Hair Loss

1 Hair Loss Summary

Hair loss is a very common complaint and affects everybody at some part of their life. It is normal to lose around 100 hairs from the scalp every day. The lost hair is replaced soon enough. The loss of hair may be limited to the scalp or generalized to the entire body.

It is more commonly seen in older adults but may be seen in children as well. Hair loss may be gradual or abrupt, as is seen in certain conditions. The loss may also be permanent or temporary for few days. Many people notice hair loss when they see unusually more hair in the drain or in the brush. Thinning of hair on the scalp may also indicate hair loss.

There are different types of hair loss, as mentioned below:

Male- and female-pattern baldness – this is the most common type of hair loss and is characterized by a receding hairline. The hair on crown and templates may become thin and may leave a semicircular shape around back and sides. It may lead to complete baldness in some people.

Alopecia areata – this causes small, circular bald patches on the scalp. It is more commonly seen among teenagers and young adults. In most of the cases, normal hair may replace these patches.

Scarring alopecia – in this type of hair loss, the hair follicle is destroyed, thus reducing chances of regrowth.

Anagen effluvium – anagen effluvium is a condition characterized by widespread loss of hair, not only on the scalp but also on the whole body. This is usually associated with certain types of medical treatment like chemotherapy.

Telogen effluvium – this condition is characterized by widespread thinning of hair in different parts of the scalp and body. The lost hair may start growing back in most of the cases.

The most common cause of hair loss is heredity. People with family history of baldness have increased chances of losing hair. Sex hormones are also known to cause some amount of hair loss, and symptoms usually start appearing by puberty.

It may also be triggered by certain diseases and conditions, treatments, surgeries, or a traumatic event in life. But in most of these cases, hair may regrow within few months. Hormonal changes as in pregnancy and childbirth are also implicated in temporary loss of hair.

Some of the diseases and conditions that may lead to alopecia include thyroid disease, scalp infections, lichen planus, scarring, and some autoimmune conditions. Certain medications used in the treatment of high blood pressure, cancer, arthritis, and depression also lead to some amount of hair loss.

Persistent loss of hair may indicate an underlying medical condition. Evaluation of health history and physical examination aid in identifying the probable cause of hair loss. Information on current medications helps in recognizing any of the medications that may be a probable causative factor.

Biopsy of scalp skin is used in diagnosing autoimmune conditions. Medications are often the first step in the treatment of hair loss. Many over-the-counter gels and creams are available to help in regrowth of hair.

Prescription medications are also used in the treatment of hair loss. Corticosteroids are often suggested to suppress the immune system in autoimmune disorders. Surgical procedures used in the treatment of hair loss include hair transplant surgery and scalp reduction techniques.

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2 Causes

It is still not clear why the longevity of certain hair type is shorter than that of another.

A number of factors are known to influence the growth and loss of hair, this includes: 

Hormones – Abnormal levels of certain hormones are known to cause hair loss. This includes abnormal levels of androgens that are implicated in hair loss.

Heredity – certain genes, from both mother and father, may influence the growth and loss of hair. Heredity is one of the most common causes of hair loss. These genes often predispose a person to male- and female-pattern baldness.

Medical conditions – conditions like thyroid diseases and iron deficiency anemia may lead to hair loss. Ringworm infection of the scalp also is a cause of loss of hair. Other medical conditions that lead to hair loss include eating disorders, diabetes, and anemia.

Stress – stress is considered to be a causative factor in hair loss.

Certain medications – medications used in the treatment of cancer, beta-androgenic blockers used in the treatment of hypertension, birth control pills, and blood thinners may lead to hair loss.

Burns and injuries – temporary loss of hair is caused by burns and injuries. Healing of the tissue in the area may lead to regrowth of hair in the area. If the healing is followed by scar formation it may prevent regrowth.

Autoimmune diseases – abnormal functioning of the immune system results in hair loss. The exaggerated reaction of the immune system may be temporary, allowing regrowth of hair. The new hair that grows back may be lighter in color. Thickness and color may return only after a period of time.

Cosmetic procedures – Hair thinning may result from some cosmetic procedures of the hair, like shampooing too often, bleaching, or dyeing of hair. These procedures may make hair thin and brittle. Hair damage may also result from using rollers or hot curlers. Once the problem is identified and resolved, hair may regrow.

Diet – low-protein diet or diet with restricted calories is also known to cause hair thinning and loss. This may be a temporary hair loss, and hair regrows once the diet is back to a healthy one.

Male- and female-pattern baldness is caused by heredity. The symptoms of hair loss start by early thirties in men. It may lead to complete baldness in men. In women, hair usually thins on the top of the head.

Abnormal immune system functioning leads to alopecia areata, characterized by patches of baldness on the scalp or on the body. Alopecia areata is more common among people with hyperthyroidism, diabetes, and Down’s syndrome.

Scarring alopecia is caused by other medical conditions. Some of the conditions that lead to scarring alopecia are scleroderma, lichen planus, frontal fibrosing alopecia, and folliculitis declares. Chemotherapy leads to anagen effluvium.

Immunotherapy and radiotherapy may also lead to hair loss. Hormonal changes, stress, childbirth, infections, liver diseases, crash dieting, and certain medications lead to telogen effluvium.

3 Diagnosis and Treatment

Diagnosis often depends on the type of hair loss noted. Temporary hair loss may be caused by short-term illnesses, certain medications, or cosmetic procedures. Persistent hair loss indicates an underlying medical condition, which needs treatment.

Review of medical history, signs, and symptoms, and physical examination help in the diagnosis of the underlying cause of the symptom. Information on the pattern of hair loss and examination of hair loss are used in the confirmation of the cause.

To determine the cause of hair loss, the doctor may collect information on characteristics of hair loss, duration of hair loss, family history, hairstyling habits, recent illnesses, current medications, and diet.

When the reason of hair loss is not clear, other tests and investigations may be recommended. In hair analysis, a sample of hair is analyzed under the microscope. Scalp sample also may be checked for abnormalities, if any.

Blood tests are used in the identification of specific conditions like hyperthyroidism or hypothyroidism. Biopsy of the skin from the scalp is also suggested in certain cases. In this procedure, a small sample of skin from the scalp is removed for laboratory testing.

Treatment varies with the underlying cause of hair loss and with treatments such as a hair transplant becoming more popular due to the cost of hair transplant procedures becoming more affordable.. A common type of hair loss like a male- and female-pattern baldness does not require any specific treatment as it is a natural part of aging and heredity.

For cosmetic reasons, some may ask for treatment in this condition. Medications are the first step in the treatment of this type of hair loss. Two medications, finasteride, and minoxidil are commonly used in the treatment of hair loss in men.

In women, minoxidil is commonly used. Alopecia areata is treated with corticosteroid injections. Steroids are also available in the form of gels and creams for controlling the symptom. Immunotherapy is used in certain conditions to reduce hair loss and other symptoms associated with abnormal immune functioning. Immunotherapy helps to stimulate hair growth.

Topical medications called prostaglandins are being tried in the treatment of hair loss in men and women. It is currently used in the enhancement of eyelashes. Many alternative cosmetic options are now available for dealing with hair loss.

Hair-fiber powders, hairpieces, synthetic pieces, wigs, hair extensions, hair weaves, laser, and surgery are some of the alternative options available. Hair-fiber powders are powdery fiber sprinkles that help to camouflage balding areas.

These fibers attach to hair and give a fuller appearance. In hair pieces and hair weaving, a mesh is attached to the hair and artificial hair of similar color and texture is woven into it. Surgical restoration includes hair transplantation and scalp reduction. Hair loss related to pregnancy may resolve on its own without any specific treatment.

Among complementary medications, vitamin supplements containing vitamin B, zinc, folate, and calcium may be of help in reducing hair loss. Multiple vitamins are considered to be good in promoting hair growth. Good hair hygiene may also be beneficial in alleviating hair loss

4 Related Clinical Trials

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