30 to 60 may notice a thinning of the hair that affects the entire scalp. The hair loss may be heavier at first, and then gradually slow or stop. There is no known cause for this type of telogen effluvium.

OTHER CAUSES

Other causes of hair loss, especially if it is in an unusual pattern, include:

  • Alopecia areata (bald patches on the scalp, beard, and, possibly, eyebrows; eyelashes may fall out).
  • Anemia
  • Autoimmune conditions such as lupus
  • Burns
  • Certain infectious diseases such as syphilis
  • Excessive shampooing and blow-drying
  • Hormone changes
  • Thyroid diseases
  • Nervous habits such as continual hair pulling or scalp rubbing
  • Radiation therapy
  • Tinea capitis (ringworm of the scalp)
  • Tumor of the ovary or adrenal glands
  • Hair styles that put too much tension on the hair follicles.

Home Care

Hair loss from menopause or childbirth often goes away after 6 months to 2 years.

For hair loss due to illness (such as fever), radiation therapy, medicine use, or other causes, no treatment is needed. Hair usually grows back when the illness ends or the therapy is finished. You may want to wear a wig, hat, or other covering until the hair grows back.

Hair weaves, hair pieces, or changes of hair style may disguise hair loss. This is generally the least expensive and safest approach to hair loss. Hair pieces should not be sutured (sewn) to the scalp because of the risk of scars and infection.

When to Contact a Medical Professional

Call your health care provider if you have any of the following:

  • Losing hair in an unusual pattern
  • Losing hair rapidly or at an early age (for example, in your teens or twenties)
  • Pain or itching with the hair loss
  • The skin on your scalp under the involved area is red, scaly, or otherwise abnormal
  • Acne, facial hair, or an abnormal menstrual cycle
  • You are a woman and have male pattern baldness
  • Bald spots on your beard or eyebrows
  • Weight gain or muscle weakness, intolerance to cold temperatures, or fatigue
  • Areas of infection on your scalp

What to Expect at Your Office Visit

A careful medical history and examination of the hair and scalp are usually enough to diagnose the cause of your hair loss.

Your provider will ask detailed questions about:

  • Symptoms of your hair loss. If there is a pattern to your hair loss or if you are losing hair from other parts of your body as well, if other family members have hair loss.
  • How you care for your hair. How often you shampoo and blow dry or if you use hair products.
  • Your emotional well-being and if you are under a lot of stress
  • Your diet, if you have made recent changes
  • Recent illnesses such as a high fever

Tests that may be performed (but are rarely needed) include:

  • Blood tests to rule out disease
  • Microscopic examination of a plucked hair
  • Skin biopsy

If you have ringworm on the scalp, you may be prescribed an antifungal shampoo and oral medicine for you to take. Applying creams and lotions may not get into the hair follicles to kill the fungus.

Your provider may prescribe a solution, such as Minoxidil that is applied to the scalp to stimulate hair growth. Other medicines, such as hormones, may be prescribed to decrease hair loss and promote hair growth. Drugs such as finasteride and dutasteride can be taken by men to decrease hair loss and grow new hair.

Hair transplant may also be recommended.

References

Avram MR, Keene SA, Stough DB, Rogers NE. Hair restoration. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 157.

Sperling LC, Sinclair RD, El Shabrawi-Caelen L. Alopecias. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 69.

    • Hair follicle

      Hair follicle - illustration

      Each hair sits in a cavity in the skin called a follicle. Over time the follicle can shrink causing the hair to become shorter and finer. Ordinarily, the hair should grow back but in men who are balding the very small follicle ceases to grow any hair. The cause of baldness is not well understood, but is thought to be related to the genes and male sex hormones of the individual.

      Hair follicle

      illustration

    • Ringworm, tinea capitis - close-up

      Ringworm, tinea capitis - close-up - illustration

      In the scalp, fungal infections often form circular, scaly, inflamed patches. Frequently, there can be temporary hair loss (hair returns when infection clears but if treatment is delayed and scarring results, permanent hair loss can be seen). This is a classical example of ringworm (tinea capitis) in a young child.

      Ringworm, tinea capitis - close-up

      illustration

    • Alopecia areata with pustules

      Alopecia areata with pustules - illustration

      Pus-filled lesions (pustules) are unusual in alopecia areata, but can occur, as in this picture. The pustules are infected where medication was injected into the area.

      Alopecia areata with pustules

      illustration

    • Alopecia totalis - back view of the head

      Alopecia totalis - back view of the head - illustration

      Hair loss is referred to as alopecia. Patchy hair loss on the scalp is called alopecia areata. Complete scalp hair loss is alopecia totalis. Loss of all body hair is called alopecia universalis.

      Alopecia totalis - back view of the head

      illustration

    • Alopecia totalis - front view of the head

      Alopecia totalis - front view of the head - illustration

      Hair loss is referred to as alopecia. Patchy hair loss on the scalp is called alopecia areata. Complete scalp hair loss is alopecia totalis. Hair loss from the entire body, including the eyebrows, eyelashes, and body hair, is alopecia universalis.

      Alopecia totalis - front view of the head

      illustration

    • Alopecia, under treatment

      Alopecia, under treatment - illustration

      This picture shows alopecia areata, under treatment. The hair loss is being treated with anthralin, which causes the brownish hyperpigmentation and can induce hair regrowth. It is very unlikely regrowth will occur when hair is lost along the scalp margin (ophiasis).

      Alopecia, under treatment

      illustration

    • Trichotillomania - top of the head

      Trichotillomania - top of the head - illustration

      Trichotillomania is repetitive twisting and twirling of the hair. The hair loss is usually in a well-defined area with shortened, broken-off hairs and early regrowth of hair. The scalp is the most commonly involved site, but eyelashes and eyebrows may also be involved. The hair loss can also be patchy and poorly defined.

      Trichotillomania - top of the head

      illustration

    • Folliculitis, decalvans on the scalp

      Folliculitis, decalvans on the scalp - illustration

      Folliculitis, decalvans causes scarring with hair loss (alopecia). There are areas of "corn stalking" (grouped hairs arising within the area of alopecia), redness (erythema), crusting, and pustules. Due to severe scarring, permanent hair loss occurs in the involved sites.

      Folliculitis, decalvans on the scalp

      illustration

      • Hair follicle

        Hair follicle - illustration

        Each hair sits in a cavity in the skin called a follicle. Over time the follicle can shrink causing the hair to become shorter and finer. Ordinarily, the hair should grow back but in men who are balding the very small follicle ceases to grow any hair. The cause of baldness is not well understood, but is thought to be related to the genes and male sex hormones of the individual.

        Hair follicle

        illustration

      • Ringworm, tinea capitis - close-up

        Ringworm, tinea capitis - close-up - illustration

        In the scalp, fungal infections often form circular, scaly, inflamed patches. Frequently, there can be temporary hair loss (hair returns when infection clears but if treatment is delayed and scarring results, permanent hair loss can be seen). This is a classical example of ringworm (tinea capitis) in a young child.

        Ringworm, tinea capitis - close-up

        illustration

      • Alopecia areata with pustules

        Alopecia areata with pustules - illustration

        Pus-filled lesions (pustules) are unusual in alopecia areata, but can occur, as in this picture. The pustules are infected where medication was injected into the area.

        Alopecia areata with pustules

        illustration

      • Alopecia totalis - back view of the head

        Alopecia totalis - back view of the head - illustration

        Hair loss is referred to as alopecia. Patchy hair loss on the scalp is called alopecia areata. Complete scalp hair loss is alopecia totalis. Loss of all body hair is called alopecia universalis.

        Alopecia totalis - back view of the head

        illustration

      • Alopecia totalis - front view of the head

        Alopecia totalis - front view of the head - illustration

        Hair loss is referred to as alopecia. Patchy hair loss on the scalp is called alopecia areata. Complete scalp hair loss is alopecia totalis. Hair loss from the entire body, including the eyebrows, eyelashes, and body hair, is alopecia universalis.

        Alopecia totalis - front view of the head

        illustration

      • Alopecia, under treatment

        Alopecia, under treatment - illustration

        This picture shows alopecia areata, under treatment. The hair loss is being treated with anthralin, which causes the brownish hyperpigmentation and can induce hair regrowth. It is very unlikely regrowth will occur when hair is lost along the scalp margin (ophiasis).

        Alopecia, under treatment

        illustration

      • Trichotillomania - top of the head

        Trichotillomania - top of the head - illustration

        Trichotillomania is repetitive twisting and twirling of the hair. The hair loss is usually in a well-defined area with shortened, broken-off hairs and early regrowth of hair. The scalp is the most commonly involved site, but eyelashes and eyebrows may also be involved. The hair loss can also be patchy and poorly defined.

        Trichotillomania - top of the head

        illustration

      • Folliculitis, decalvans on the scalp

        Folliculitis, decalvans on the scalp - illustration

        Folliculitis, decalvans causes scarring with hair loss (alopecia). There are areas of "corn stalking" (grouped hairs arising within the area of alopecia), redness (erythema), crusting, and pustules. Due to severe scarring, permanent hair loss occurs in the involved sites.

        Folliculitis, decalvans on the scalp

        illustration

      Review Date: 4/14/2015

      Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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