What is hair loss?

Hair loss, clinically known as alopecia. Alopecia refers to any form of hair loss, hair thinning, partial or total balding anywhere in the body. Men, women and even children can experience hair loss. Hereditary is the most common cause of hair fall. But other well known causes for the hair loss are aging, hormonal changes, vitamin or protein deficiency, stress, pregnancy in women, chemotherapy, medical conditions, side-effects of some medications etc.

Hair is made up of keratin protein produced within the hair follicles on the uppermost layer of the skin. The follicles keep producing new hair cells and push out the old dead cells. The hair on the head are compact strands made of dead keratinized cells. At any given time, 90% or more of the hair on the scalp keeps growing. No two hairs have the same growth pace because each hair follicle has its own growth cycle. This growth cycle may be influenced by crucial factors such as age, nutrition, illness and ethnicity. If all the hairs on head have the same growth cycle then all hair would grow at once as well as fall off at once.

Normally everybody loses up to 100 hairs per day out of 100,000 to 150,000 hairs on an adult head. But losing more than 100 hairs per day can cause bald spots to appear on a man’s head. In the case of a woman, there is thinning of the hair on the top of her head. Generally people don’t treat hair fall until it is in a severe phase. Hair fall is not a life-threatening condition or a medical emergency. But it can be distressing, impacting self-esteem, self-confidence and mental health.

If someone notices rapid changes in his/her hair such as loss of clumps of hair from scalp, excessive thinning of hair then a person should consult a family physician or a general practitioner immediately. Depending on severity, the general practitioner may refer to a dermatologist or a trichologist or an endocrinologist if the hair loss is related to hormonal imbalance or a psychologist if the person is suffering from trichotillomania.

Causes of hair loss

There are many types of hair loss and thus it is challenging to find the exact cause of hair loss for a specific person. The most common causes of hair loss occurring on normal unscarred scalp skin are listed below.

Family History:   Genetics play a huge role in the hair fall. Genes from family hereditary can increase the chances of a person having male or female pattern baldness.

Hormones:   Abnormal androgen levels may cause hair fall.

Natural Aging:   Men and women may experience hair thinning or hair fall mainly after the age of 40s due to the overall aging process.

Trichotillomania:   This is a hair-pulling disorder in which a person will repeatedly pluck hairs from head and/or body.

Autoimmune Disorders:   Immune system of the body attacks its own healthy cells including hair follicles in autoimmune disorders such as alopecia areata or lupus and this may result in hair fall.

Medical Conditions:   Chemotherapy, thyroid disease, anemia, lupus, iron deficiency, diabetes, secondary syphilis, polycystic ovary syndrome (PCOS) in women, eating disorders may lead to hair fall. Usually, hair grows back again when the medical condition is treated.

Medications:   Blood thinners, antidepressants, cancer treatment drugs, birth-control medications, excessive amounts of Vitamin A supplements may lead to hair fall.

Protein Deficiency:   Poor diet with less protein intake may cause hair loss as hair strands are essentially made of the keratin protein.

Vitamin Deficiency:   Vitamins play an essential role in the growth of hair. Deficiency of Niacin or vitamin B3, Biotin and Vitamin D may cause hair loss or may slow down the growth of the hair.

Scalp Infections:   Ringworm or fungal infections in the head scalp may result in hair loss.

Burns:   Scarring from a burn can prevent hair from growing in the area of the scar.

Pregnancy:   Pregnancy and childbirth in women which can result in hormonal imbalances and it may cause hair loss.

Cosmetics:   Trichorrhexis nodosa is a hair loss disorder caused by damage to the hair. It arises due to excessive use of shampoo, excessive hair brushing, heat treatments, too tight hairstyles, hair bleaching, hair dying etc. All these make hair brittle and weak and may cause hair thinning and hair loss.

Physical Trauma:   High fever, injuries, accident, surgeries, major illnesses, extreme weight loss and menopause can trigger acute hair fall. Generally, hair starts growing back on its own after some time in such cases.

Emotional Trauma:   traumatic events like death of the loved one, hyper stress can trigger acute hair fall. Generally, hair starts growing back on its own after some time in such cases.

Types of hair loss

Hair loss and hair thinning begins when the hair growth cycle is disturbed due to the age or other number of causes. This disruption can result in different types of alopecia such as:

Androgenic Alopecia:   This is a genetic condition where both men and women can be affected by this condition. Men with this condition may start losing hair even in their teenage years. This is known as male-pattern baldness. It is marked by gradual hair loss from the frontal scalp and the crown and the hairline receding. Women with this condition have hair thinning after their forties from the frontal scalp and the crown. It is known as female-pattern baldness.

Androgenic Alopecia:   This is a genetic condition where both men and women can be affected by this condition. Men with this condition may start losing hair even in their teenage years. This is known as male-pattern baldness. It is marked by gradual hair loss from the frontal scalp and the crown and the hairline receding. Women with this condition have hair thinning after their forties from the frontal scalp and the crown. It is known as female-pattern baldness.

Involutional Alopecia:   This is the natural and gradual thinning of hair with age. Most of the hair follicles go into the resting phase with age and that could prevent growing new hair. The length of the rest of the hairs gradually become shorter and thinner.

Alopecia Areata:   This condition is also known as spot baldness. This condition starts suddenly and leads to hair loss in patches anywhere in the body in young adults and children. This condition could be the result of autoimmune disease where the immune system of the body mistakenly attacks the hair follicles. This can be a temporary condition and the hair may grow back after a few years but not guaranteed.

Scarring Alopecia:   This is an irreversible hair loss condition. Conditions such as folliculitis decalvans, lupus, acne, cellulitis, lichen planus destroy the hair follicles that could lead to hair's inability to regenerate.

Traction Alopecia:   This condition is common in women. Many women tie their hair too tight in ponytails, pigtails or braids and this tightness could create tension in the hair shafts and could lead to prolonged traction alopecia where the hair on the affected areas may never grow back.

Trichotillomania:   This condition is a psychological disorder and can be seen mainly in children who tear and pull out their hair. This can destroy hair follicles and prevent hair from growing.

Telogen Effluvium:   This condition occurs mainly due to hormonal imbalances, mental or physical stress, illnesses such as high fever or cancer or thyroid disease, vitamin or protein deficiencies, side effects of medications such as blood thinners or birth-control pills, stress during pregnancy and childbirth. Hair thinning occurs on the scalp during the condition and hair usually regrows after the stress period is over.

Anagen Effluvium:   This is a temporary condition where hair loss occurs all over the body due to chemotherapy or immunotherapy or radiotherapy. The hair loss is usually temporary and grows back once the therapy or medication is over.

Tinea Capitis:   This condition is known as scalp ringworm and hair loss occurs due to a fungal infection. This is mostly seen in children. It leads to hair falling out often in circular patches which can grow over time. The affected skin in these cases is red, flaky and itchy.

Symptoms of hair loss

Hair loss may occur anywhere on the body but especially on the head scalp. Some of common symptoms are listed below:

  Excessive hair loss from the scalp (more than 100 hairs per day)

  Excessive hair loss while shampooing

  Hair loss from other parts of the body

  Hair falling out in clumps or patches

  Hair thinning on the head and especially on scalp

  Brittle hair

  an M shaped pattern above forehead of men

How is hair loss diagnosed?

Family doctors or skin specialists may diagnose hair loss by gathering more information about person’s medical condition by examining and knowing following things:

  By knowing about the patient's symptoms & possible triggers.

  By knowing about the medical history of the patient.

  By knowing about the family history of the person.

Most types of hair loss such as pattern baldness, telogen effluvium and anagen effluvium can be diagnosed based on symptoms and medical history alone.

Hair Pulling Test:   A doctor can perform a physical hair pulling test to determine the strength of follicles.

Light microscopy:   A doctor can examine a few hairs under a microscope to diagnose the case of alopecia areata.

Scalp Biopsy:   A doctor can perform a scalp biopsy to rule out the possibilities of fungal, ringworm or other infections.

Blood Tests:   A doctor can suggest blood tests to determine if the hair loss is due to an autoimmune disease or hormonal imbalance.

Treatment of shingles

Unfortunately, there are no universal solutions to prevent hair fall that will work for all people. Hair fall solutions can be addressed for a specific person by diagnosing the person's gender, medical history, family history, symptoms and possible triggers. Some medications, drugs, creams and ointments as well as diet and lifestyle management help to improve hair growth and reduce hair fall.

Medications:  

   Minoxidil ( Rogaine ) (For male and female pattern baldness)

   Finasteride ( Propecia ) (For male and female pattern baldness)

   Avodart ( Dutasteride ) (For male pattern baldness)

   Terbinafine (Antifungal medications)

   Itraconazole ( Sporanox ) (Antifungal medications)

   Fluconazole ( Diflucan ) (Antifungal medications)

   Griseofulvin (Antifungal medications)

   Escitalopram ( Lexapro ) (Antidepressant for Trichotillomania)

   Fluoxetine ( Prozac ) (Antidepressant for Trichotillomania)

Medical Treatments:  

Platelet-rich plasma (PRP):   This is a newer treatment that doctors use for androgenetic alopecia. Blood samples run through a centrifuge machine and it separates the PRP in the blood so the doctor can extract the platelets and inject them into specific areas of a person’s scalp. The platelets may heal the damaged hair follicles. This treatment is not FDA-approved.

Light therapy:   This low level laser therapy irradiates photons into scalp tissues. These photons are absorbed by weak cells to encourage hair growth. It’s widely accepted that the procedure is safe and tolerable. As per medical experts, this treatment may work for some people but not for others.This treatment is FDA-approved.

Hair transplantation:   This is a surgical procedure that removes hair follicles from one part of the body mainly from the back of the head to a bald part of the body. The technique is primarily used to treat male pattern baldness. Always check the surgeon's credentials and experience carefully before considering a hair transplant. Hair transplants may be very expensive and time consuming procedures.

Hair-fiber powders:   Hair fibers are camouflaging products made of keratin protein. They are commercially available in either spray or powder form that can be sprayed or sprinkled on the scalp. They stick to hair and give hair a thicker and fuller appearance by hiding bald or thinning spots in the scalp. This is a relatively inexpensive and easy to use temporary solution.

Diet:   Diet also plays a crucial role in hair growth. Person should take the following protein, vitamin and mineral rich foods:

  Eggs

  Lean beef

  Fish

  Lean pork

  Poultry

  Salmon

  Cod liver oil

  Milk

  Low-fat yogurt

  Low-fat cheese

  Beans

  Nuts

  Seeds

  Whole grains

  Green leafy vegetables

  Citrus fruits like orange, strawberries

  Carrot

  Sweet Potato

  Onion

  Garlic

Lifestyle management:   Person should take the following steps to reduce symptoms:

  Take your prescribed medications regularly.

  Take vitamin, mineral and protein supplements.

  Use a mild shampoo when washing hair and then apply conditioners.

  Dry hair with an absorbent towel instead of a blow-dryer.

  Reduce hair bleaching or dying as much as possible.

  Reduce usage of curling irons, heating lamps, blow-dryers etc that expose hair to heat.

  Apply loose hairstyles instead of braids, ponytails, pigtails etc to avoid tension that could be created with tight hairstyles.

Egg whites:   They are the liquid contained within an egg. They contain proteins, minerals and B-complex which provide nutrients for hair growth and they also strengthen the hair.

Aloe vera gel:   It contains amino acids and proteolytic enzymes which are good for hair growth.

Onion juice:   It contains dietary sulfur that is required for enzymes and protein production. Antimicrobial properties of onion juice help scalp to fight against infections. On the other hand, the antioxidant property reduces damage to hair follicles.

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