Hair loss

Hereditary hair loss: Millions of men and women have hereditary hair loss. This type of hair loss can often be successfully treated.

Hair loss: Overview

Also called alopecia (al-o-PEE-shah)

Everyone loses hair. It is normal to lose about 50-100 hairs every day. If you see bald patches or lots of thinning, you may be experiencing hair loss.

There are many causes of hair loss. Women may notice hair loss after giving birth. People under a lot of stress can see noticeable hair loss. Some diseases and medical treatments can cause hair loss.

The most common cause of hair loss is a medical condition called hereditary hair loss. About 80 million men and women in the United States have this type of hair loss. Other names for this type of hair loss are:

• Male-pattern baldness.
• Female-pattern baldness.
• Androgenetic alopecia.

Luckily, most causes of hair loss can be stopped or treated. Anyone troubled by hair loss should see a dermatologist. These doctors specialize in treating our skin, hair, and nails.

Photograph used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Hair loss: Signs and symptoms

Hair loss may cause gradual thinning, bald patches, or complete baldness. The photos below some of the different types of hair loss.

Alopecia areata: This disease can cause complete hair loss in otherwise healthy people.

Hereditary hair loss: In women, hereditary hair loss causes thinning that begins in the center of the scalp.

Traction alopecia: Hairstyles that constantly pull on the scalp cause this type of hair loss.

Alopecia areata: This disease often causes the hair to fall out in round patches.

Alopecia areata: Some people loss their eyelashes. Hair loss can occur anywhere on the body.

Trichotillomania: This psychological condition causes people to pull on their hair until it comes out.

Photos used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Hair loss: Who gets and causes

Who experiences hair loss?

Millions of people experience hair loss. Some people see their hair re-grow without doing anything. Others need treatment for their hair to re-grow. Sometimes, hair will not re-grow.

To find out what is possible, you should see a dermatologist. These doctors specialize in treating diseases that affect the skin, hair, and nails.

What causes hair loss?

The reasons for hair loss are many. When hair loss begins suddenly, the cause may be due to illness, diet, medicine, or childbirth. If hair loss is gradual and becomes more noticeable with each passing year, a person may have hereditary hair loss. Certain hair care practices also can cause noticeable hair loss.

The following describes some of the many things that cause hair loss: 

Hair disorders

• Hereditary thinning or baldness (also called androgenetic alopecia): This is the most common cause of hair loss. It affects men and women. About 80 million people in the United States have hereditary thinning or baldness.
  
  When men have hereditary hair loss, they often get a receding hairline. Many men see bald patches, especially on the top of the head. Women, on the other hand, tend to keep their hairline. They see noticeably thinning hair. The first sign of hair loss for many women is a widening part. In rare cases, men see noticeably thinning hair. And in rare cases, women can see a receding hairline or bald patches. The reasons for this are unknown.
• Alopecia areata: Researchers believe that this is an autoimmune disease. Autoimmune means the body attacks itself. In this case, the body attacks its own hair. This causes smooth, round patches of hair loss on the scalp and other areas of the body. People with alopecia areata are often in excellent health. Most people see their hair re-grow. Dermatologists treat people with this disorder to help the hair re-grow more quickly.
• Cicatricial (scarring) alopecia: This rare disease develops in otherwise healthy people. The disease destroys a person’s hair follicles. Scar tissue forms where the follicles once were, so the hair cannot re-grow. Treatment tries to stop the inflammation, which destroys the hair follicles.
• Central centrifugal cicatricial (scarring) alopecia: This type of hair loss occurs most often in women of African descent. It begins in the center of the scalp. As it progresses, the hair loss radiates out from the center of the scalp. The affected scalp becomes smooth and shiny. The hair loss can be very slow or rapid. When hair loss occurs quickly, the person may have tingling, burning, pain, or itching on the scalp. Treatment may help the hair re-grow if scarring has not occurred.

Disease

• Underlying medical condition: Hair loss can be the first sign of a disease. About 30 diseases, including thyroid disease and anemia, cause hair loss. By treating the disease, hair loss often can be stopped or reversed.
• Illness: Significant hair loss can occur after an illness. A major surgery, high fever, severe infection, or even the flu can cause hair loss. Your dermatologist may call this type of hair loss telogen (tee-lə-jen) effluvium (ih-flu-vee-uhm).
• Some cancer treatments: Radiation therapy and chemotherapy can cause hair loss. This hair loss is often temporary, but it can cause great distress.​
• Ringworm of the scalp: This disease is contagious and common in children. Without effective treatment, ringworm can cause balding.
• Trichotillomania (trick-uh-til-uh-mey-knee-uh): This medical disorder causes people to repeatedly pull out their own hair. They often feel a constant urge to pull out the hair on the scalp. Some sufferers say they feel compelled to pull out their eyelashes, nose hairs, eyebrows, and other hairs on their bodies.

Hormones and stress

• Giving birth: After giving birth, some women have noticeable hair loss. Falling estrogen levels cause this type of hair loss. The hair loss is temporary. In a few months, women see their hair re-grow.
• Menopause: Hair loss is common during menopause. This loss is often temporary. Hair re-grows with time. If a woman is 40 years of age or older, she should not expect her hair to have the fullness that it did when she was younger.
• Stress: Experiencing a traumatic event (e.g., death of a loved one or divorce) can cause hair loss.

Dieting and poor nutrition

• Weight loss: Some people see hair loss after losing more than 15 pounds. The hair loss often appears 3 to 6 months after losing the weight. This hair loss is common. The hair re-grows without help.
• Vitamin A: Too much vitamin A can cause hair loss. People can get too much of this vitamin through vitamin supplements or medicines. Once the body stops getting too much vitamin A, normal hair growth resumes.
• Protein: When the body does not get enough protein, it rations the protein it does get. One way the body can ration protein is to shut down hair growth. About 2 to 3 months after a person does not eat enough protein, you can see the hair loss. Eating more protein will stop the hair loss. Meats, eggs, and fish are good sources of protein. Vegetarians can get more protein by adding nuts, seeds, and beans to their diet.
• Iron: Not getting enough iron can lead to hair loss. Good vegetarian sources of iron are iron-fortified cereals, soybeans, pumpkin seeds, white beans, lentils, and spinach. Clams, oysters, and organ meats top the list of good animal sources of iron.
• Eating disorder: When a person has an eating disorder, hair loss is common. Anorexia (not eating enough) and bulimia (vomiting after eating) can cause hair loss.

Medicine

Some prescription medicines can cause hair loss. These include:

• Blood thinners.
• High-dose vitamin A.
• Medicines that treat arthritis, depression, gout, heart problems, and high blood pressure.
• Birth control pills: Some women who take the pill see hair loss. Sometimes, the hair loss begins when a women stops taking the pill. Women who get this hair loss often have hereditary hair loss.
• Anabolic steroids (steroids taken to build muscle and improve athletic performance) may cause hair loss.

Hair care

Your hairstyle and even some of the products you use on your hair can cause hair loss.

• Products: Frequent bleaching or permanents can cause the hair to break. Regular or improper use of dyes, gels, relaxers, and hair sprays also can cause hair breakage. Dermatologists recommend limiting use of these hair products. Less use often means less hair breakage.
• Blow dryers, flat irons, and other devices: Frequent use of a blow dryer tends to damage hair. The high heat from a blow dryer can boil the water in the hair shaft leaving the hair brittle and prone to breakage. Dermatologists recommend that you allow your hair to air dry. Then style your hair when it is dry. Dermatologists also recommend limiting the use of flat irons (these straighten hair by using high heat) and curling irons.
• Hairpins, clips, and rubber bands: When used to hold hair tightly, hairpins, clips, and rubber bands can break hair. Here are dermatologists’ tips for choosing these:

Hairstyles

Years of wearing hair in a style that pulls on the hair such as a ponytail, cornrows, or braids can cause a type of hair loss known as traction alopecia.

Improper washing, drying, and combing

The following practices often cause the hair to break:

• Too much shampooing, combing, or brushing (100 strokes or more a day).
• Rubbing wet hair dry with a towel.
• Brushing or combing wet hair (especially people who are Asian or Caucasian).

For many people, hair is more elastic when wet. This means it breaks off more easily than dry hair. When hair breakage occurs, the hair appears shaggy or too thin. For people who are of African descent, their hair is not more elastic when wet.

Central centrifugal cicatrical alopecia: If a woman is concerned about hair loss, she should see a dermatologist. The earlier treatment begins, the better the outcome.*

Hair loss: Diagnosis and treatment

How do dermatologists diagnose hair loss?

Because so many things can cause hair loss, a dermatologist acts like a detective. A dermatologist may begin by asking questions. The dermatologist will want to know whether the hair loss happened suddenly or gradually. Knowing this helps to eliminate causes.

A dermatologist also will ask what medicines you take, what allergies you have, and whether you have been dieting. It is important to give the dermatologist accurate information. Like a murder mystery, the slightest clue can solve the case. Women may be asked about their periods, pregnancies, and menopause.

The dermatologist also will carefully look at your scalp and hair. During an exam, the dermatologist may pull on your hair. Sometimes a dermatologist needs to pull out a hair to get the necessary evidence. And sometimes a dermatologist needs to look at the hair on the rest of your body to see whether there is too little or too much hair in other areas.

Sometimes the evidence lies in your scalp. The dermatologist may remove a small piece of the scalp. This is called a scalp biopsy. A dermatologist can quickly and safely perform a scalp biopsy during an office visit. A scalp biopsy can be essential to solving the case. Sometimes, a blood test is necessary.

Because so many things can cause hair loss, it can take time to find the cause. You may need to make a few appointments.

How do dermatologists treat hair loss?

Just as there are many causes, there are many treatments for hair loss. Dermatologists recommend treating hair loss early. Early means before you lose a lot of hair. Hair loss is harder to treat when a person has a lot of hair loss.

One or more of the following treatments may be part of your treatment plan.

Treatment available without a prescription

• Minoxidil: This medicine is applied to the scalp. It can stop hairs from getting thinner and stimulate hair growth on the top of the scalp. The U.S. Food and Drug Administration (FDA) has approved minoxidil to treat hair loss. It is the only hair re-growth product approved for men and women. A dermatologist may combine minoxidil with another treatment.
  
  
• Laser devices: Brushes, combs, and other hand-held devices that emit laser light might stimulate hair growth. These devices might make hair look more youthful in some people. Because the FDA classifies these products as medical devices, the products do not undergo the rigorous testing that medicines undergo. The long-term effectiveness and safety for these devices are not known.

Prescription medicine

• Finasteride: The FDA approved this medicine to treat men with hair loss. It comes in pill form and helps slow hair loss in most (about 88%) men. It helps stimulate hair re-growth in many (about 66%) men. Finasteride works by stopping the body from making a male hormone, dihydrotestosterone (DHT).
  
  
• Corticosteroid: If your hair loss is caused by inflammation in your body, a dermatologist may inject a medicine called a corticosteroid into your scalp. This can help stop the inflammation that happens when a person has alopecia areata. A corticosteroid is different from an anabolic steroid.

Hair transplant: After getting a hair transplant, it takes time for the hair to grow. This photo was taken 7 months after this man's last treatment.**

Procedures
The type of procedure that a dermatologist recommends will depend on how much hair you have lost. To achieve the best results, a dermatologist may use one or more of the following procedures:

• Hair transplantation: Skin on the scalp that has good hair growth is removed and transplanted to areas of the scalp that need hair.
  
  
• Scalp reduction: Bald scalp is surgically removed and hair-bearing scalp is brought closer together to reduce balding. Scalp reduction surgery can be performed alone or in conjunction with a hair transplant.
  
  
• Scalp expansion: Devices are inserted under the scalp for about 3 to 4 weeks to stretch the skin. This procedure may be performed before a scalp reduction to make the scalp more lax. It also can be performed solely to stretch hair-bearing areas, which reduces balding.
  
  
• Scalp flaps: A hair-bearing segment of scalp is surgically moved and placed where hair is needed.

Outcome

Once your dermatologist knows what is causing the hair loss, your dermatologist can tell you what to expect. Sometimes hair loss does not need treatment. The hair will start to re-grow on its own. In some cases, changing what you do will stop the hair loss, allowing your hair to start re-growing. Sometimes treatment can restore hair.

*Photograph used with permission of the Journal of the American Academy of Dermatology. This photograph was published in the Journal of the American Academy of Dermatology, Vol. # 60, Gathers RC, Jankowski M, Eide M, et al. “Hair grooming practices and central centrifugal cicatricial alopecia,” 660-8. Copyright Elsevier (2009). Journal of the American Academy of Dermatology.

**Photo used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

Hair loss: Tips for managing

Dermatologists often offer their patients who have hair loss the following tips.

1. Practice good hair care. Many people are surprised to learn that a hairstyle or even the way they wash and dry their hair has contributed to their hair loss.

2. Do not stop taking a medicine that your doctor prescribed. Some medicines can cause hair loss. Doctors warn that you should not stop taking a medicine that your doctor prescribed if you see hair loss. Immediately stopping some medicines can cause serious side effects.

If you think a medicine may be causing hair loss, talk with the doctor who prescribed the medicine. Ask if the medicine could be causing your hair loss. If the medicine seems to be the cause, ask your doctor whether you can take another medicine.

3. Realize that your hair loss may be temporary. Some things in life cause temporary hair loss. These include illness, childbirth, and stress.

During a very stressful time, your body may react by causing more hairs than normal to go into resting phase. The medical term for this condition is telogen (tee-lə-jen) effluvium (ih-flu-vee-uhm). During telogen effluvium, the body sheds a dramatic amount of hair. For most people, the hair will start to grow again without any help.

4. Make an appointment to see a dermatologist. Many things can cause hair loss. If hair loss concerns you, be sure to see a dermatologist. A dermatologist can find the cause and tell you what you what to expect.

Treatment for hair loss helps many people feel better. Hair loss, especially in women, can cause low self-esteem. Many women feel unattractive and embarrassed. A dermatologist can offer solutions to help you feel and look your best.

Related resources:

Alopecia World
Social network for people living with hair loss.

Children’s Alopecia Project
Devoted to helping children living with alopecia areata.

Cicatricial Alopecia Research Fund
Offers support groups in the United States and abroad.

National Alopecia Areata Foundation
Resources for people living with alopecia areata.

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