What is it?
- Hair loss can start with a few extra hairs in the sink or in your comb. Later, it can progress to a bare scalp.
- Baldness typically refers to excessive hair loss from your scalp and can be the result of heredity, certain medications or an underlying medical condition. Anyone — men, women and children — can experience hair loss.
- Some people prefer to let their baldness run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the medications and surgical procedures that are available to treat hair loss. Before pursuing any treatment option, talk with your doctor about the cause of and best possible treatments for your hair loss.
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.
Permanent hair loss
- Male-pattern baldness (androgenetic alopecia). For men, pattern baldness can begin early, even in the teens or early 20s. It's typically characterized by a receding hairline at the temples and balding at the top of the head. The end result may be partial or complete baldness.
- Female-pattern baldness (androgenetic alopecia). Women with permanent hair loss usually have hair loss limited to thinning at the front, sides or crown. Women usually maintain their front hairline and rarely experience complete baldness.
- Cicatricial (scarring) alopecia. This rare condition occurs when inflammation damages and scars hair follicles, causing permanent hair loss. Sometimes the patchy hair loss is associated with itching or pain.
Temporary hair loss
- Alopecia areata. Hair loss usually occurs in small, round, smooth patches about the size of a quarter. Usually the disease doesn't extend beyond a few bare patches on the scalp, but it can cause patchy hair loss on any area that has hair, including eyebrows, eyelashes and beard. In rare cases, it can progress to cause hair loss over the entire body. If the hair loss includes your entire scalp, the condition is called alopecia totalis. If it involves your whole body, it's called alopecia universalis. Soreness and itching may precede the hair loss, but symptoms are often minimal.
- Telogen effluvium. This type of temporary hair loss occurs suddenly, most often after a significant illness or major life stress. Handfuls of hair may come out when combing or washing your hair or may fall out after gentle tugging. This type of hair loss usually causes overall hair thinning and not bald patches.
- Traction alopecia. Bald patches can occur if you regularly wear certain hairstyles, such as pigtails, braids or cornrows, or if you use tight rollers. Hair loss typically occurs between the rows or at the part where hair is pulled tightly.
- Anagen effluvium. In this type of hair loss, actively growing hairs in the anagen state are affected most often by chemotherapeutic drugs given to fight cancer or lymphoma. Hair loss starts soon after beginning therapy and is more extensive than in the telogen effluvium state. In the weeks after the therapy has been completed, the hair cycles re-establish themselves, although the hair may not return as thickly as before chemotherapy.
Due to hormonal changes, irritation or damage, some hair follicles have a shorter growth phase and produce thinner, shorter hair shafts. Your hair goes through a cycle of growth and rest. The course of each cycle varies by individual. But in general, the growth phase of scalp hair, known as anagen, typically lasts two to three years. During this time, your hair grows just less than 1/2 inch (1 centimeter) a month. The resting phase is called telogen. This phase typically lasts three to four months. At the end of the resting phase, the hair strand falls out and a new one begins to grow in its place. Once a hair is shed, the growth stage begins again.
Most people normally shed 50 to 100 hairs a day. But with about 100,000 hairs in the scalp, this amount of hair loss shouldn't cause noticeable thinning of the scalp hair.
Gradual thinning is a normal part of aging. However, hair loss may lead to baldness when the rate of shedding exceeds the rate of regrowth, when new hair is thinner than the hair shed or when hair comes out in patches.
Causes of specific types of hair loss
- Pattern baldness (androgenetic alopecia). In male- and female-pattern baldness, the time of growth shortens, and the hairs are not as thick or sturdy. With each growth cycle, the hairs become rooted more superficially and more easily fall out. Heredity likely plays a key role. 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.
- Cicatricial (scarring) alopecia. This type of permanent hair loss occurs when inflammation damages and scars the hair follicle. This prevents new hair from growing. This condition can be seen in several skin conditions, including lupus erythematosus or lichen planus. It's not known what triggers or causes this inflammation.
- Alopecia areata. This is classified as an autoimmune disease, but the cause is unknown. People who develop alopecia areata are generally in good health. A few people may have other autoimmune disorders, including thyroid disease. 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.
- Telogen effluvium. This type of hair loss is usually due to a change in your normal hair cycle. It may occur when some type of shock to your system — emotional or physical — causes hair roots to be pushed prematurely into the resting state. The affected growing hairs from these hair roots fall out. In a month or two, the hair follicles become active again and new hair starts to grow. Telogen effluvium may follow emotional distress, such as a death in the family or a physiological stress, such as a high fever, sudden or excessive weight loss, extreme diets, nutritional deficiencies, surgery, or metabolic disturbances. Hair typically grows back once the condition that caused it corrects itself, but it usually take months.
- Traction alopecia. Excessive hairstyling or hairstyles that pull your hair too tightly cause traction alopecia. If the pulling is stopped before there's scarring of your scalp and permanent damage to the root, hair usually grows back normally.
Other causes of hair loss
- 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.
- 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.
- Disease. Diabetes and lupus can cause hair loss.
- Medical treatments. Undergoing chemotherapy or radiation therapy may cause you to develop alopecia. Under these conditions, healthy, growing (anagen) hairs can be affected. After your treatment ends, your hair typically begins to regrow.
- Hormonal changes. Hormonal changes and imbalances can cause temporary hair loss. This could be due to pregnancy, childbirth, discontinuation of birth control pills, the onset of menopause, or an overactive or underactive thyroid gland. The hair loss may be delayed by three months following a hormonal change, and it'll take another three months for new hair to grow back. During pregnancy, it's normal to have thicker, more luxuriant hair. It's also common to lose more hair than normal about three months after delivery. If a hormonal imbalance is associated with an overproduction of testosterone, there may be a thinning of hair over the crown of the scalp. Correcting hormonal imbalances may stop hair loss.
- Hair treatments. Chemicals used for dying, tinting, bleaching, straightening or permanent waves can cause hair to become damaged and break off if they are overused or used incorrectly. Overstyling and excessive brushing also can cause hair to fall out if the hair shaft becomes damaged.
- Scalp infection. Infections, such as ringworm, can invade the hair and skin of your scalp, leading to hair loss. Once infections are treated, hair generally grows back. Ringworm, a fungal infection, can usually be treated with a topical or oral antifungal medication.
- Trichotillomania (hair-pulling disorder). Trichotillomania is a type of mental illness in which people have an irresistible urge to pull out their hair, whether it's from the scalp, their eyebrows or other areas of the body. Hair pulling from the scalp often leaves them with patchy bald spots on the head, which they may go to great lengths to disguise. Causes of trichotillomania are still being researched, and no specific cause has yet been found.
A complete medical history, family history and physical examination can help in a diagnosis. The pattern and rate of hair loss, the appearance of nearby hairs (for example, if hairs are broken off), and accompanying symptoms are considered when making the diagnosis.
Tests may be necessary if the cause isn't apparent after the examination. These include:
- Pull test. Several dozen hairs are gently pulled to see how many come out. This helps determine the stage of the shedding process and can help diagnose or rule out telogen effluvium.
- Skin scrapings. Samples taken from the skin or from a few hairs plucked from the scalp can help verify whether an infection is causing hair loss.
- Punch biopsy. When a diagnosis is difficult to confirm, especially in the case of alopecia areata or scarring alopecia, your doctor may perform a punch biopsy. During this test, the doctor uses a circular tool to remove a small section of your skin's deeper layers.
- Screening tests for related diseases. Your doctor may perform tests to determine if you have a medical condition that causes hair loss, such as thyroid disease, diabetes or lupus. Your doctor may also ask questions about the types of medications you're taking. Sometimes hair loss is a side effect of certain drugs, such as those that treat gout, arthritis, depression, heart problems and high blood pressure.