Hair loss is extremely common, affecting about 50 million men and 30 million women in the U.S. About 50% of men will have some hair loss by the time they turn 50. Hair loss is not life-threatening, though it can have devastating psychological effects, particularly in women.
Hair loss is often distressing and can have a significant effect on the patient’s quality of life. Patients may present to their family physician first with diffuse or patchy hair loss. Scarring alopecia is best evaluated by a dermatologist.
Nonscarring alopecias can be readily diagnosed and treated in the family physician’s office. Androgenetic alopecia can be diagnosed clinically and treated with minoxidil. Alopecia areata is diagnosed by typical patches of hair loss and is self-limited. Tinea capitis causes patches of alopecia that may be erythematous and scaly and must be treated systemically.
Physiology of Hair Growth
Hair grows in three phases: anagen (active growing, about 90 % of hairs), catagen (degeneration, less than 10% of hairs) and telogen (resting, 5% to 10% of hairs). Hair is shed during the telogen phase.
Causes of Hair Loss
Hair loss is often caused by genetics, that is, it runs in families. In general, it is not a symptom of disease, however, thyroid disease, anemia, ringworm of the scalp, and anorexia can cause hair loss. In addition, some medications such as cancer chemotherapy may cause temporary hair loss. Hair growth usually returns to normal when the medications are stopped. In some cases, hormones changes after giving birth or during menopause can cause thinning hair.
Types of Hair Loss
There are several types of hair loss, often classified by whether the loss is localized, or if it affects large areas, or if the hair loss is patchy or affects the entire scalp. Some of the more common hair loss causes are discussed on the following slides.
- Alopecia Areata – Alopecia areata (AA) is a common form of hair loss. It is believed to be an autoimmune condition where circular bald patches appear on the scalp and other hair-bearing areas.
- Traction Alopecia – Traction alopecia is caused over time by constant pulling on hair roots. Hairstyles that cause tension on the hair follicles such as tight braids, or “corn rows,” often cause this condition. It may also be caused by chemical straightening or weaving.
- Trichotillomania – A medical disorder that causes people to pull out their own hair is called trichotillomania. Often a person feels compelled to pull out hairs on their scalp, eyelashes, eyebrows, or other hairs on the body. Cognitive behavioral therapy and medications can help treat the condition.
- Tinea Capitis (Fungal Infection) – Tinea capitis, or ringworm of the scalp, is a fungal infection that tends to attack hair shafts and follicles leading to hair loss. It appears as bald spots with black dots where the hair has broken off. It most commonly affects children, but can affect adults as well. Treatment usually includes antifungal compounds.
- Telogen Effluvium – Telogen effluvium (TE) is a thinning of the hair on the scalp, not necessarily evenly. Hair growth involves several phases. Hair grows for a few years, rests (the telogen phase), sheds, and then regrows. When hair roots prematurely reach the resting phase, this is called telogen effluvium.
Some men may start to notice thinning hair as early as their 20s, and by age 50, 50% of men see some hair loss. Hair is usually lost in a pattern, starting at the temples, revealing the classic “M” shaped hairline seen as men age.
It’s not just men who lose their hair. While men tend to start losing hair on their forehead hairline, women tend to notice hair loss appearing on the top and crown of the scalp. As in men, it may be related to genetics (family history), and it is more commonly seen after menopause. Unlike men, the hair loss does not tend to be total and the front hairline is not usually affected any more than it is in women without hair loss.
Hair Loss Treatment
First, it is important to determine that hair loss is not caused by an underlying medical condition. If that is the case, the medical condition needs to be addressed.
If there is no medical problem causing the hair loss, treatment options include medications, surgery, grooming techniques, wigs, and hairpieces.
Medications for Hair Loss
There is no shampoo, conditioner, or other product that will help hair to grow. There are, however, products that can slow down hair loss.
Laser Treatments for Hair Loss
Low-dose laser therapy is being used under several names as a treatment for genetic baldness. This therapy is also called red light therapy, cold laser, soft laser, biostimulation, and photobiomodulation. Laser therapy may be used instead of, or in addition to, surgical options. Options include:
- Hoods worn inside a salon
- Hand-held laser devices
- Caps and combs used at home
Surgery for Hair Loss
Permanent hair loss can be treated with surgery. There are three common types of hair replacement surgery:
- Hair Transplant – also called hair grafting – hair is taken from the back of the head and replaced in the front
- Scalp reduction – bald areas are surgically removed and the hair-bearing areas of the scalp are stitched together
- Scalp expansion – devices are inserted under the scalp to stretch the skin. This may be used before scalp reduction to help make the scalp laxer, or on hair-bearing areas, which can reduce balding.
These procedures are best for men with male-pattern baldness, and some women with female-pattern baldness. It is not recommended for people who do not have sufficient hair in “donor” sites (the parts of their scalp where hair will be taken), and people who tend to form keloid scars.