Medically Reviewed April 2023, by Dr. Ayad Harb, one of the world's leading plastic surgeons
Hair loss often has a genetic component. Known as androgenic alopecia, this type of hair loss can be traced through family history. It involves the inheritance of genes that make hair follicles more susceptible to the effects of certain hormones, leading to a gradual thinning and eventual loss of hair. This type of baldness, which follows a predictable pattern in men and a different pattern in women, accounts for the majority of hair loss cases.
Hormonal fluctuations can have a dramatic effect on hair growth.
Conditions such as thyroid disorders can lead to hair loss, as the thyroid gland plays a pivotal role in regulating hormones that support hair growth. Similarly, menopause in women often brings about hormonal changes that can lead to hair thinning or loss. Pregnancy, childbirth, and discontinuation of birth control pills are other instances where hormonal shifts can impact hair health.
Certain medical conditions and diseases can lead to hair loss. Autoimmune diseases, where the body's immune system mistakenly targets its cells, can result in alopecia areata, where the immune system attacks hair follicles leading to hair loss. Diabetes, lupus, and other chronic illnesses may also have hair loss as a symptom, reflecting underlying imbalances and disturbances in the body.
Hair loss can also be a side effect of specific medications and treatments. For example, chemotherapy, utilized in cancer treatment, targets rapidly dividing cells, including those in hair follicles, leading to temporary hair loss. Other medications for treating heart problems, depression, arthritis, and high blood pressure might cause hair loss as well. Patients should consult with their healthcare providers if they notice hair loss after starting a new medication, as alternative treatments might be available.
Lifestyle choices and environmental factors can also contribute to hair loss. A diet lacking in essential nutrients can weaken hair follicles and impede growth. Chronic stress, a prevalent issue in modern life, can also lead to temporary hair loss as the body diverts resources away from non-essential functions like hair growth. Excessive physical or chemical damage to the hair, such as over-styling or using harsh hair products, can weaken hair and cause it to break or fall out. Even exposure to polluted environments may impact hair health.
With advancing age, hair naturally tends to thin. The hair growth cycle slows down, and the follicles produce thinner and shorter hairs. While this is a normal part of aging, it may be more pronounced in some individuals.
Certain infections can lead to hair loss, such as fungal infections like ringworm. These infections invade the hair shafts and follicles, leading to hair breakage and loss. Scalp conditions such as seborrheic dermatitis or psoriasis can also affect the health of the scalp and thereby influence hair growth.
In some cases, psychological factors may play a role in hair loss. Conditions such as trichotillomania, where individuals have a compulsive urge to pull out their hair, can lead to noticeable hair loss. Support from mental health professionals may be needed in these instances.
Hair loss is a complex phenomenon with a multitude of contributing factors. From genetics and hormones to medications and lifestyle choices, understanding the specific causes in individual cases requires a thorough examination and often professional medical assessment. Treatment and management strategies will greatly depend on identifying the underlying causes, making a proper diagnosis crucial to successfully addressing hair loss.
Androgenic alopecia, also known as male or female pattern baldness, is the most prevalent form of hair loss. In men, it often begins with a receding hairline and thinning on the crown, while in women, it manifests as a general thinning across the scalp. The condition is strongly linked to genetic factors and hormones, specifically dihydrotestosterone (DHT), which causes hair follicles to shrink and eventually stop producing hair. Though both men and women can experience this type of hair loss, the pattern and progression can vary between genders. Various treatments, including topical solutions like Minoxidil, oral medications like Finasteride, and surgical options like hair transplantation, can be employed to address this condition. Early intervention often leads to better outcomes.
Alopecia areata is an autoimmune disorder that leads to sudden and unpredictable hair loss, usually in small, round patches. In this condition, the immune system mistakenly targets hair follicles, causing inflammation and subsequent hair loss. It can affect both men and women at any age but often starts in childhood. The condition can progress to total hair loss on the scalp (alopecia totalis) or even the entire body (alopecia universalis). The exact cause is unknown, though genetic factors may play a role. Treatments can include corticosteroids to suppress the immune response and other medications that promote hair growth, but the success of treatment can be variable, and recurrence is common.
Telogen effluvium is a temporary form of hair loss characterized by a significant number of hair follicles entering the resting (telogen) phase simultaneously. This condition often occurs after a stressful event, such as surgery, childbirth, severe illness, or extreme weight loss. It results in diffuse hair shedding, usually a few months after the triggering event. Unlike other forms of hair loss, telogen effluvium does not typically result in complete baldness. Most cases resolve spontaneously within six to nine months, though efforts to identify and address the underlying cause, such as improving diet or managing stress, can aid recovery.
Scarring alopecias, also known as cicatricial alopecias, involve hair loss accompanied by scarring of the scalp. These conditions destroy the hair follicles, replacing them with scar tissue, which leads to permanent hair loss. The causes of scarring alopecias can be diverse, including infections, inflammatory disorders, or tumors. Symptoms might include itching, pain, and redness in the affected area. Early diagnosis and treatment are crucial to prevent irreversible damage to the hair follicles. Treatment typically involves anti-inflammatory medications to halt the progression of scarring.
Traction alopecia is hair loss caused by persistent pulling or tension on the hair, often as a result of specific hairstyles like tight braids or ponytails. It may also occur with the habitual pulling of hair or the use of tight hair accessories. The continuous tension injures the hair follicles, leading to weak and easily breakable hair, and eventually permanent hair loss if the practice continues.
Prevention and treatment of traction alopecia primarily involve identifying and eliminating the cause of the tension. If caught early, the condition can be reversible, but if the tension and damage persist, it can lead to permanent hair loss in the affected areas.
Hair transplantation is a surgical procedure that has become an increasingly popular and effective treatment for certain types of hair loss, particularly androgenic alopecia. The procedure involves extracting hair follicles from areas where hair is dense and healthy, known as the donor site, and transplanting them into areas where hair is thinning or absent, referred to as the recipient site. There are two primary methods used: Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). FUT involves removing a strip of scalp from the donor site, while FUE extracts individual hair follicles. The latter method is less invasive and generally leaves no noticeable scarring. Once the follicles are extracted, they are meticulously implanted into the recipient area, following the natural hair growth pattern to achieve an aesthetically pleasing result. Post-operative care is crucial to ensure the success of the transplant, and patients may be advised to follow specific guidelines regarding hair washing, sun exposure, and physical activity. Potential risks include infection, scarring, and unnatural appearance if not performed skillfully. Hair transplants are generally suitable for patients with sufficient donor hair and are often considered a permanent solution to hair loss.
Topical Treatments: Topical treatments, such as Minoxidil, are widely used in the treatment of hair loss and are available over the counter. Minoxidil, originally developed to treat high blood pressure, was discovered to have the side effect of promoting hair growth. It is applied directly to the scalp and works by prolonging the growth phase of hair follicles. Regular and consistent use is required to maintain results, and discontinuation of the product will likely lead to a return to the previous pattern of hair loss. Side effects are typically minimal but may include scalp irritation.
Oral Medications: Oral medications like Finasteride are prescribed primarily for male pattern baldness. Finasteride inhibits the enzyme that converts testosterone into dihydrotestosterone (DHT), a hormone that contributes to hair follicle shrinkage. By reducing DHT levels, the medication helps slow hair loss and may even promote regrowth in some cases. It requires a prescription and ongoing use to maintain benefits. Potential side effects can include sexual dysfunction, and it is not suitable for women of childbearing age.
Laser Therapy: Low-level laser therapy (LLLT) is a non-invasive treatment that uses red light to stimulate hair follicles, increase blood flow, and encourage hair growth. Devices are available for home use, including laser combs and helmets, or treatments can be performed in a clinical setting. Regular, consistent treatment is required, and results may vary between individuals. LLLT is generally considered safe, with no known serious side effects.
PRP (Platelet-Rich Plasma) Treatment: PRP therapy involves drawing a patient's blood and processing it to concentrate the platelets, which are rich in growth factors. This concentrated plasma is then injected into the scalp, where it may stimulate hair follicles and promote hair growth. PRP treatment has gained popularity in recent years, though research is ongoing, and results can vary. It is often used in conjunction with other treatments to enhance outcomes. Potential risks are generally minimal but can include infection, injury to blood vessels or nerves, and temporary discomfort at the injection site.
The variety of treatments available for hair loss provides options to suit different types and causes of hair loss, as well as individual preferences and needs. Choosing the right treatment involves careful consideration of the specific diagnosis, the severity of the hair loss, the patient's overall health, budget, and lifestyle. It's essential to consult with a healthcare provider specializing in hair loss to determine the most appropriate treatment plan.