What Is Hair Loss?
The American Academy of Dermatology (AAD) notes that 80 million men and women in America have hereditary hair loss (alopecia). (AAD) It can affect just the hair on your head or your whole body. Although it is more prevalent in older adults, excessive hair loss can even occur in children.
According to Kids Health and the AAD, it is natural to lose between 50 and 100 hairs a day. (Kids Health). With about 100,000 hairs on your head, that small loss is unnoticeable. The lost hair is normally replaced by new hair but not always. Hair loss can develop gradually over years or happen abruptly. Hair loss can be permanent or temporary.
It is impossible to count the amount of hair lost on a given day. You may be losing more hair than is normal if you notice:
- a large amount of hair in the drain after washing your hair
- clumps of hair in your brush
- you notice thinning patches of hair
- you experience baldness
If you notice that you are losing more hair than usual, you should discuss the problem with your doctor. He or she can determine the underlying cause of your hair loss and suggest appropriate treatment plans.
Causes of Hair Loss
First your doctor or dermatologist (a doctor who specializes in skin problems) will try to determine the underlying cause of your hair loss. The most common cause of hair loss is hereditary male- or female-pattern baldness. If you have a family history of baldness, you may be susceptible to this type of hair loss. It is triggered by certain sex hormones and may begin as early as puberty.
In some cases, hair loss may be related to a simple halt in the cycle of hair growth. Major illnesses, surgeries, or traumatic events can trigger hair loss. However, your hair will usually start growing back without treatment.
Hormonal changes associated with pregnancy, childbirth, discontinuing the use of birth control pills, and menopause can cause temporary hair loss.
Medical conditions that can cause hair loss include thyroid disease, alopecia areata (an autoimmune disease that attacks hair follicles), and scalp infections like ringworm. Diseases that cause scarring like lichen planus and some types of lupus can result in permanent hair loss because of the scarring.
Hair loss can also be caused by medications used to treat cancer, high blood pressure, arthritis, depression, and heart problems.
A physical or emotional shock may trigger hair loss that will be noticeable after the event. Examples of this type of shock include a death in the family, extreme weight loss, or a high fever. People with the mental illness trichotillomania (hair-pulling disorder) have a compulsion to pull out their hair—usually from their head, eyebrows, or eyelashes. Traction hair loss can be caused by hairstyles that put pressure on the follicles by pulling the hair back very tightly.
A diet lacking in protein, iron, and other nutrients can lead to thinning hair.
Diagnosing Hair Loss
Persistent hair loss is often indicative of an underlying health issue. Your doctor or dermatologist can determine the cause of your hair loss based on a physical examination and your health history. In some cases, simple dietary changes can help, along with switching prescription medications.
If your dermatologist suspects an autoimmune or skin disease, he or she might take a biopsy of the skin on your scalp. This will involve carefully removing a small section of skin for laboratory testing. It is important to keep in mind that hair growth is a complex process, so it may take time to determine the exact cause of your hair loss.
Medications for Hair Loss
Medications will likely be the first course of treatment for hair loss. Over-the-counter medications generally consist of topical creams and gels that are applied directly to the scalp. The most common products contain an ingredient called minoxidil (Rogaine). According to the American Academy of Dermatology, minoxidil achieves the best results when used in conjunction with other hair loss treatments. Side effects of minoxidil include scalp irritation and hair growth in adjacent areas like your forehead or face.
Prescription medications may also be used in the treatment of hair loss. The oral medication finasteride (Propecia) is prescribed for male-pattern baldness. It is taken daily to slow hair loss. Some men experience new hair growth when taking finasteride. Rare side effects of this medication include diminished sex drive and impaired sexual function. There may be a link between use of finasteride and a fast-growing type of prostate cancer.
Corticosteroids like prednisone may be prescribed for individuals with alopecia areata to reduce inflammation and suppress the immune system. Corticosteroids mimic the hormones made by your adrenal glands; when the amount of the corticosteroid is higher than would be made by your body, it reduces inflammation and suppresses the immune system. Side effects from these medications must be monitored carefully. They include:
- glaucoma (high intraocular pressure)
- fluid retention and swelling in lower legs
- higher blood pressure
- high blood sugar
- increased risk for infections
- calcium loss from bones that may lead to osteoporosis
- thin skin and easy bruising
- sore throat
Sometimes, medications aren’t enough to stop hair loss. There are surgical procedures to treat baldness.
Hair transplant surgery involves moving small plugs of skin, each with a few hairs, to bald parts of your scalp. This works well for people with inherited baldness since they typically lose hair on the top of the head. Because that type of hair loss is progressive, you would need multiple surgeries over time.
In a scalp reduction, a surgeon removes part of your scalp that lacks hair. The area is closed with a piece of your scalp that has hair. Another option is a flap: your surgeon folds scalp that has hair over a bald patch. This is a type of scalp reduction.
Tissue expansion can also be used to cover bald spots. It requires two surgeries; in the first a tissue expander is placed under a part of the scalp that has hair and is next to the bald spot. After several weeks, the expander will have caused the growth of new skin cells. In the second surgery, the expander will be removed, and the new skin with hair will be placed over the bald spot.
These surgical remedies for baldness tend to be expensive and carry risks, including:
- patchy hair growth
- wide scars
- grafts may not take, and the surgery would need to be repeated
According to the Mayo Clinic, if you are experiencing hair loss there are things you can do to prevent further loss. (Mayo) Don’t wear tight hairstyles like braids, ponytails, or buns that put too much pressure on your hair. Over time those styles permanently damage your hair follicles. Make sure your diet is nutritionally balanced and that you are getting adequate amounts of iron and protein. Try not to pull on your hair or twist/rub it.
Certain beauty regimens can actually worsen or cause hair loss. If you are currently losing hair, use a gentle baby shampoo to wash your hair. Unless you have extremely oily hair, you may consider washing your hair only every other day. Always pat the hair dry and avoid rubbing your hair.
Styling products and tools are also common culprits in hair loss. Use the following sparingly, if at all:
- blow dryers
- heated combs
- hair straighteners
- coloring products
- bleaching agents
If you do decide to style your hair with heated tools, only do so when your hair is damp or dry. Also, use the lowest settings possible.
Outlook for Hair Loss
Hair loss can be stopped and even reversed with aggressive treatment, especially if it’s caused by an underlying medical condition. Hereditary hair loss may be more difficult to treat, but certain procedures such as hair transplants can help reduce the appearance of baldness. This condition can be embarrassing, but it is important to know that you have options to lessen the effects of hair loss.