Hair Loss & Hair Restoration

When your hair starts to thin or fall out, it can be troubling. If you are experiencing hair loss, a board-certified dermatologist can help determine what type of hair loss you have and recommend treatment options.

WHAT IS NORMAL HAIR GROWTH?

With more than 100,000 hair follicles on your scalp, about 85-90 percent of your hair is growing at any time. This growth phase lasts between two and six years.

Ten to 15 percent of your hair is in a resting (telogen) phase. This phase lasts two to three months. At the end of this phase, the hair falls out. It is normal to lose 50 to 100 hairs a day; this should not be cause for alarm.

When you shed a hair, a new hair from the same hair follicle (structure that contains the hair root) replaces it. This starts the growing cycle again.

The hair on your head grows approximately half an inch per month. As you age, the rate of hair growth slows.

Androgenetic Alopecia: Male (L) and Female (R)

WHAT CAUSES HAIR LOSS?

Hereditary Hair Loss

This is the most common cause of hair loss. It is also known as male pattern baldness, female pattern baldness or androgenetic alopecia. You can inherit the baldness trait from either side of your family. Hereditary hair loss can start in your teens, 20s or 30s, or later, especially in women, who may experience hair loss after menopause.

Men with hereditary hair loss may see a receding hairline and bald patches, especially on top of their head. Women may see thinning hair and a wider part when they style their hair, but they usually do not become fully bald.

Telogen Effluvium

Illness, stress and other events can cause too many hairs to enter the resting (telogen) phase of the hair growth cycle. This leads to a large increase in hair shedding (effluvium) over a short period of time. This condition causes hair thinning, but it usually does not result in bald patches.

Some causes of telogen effluvium include:

• Childbirth or
• High fever or serious
• Major surgery or chronic (long-term)
• Untreated thyroid
• A diet lacking in iron or
• Birth control pills and other

• Cancer treatments.
• Other stressful life

In many cases, telogen effluvium goes away after the cause is no longer affecting your body.

Alopecia Areata

This is a rare autoimmune disorder (a condition in which the immune system attacks healthy cells) that causes smooth, round patches of hair loss, about the size of a coin or larger. Alopecia areata can result in the loss of all scalp hair and sometimes all body and facial hair. It can affect children and adults of any age.

Your genes may play a role in triggering alopecia areata. Research has found that some genes associated with this condition have a link to other autoimmune diseases, such as rheumatoid arthritis, type 1 diabetes, thyroid disease and celiac disease (gluten intolerance). More research is needed to confirm the role of genes in alopecia areata.

Alopecia areata

Other Disorders

Other causes of hair loss may include:

• Cicatricial (scarring) alopecia: This is a rare illness that causes patchy hair loss, as well as itching, inflammation and pain around the hair follicles. The cause of this disease is unknown.

• Central centrifugal cicatricial alopecia: This scarring disorder, more common in women of African descent, causes hair loss that begins at the center of the scalp and moves outward. The affected scalp becomes smooth and shiny. People with this condition may experience tingling, burning, pain or itching on the scalp; however, most have no symptoms.
• Frontal fibrosing scarring alopecia: This scarring disorder, more common in Caucasian women, causes a band of hair loss at the front of the scalp, often preceded by eyebrow loss. The affected scalp becomes smooth and is typically lighter in color. While people with this condition may experience tingling, burning, pain or itching on the scalp, most have no
• Tinea capitis (scalp ringworm): This fungus can cause itchy and scaly patches on the scalp, along with broken hair, redness, swelling and even oozing. This fungus is very contagious and most common in

Hair Pulling

Hair pulling or twirling in young children is often a habit that goes away on its own. Hair pulling in teens and adults may be a sign of a disorder known as trichotillomania. Talk with a board-certified dermatologist if you are concerned about this habit in yourself or your child.

HOW DOES A BOARD-CERTIFIED DERMATOLOGIST TREAT HAIR LOSS?

In some cases of hair loss, such as those caused by alopecia areata, hair will regrow on its own over time. While there is no cure for hereditary hair loss, treatment may help some patients regrow their hair. Because scarring hair loss has the potential to become permanent if the hair follicle is destroyed during the active phase of disease, it is important to seek treatment early.

A board-certified dermatologist can identify the cause of your hair loss and recommend the treatment that is best for you. Your doctor may do a blood test to help determine the cause. Treatment plans may include:

• Minoxidil: This topical treatment is approved by the U.S. Food and Drug Administration to treat hair loss in both men and women. It is available both over-the-counter and by
• Antibiotics: These may be given to treat hair loss and are often used for their anti-inflammatory
• Finasteride: This oral medication is FDA-approved to treat hair loss in men. It is only available by
• Corticosteroids: These medications, which may be applied topically, injected or taken orally, can speed up hair regrowth in some patients whose hair loss is associated with inflammation.

• Vitamin supplementation: Some vitamin and mineral deficiencies may contribute to hair loss. Your dermatologist may order blood tests to check your vitamin and mineral levels if this is suspected.

Additionally, the FDA has approved brushes, combs and other handheld devices that emit laser light for the treatment of hair loss. These devices may stimulate hair growth. Because the FDA classifies these products as medical devices, they do not undergo the same rigorous testing as medicines. The long-term effectiveness for these devices is not known.

WHAT IS HAIR RESTORATION?

A hair restoration procedure can increase the amount of hair in bald or thinning areas and, in some cases, restore your natural hairline. The type of procedure that your dermatologist recommends will depend on how much hair you have lost and how healthy your remaining hair is.

• Hair transplants: Areas of healthy hair growth are surgically removed and placed in bald or thinning areas of your scalp. The transplanted hair starts to grow three to six months after the last procedure and grows in fully about one year after the
• Scalp reduction: Primarily used if you have a large bald area, this procedure involves removing a few inches of the bald skin, pulling the sides that have hair together and suturing (sewing) them shut. This procedure can decrease or even eliminate bald spots. For the best results, your dermatologist may recommend this procedure along with a hair transplant.
• Scalp expansion: Prior to a scalp reduction, you may undergo this procedure, which stretches the skin under the scalp for several weeks to make it easier to bring together for a scalp

These procedures may be performed in a board-certified dermatologist’s office, an ambulatory surgery center or another outpatient center using local anesthesia (which numbs only the area to be treated). You can expect natural-looking results.

Talk to your doctor to learn about the potential risks associated with each approach to hair restoration.

HOW CAN I TAKE CARE OF MY HAIR AND PREVENT HAIR LOSS?

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

• At-home hair colors, straighteners and permanent waves: Follow the instructions carefully. When these products are used incorrectly or used too often, hair can become weak and break. If your hair becomes damaged and brittle from chemical treatments, it is best to stop using these treatments until your hair grows
• “Long-lasting hold” styling products: Try not to use these products daily. Using a comb to style your hair after you apply these products can cause the hair to break, leading to hair loss over
• Flat irons and curling irons: Use these on dry hair on a low or medium heat setting, no more often than every other day. Leave these tools in place on your hair for only a second or two. No matter your hair type, excessive heat can damage your

• Braids, cornrows, ponytails, buns, hair weaving and hair extensions: Avoid wearing these daily. These styles pull on the hair and can cause tension that leads to breakage. This may lead to a type of hair loss known as traction

A board-certified dermatologist is a medical doctor who specializes in the diagnosis and medical, surgical and cosmetic treatment of skin, hair and nail conditions. To learn more about hair loss and hair restoration, or to find a board-certified dermatologist in your area, visit aad.org/hairloss or call toll-free (888) 462-DERM (3376).

All content solely developed by the American Academy of Dermatology.Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association.

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

American Academy of Dermatology

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