Hair Loss

What causes hair loss?

There are numerous sources of hair loss. Collectively all forms of hair loss are referred to as alopecia, at term that simply means "hair loss". Hair loss can be a significant source of frustration and can cause lack of self esteem and can even lead to depression. For some causes of hair loss, it can also be accompanied by significant scalp pain or itching. Below we will cover some of the most common causes of hair loss. 

 

Male and Female Pattern Hair Loss

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These are the most common causes of hair loss. They are also referred to as androgenic or androgenetic hair loss. This type of hair loss becomes more common with age and is most heavily influenced by genetics. The hair loss is caused by production of androgens (testosterone-type hormones) that cause hairs in certain areas of the scalp to shrink and in some cases completely disappear. For men, this typically happens on the frontal and central scalp. Women tend to experience more diffuse thinning of hair throughout the entire top of the scalp. Hairs on the sides of the scalp are not as sensitive to the hormones that cause hair loss and are not typically affected. This is why hair transplants work, as the hairs from the sides maintain this unique property even when transplanted to the top of the scalp. 

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This type of hair loss has several options for treatment. The most common, and one that is highly effective in many patients, is use of topical over the counter Rogaine (minoxidil). For more severe cases, oral medications such as Propecia (finasteride) have been shown to be effective. More recently, oral minoxidil has been shown to be effective and safe if used in low doses. For those who do not respond to typical forms of therapy, hair transplants can be an effective, albeit expensive option. 

Alopecia Areata

Although many, especially in the media, simply refer to this form of hair loss as "alopecia", the correct term is alopecia areata. Alopecia areata typically appears as round patches of complete hair loss and most commonly appears on the scalp, although it can appear anywhere on the body. This disease is due to the body's own immune system attacking hair follicles and causing the hairs to disappear. It is unknown why this happens, but patients with alopecia areata are more likely to suffer from other autoimmune conditions such as thyroid disease. 

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This form of hair loss is typically treated with medications that suppress the immune response to allow hairs to grow normally. This can be done with topical medications such as anti-inflammatory steroid creams or steroid injections. For more severe disease, oral medications may also be used. The good news with this form of hair loss is that although hairs may no longer be visible, the "roots" are still there and with proper treatment the hairs can return. 

Telogen Effluvium

Our bodies naturally lose about 100 hairs a day. This is because our hairs naturally go through phases of growth, rest, and then shedding. Typically about 10% of our hairs are in the shedding phase. When certain life stressors occur such a pregnancy, major illnesses, or starting new medications, a higher percentage of hairs will enter the shedding phase. This may continue until the stressor is eliminated. Once the stressor is removed, hairs slowly return to their normal cycle distribution and a full head of hair returns. This process can take up to 6-12 months. Treatments similar to those done for male and female pattern hair loss may be done to help speed up the return of hairs to their normal state. 

Hair Loss due to Inflammatory or other Skin Diseases

There are many other forms of hair loss. Some are due to actual diseases of the skin. Some examples would include lichen planopilaris, frontal fibrosing alopecia, lupus, psoriasis, seborrheic dermatitis, and several others. The most important step is to make a proper diagnosis which can lead to the appropriate treatment. Diagnosis is not always easy as many conditions can show similar features, so evaluation by an expert of the hair and skin such as a dermatologist is essential. Once a diagnosis is established, most patients can see significant improvement through proper treatment.