Hair loss (Alopecia) Causes, Types, Symptoms,Diagnosis, Treatment, Home Remedies

Hair loss (Alopecia) Causes, Types, Symptoms,Diagnosis, Treatment, Home Remedies


What is Alopecia?


Alopecia is the loss of hair. Hair loss can be caused by different reasons, including damage to the hair shaft or follicles. Fungal infections can also cause hair loss.

Hair loss (alopecia) can affect just your scalp or your entire body. It can be the result of heredity, certain medications or an underlying medical condition. Anyone — men, women and children — can experience hair loss.

Baldness typically refers to excessive hair loss from your scalp. Some people prefer to let their baldness run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the medications or surgical procedures that are available to treat hair loss.

Before pursuing any treatment option, talk with your doctor about the cause of and best possible treatments for your particular type of hair loss.

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Types of hair loss


There are many types of hair loss with different symptoms and causes. Some of the more common types of hair loss are described below.

Male- and female-pattern baldness


Male-pattern baldness is the most common type of hair loss. As well as affecting men, it can sometimes affect women (female-pattern baldness). It can be particularly difficult for both men and women to cope with.

Male-pattern baldness follows a pattern of a receding hairline, followed by thinning of the hair on the crown and temples. During female-pattern baldness, hair usually only thins on top of the head.

Male- and female-pattern baldness is also called androgenic or androgenetic alopecia. Male-pattern baldness is a condition that runs in families, but it is not clear if this is the case with female-pattern baldness.

Alopecia areata


Alopecia areata is patches of baldness that may come and go. It can occur at any age, but mostly affects teenagers and young adults. Six out of 10 people affected develop their first bald patch before they are 20 years old.

Alopecia areata is thought to be caused by a problem with the immune system (the body's natural defence against infection and illness). It is also believed that some people's genes make them more susceptible to alopecia areata, as one in five people with the condition have a family history of the condition. In many cases the hair grows back after about a year.

Scarring alopecia


Scarring alopecia, also known as cicatricial alopecia, is hair loss that can occur as a result of complications from another condition. In this type of alopecia, the hair follicle (the small hole in your skin that an individual hair grows out of) is completely destroyed. This means your hair will not grow back.

Conditions that can cause scarring alopecia include lichen planus (an itchy rash affecting many areas of the body) and discoid lupus (a mild form of lupus affecting the skin, causing scaly marks and hair loss).

Anagen effluvium


Anagen effluvium is widespread hair loss that can affect your scalp, face and body. One of the most common causes of this type of hair loss is the cancer treatment chemotherapy.

It may be possible to reduce hair loss from chemotherapy by wearing a special cap that keeps the scalp cool. However, scalp cooling is not always effective and not widely available.

In most cases, hair loss in anagen effluvium is temporary. Your hair should start to grow back a few months after chemotherapy has stopped.

Telogen effluvium


Telogen effluvium is a common type of alopecia where there is widespread thinning of the hair, rather than specific bald patches. Hair is shed from the scalp, usually as a reaction to stress or medication. This type of hair loss tends to improve without treatment after a few months.


Causes of hair loss


Male- and female-pattern baldness


Male-pattern baldness is hereditary, which means it runs in families. It is not clear if this is the case with female-pattern baldness.

Male-pattern baldness is thought to be caused by oversensitive hair follicles (holes in the skin that contain the roots of each hair). This is linked to the hormone dihydrotestosterone (DHT), which is made from the male hormone testosterone.

If there is too much DHT, the follicles react to it. The hair becomes thinner and grows for a shorter length of time than normal. The balding process is gradual because different follicles are affected at different times.
The causes of female-pattern baldness are less well understood. Women who have been through the menopause may have an increased chance of female-pattern baldness because they have fewer female hormones.

Alopecia areata


Immune system imbalance

Alopecia areata is an autoimmune condition. The immune system is the body's natural defence system, which helps protect it from infection by bacteria and viruses.

Usually, the immune system attacks the cause of an infection, but in the case of alopecia areata it damages the hair follicles instead. It is not clear exactly why this happens. Fortunately, the hair follicles are not permanently damaged and in many cases the hair grows back within a few months.

Alopecia areata is more common among people with other autoimmune conditions, such as:
  • thyroid disease – conditions that affect your thyroid gland, such as an overactive thyroid (hyperthyroidism) 
  • diabetes – a condition caused by too much glucose (sugar) in the blood 
  • vitiligo – a condition that produces white patches on the skin
Alopecia areata is also more common among people with Down syndrome, a genetic condition that causes learning difficulties and affects physical development. More than one in 20 people with Down syndrome have alopecia areata.

Genetics

Some people may be genetically more vulnerable to alopecia areata. Certain genes (units of genetic material) may make the condition more likely.

Around one in five people with alopecia areata have a family history of the condition, suggesting that the tendency to develop the condition may be inherited. You may also be at an increased risk of alopecia areata if a member of your family has one of the autoimmune conditions mentioned above.

Scarring alopecia


Scarring alopecia is caused by permanent damage to the hair follicles. In many cases, it is not clear why this happens, although it is sometimes the result of another condition.

Conditions that can cause scarring alopecia include:
  • scleroderma – a condition that affects the body's connective (supporting) tissues, resulting in hard, puffy and itchy skin
  • lichen planus – a non-infectious, itchy rash that can affect many areas of the body
  • discoid lupus – a mild form of lupus that affects the skin, causing scaly marks and hair loss
  • folliculitis decalvans – a rare form of alopecia that most commonly affects men, causing baldness and scarring of the affected areas
  • frontal fibrosing alopecia – a type of alopecia that affects post-menopausal women where the hair follicles are damaged, and the hair falls out and is unable to grow back

Anagen effluvium


Anagen effluvium is usually caused by medical treatments for cancer, most commonly chemotherapy.
However, not all chemotherapy drugs cause hair loss and sometimes the hair loss is so small it is hardly noticeable.

In some cases, other cancer treatments – including immunotherapy and radiotherapy – may also cause hair loss.

Telogen effluvium


Telogen effluvium is a type of temporary hair loss that can be caused by your body reacting to:
  • hormonal changes, such as those that take place when a woman is pregnant
  • intense emotional stress
  • intense physical stress, such as childbirth
  • a short-term illness, such as a severe infection or an operation
  • a long-term illness, such as cancer or liver disease
  • changes in your diet, such as crash dieting
  • some medications, such as anticoagulants (medicines that reduce the ability of your blood to clot) or beta-blockers (used to treat a number of conditions, such as high blood pressure)

Symptoms of hair loss


Male- and female-pattern baldness


Male-pattern baldness usually starts around the late twenties or early thirties. By their late thirties, most men have some degree of hair loss.

Male-pattern baldness is so called because it generally follows a set pattern. The first stage is usually a receding hairline, followed by thinning of the hair on the crown and temples. This can leave a horseshoe shape of hair around the back and sides of the head. Sometimes it can progress to complete baldness, although this is uncommon.

Women's hair gradually thins with age, but women generally lose hair from the top of their head only. This is usually more noticeable after the menopause (when a woman's periods stop at around 52 years of age).

Alopecia areata


Alopecia areata causes patches of baldness about the size of a large coin. They usually appear on the scalp but can occur anywhere on the body.

There are usually no other symptoms, although in around one in 10 people the fingernails may also be affected, and may have a pitted or grooved appearance.

In most cases of alopecia areata, hair will grow back in a few months. At first, hair may grow back fine and white, but over time it should thicken and regain its normal colour.

Some people with alopecia areata go on to develop a more severe form of hair loss, such as:
  • alopecia totalis (no scalp hair) 
  • alopecia universalis (no hair on the scalp and body)

Scarring alopecia


As scarring alopecia is caused by another health condition, you will have symptoms relating to this condition besides hair loss. Unlike other forms of hair loss, the skin where the hair has fallen out is likely to be affected in some way. 

For example, in cases where lichen planus has caused scarring alopecia, the skin may develop an itchy rash and may be inflamed.  

In scarring alopecia, the hair follicles (small holes in the skin that contain the roots of each hair) are damaged and replaced with scar tissue. This means that new hair cannot grow, so the hair loss is permanent.

Anagen effluvium


Anagen effluvium, most commonly caused by chemotherapy, usually occurs quickly. In most cases, hair loss is noticeable within a few weeks of chemotherapy starting.

In anagen effluvium, hair loss is widespread, rather than in patches. As well as losing hair from your scalp, you may also lose hair from your body and face.

This type of hair loss is usually temporary. Your hair should stop falling out and start to grow back a few months after chemotherapy has stopped.

Telogen effluvium


In telogen effluvium, there is widespread hair loss from your scalp, rather than specific bald patches. Your hair may feel thinner than before, but you are unlikely to lose it all. Your other body hair will not usually be affected.

In most cases of telogen effluvium, your hair will stop falling out and start to grow back within six months.

Tests and diagnosis for Hair loss (Alopecia)


A complete medical history, family history and physical examination can help in a diagnosis. The pattern and rate of hair loss, the appearance of nearby hairs, and accompanying symptoms are considered when making the diagnosis.

Lab tests


Your doctor may perform blood tests to determine if you have a medical condition that causes hair loss, such as thyroid disease, diabetes or lupus.

Biopsies and samples


During a pull test, several dozen hairs are gently pulled to see how many come out. This helps determine the stage of the shedding process. Scraping samples taken from the skin or from a few hairs plucked from the scalp can help verify whether an infection is causing hair loss. When a diagnosis is difficult to confirm, your doctor may perform a punch biopsy. During this test, the doctor uses a circular tool to remove a small section of your skin's deeper layers.

Treatment of Hair loss (Alopecia)


Male-pattern baldness


Male-pattern baldness is not usually treated, as the treatments available are expensive and do not work for everyone.

Two medicines that may be effective in treating male-pattern baldness are:
  • finasteride 
  • minoxidil
Neither treatment is available on the NHS.

You may also want to consider wearing a wig or having surgery.

Finasteride

Finasteride is available on private prescription from your GP. It comes as a tablet that you take every day. 
It works by preventing the hormone testosterone being converted to the hormone dihydrotestosterone (DHT). DHT causes the hair follicles to shrink, so blocking its production allows the hair follicles to regain their normal size.

Studies have suggested finasteride can increase the number of hairs people have (hair count) and can also improve how people think their hair looks.

It usually takes three to six months of continuously using finasteride before any effect is seen. The balding process usually resumes within six to 12 months if treatment is stopped.

Side effects for finasteride are uncommon. Less than one in 100 men who take finasteride experience a loss of sex drive (libido) or erectile dysfunction (the inability to get or maintain an erection).

Minoxidil

Minoxidil is available as a lotion that you rub on your scalp every day. It is available from pharmacies without a prescription. It is not clear how minoxidil works, but evidence suggests it can cause hair regrowth in some men.

The medication contains either 5% or 2% minoxidil. Some evidence suggests the stronger version (5%) is more effective. Other evidence has shown that this is no more effective than the 2% version. However, the stronger version may cause more side effects, such as dryness or itchiness in the area it is applied.

Like finasteride, minoxidil usually needs to be used for several months before any effect is seen. The balding process will usually resume if treatment with minoxidil is stopped. Any new hair that regrows will fall out two months after treatment is stopped. Side effects are uncommon.

Female-pattern baldness


Minoxidil is currently the only medicine available to treat female-pattern baldness.

Minoxidil lotion may help hair grow in around one in four women who use it, and it may slow or stop hair loss in other women. In general, women respond better to minoxidil than men. As with men, you need to use minoxidil for several months to see any effect.

Alopecia areata


There is no completely effective treatment for alopecia areata. However, in most cases the hair grows back after about a year without treatment. So "watchful waiting" is sometimes best, particularly if you just have a few small patches of hair loss.

Some treatments for alopecia areata are outlined below.

Corticosteroid injections

Corticosteroids are medicines containing steroids, a type of powerful chemical called a hormone. They work by suppressing the immune system (the body's natural defence against infection and illness). This is useful in alopecia areata because the condition is thought to be caused by the immune system damaging the hair follicle.

Corticosteroid injections appear to be the most effective treatment for small patches of alopecia. As well as your scalp, they can also be used in other areas, such as your eyebrows.

A corticosteroid solution is injected several times into the bald areas of skin. This stops your immune system from attacking the hair follicles. It can also stimulate hair to grow again in those areas after about four weeks. The injections are repeated every few weeks. Alopecia may return when the injections are stopped.

Side effects of corticosteroid injections include pain at the injection site and thinning of your skin (atrophy).
Topical corticosteroids

Topical corticosteroids (creams and ointments) are widely prescribed for treating alopecia areata, but their long-term benefits are not known.

They are usually prescribed for a three-month period. Possible corticosteroids include:
  • betamethasone 
  • hydrocortisone
  • mometasone
These are available as a lotion, gel or foam depending on which you find easiest to use. However, they cannot be used on your face, for example on your beard or eyebrows.

Possible side effects of corticosteroids include thinning of your skin and acne (spots).

Corticosteroids tablets are not recommended due to the risk of serious side effects, such as diabetes and stomach ulcers.

Minoxidil lotion

Minoxidil lotion is applied to the scalp and can stimulate hair regrowth after about 12 weeks. However, it can take up to a year for the medication to take full effect.

Minoxidil is licensed to treat both male- and female-pattern baldness, but is not specifically licensed to treat alopecia areata. This means it has not undergone thorough medical testing for this purpose.

Minoxidil is not recommended for those under 18 years old. It is not available on the NHS, but can be prescribed privately or bought over the counter.

Immunotherapy

Immunotherapy may be an effective form of treatment for extensive or total hair loss, although fewer than half of those who are treated will see worthwhile hair regrowth.

A chemical solution called diphencyprone (DPCP) is applied to a small area of bald skin. This is repeated every week using a stronger dose of DPCP each time. The solution eventually causes an allergic reaction and the skin develops mild eczema (dermatitis). In some cases, this results in hair regrowth after about 12 weeks.
A possible side effect of immunotherapy is a severe skin reaction. This can be avoided by increasing the DPCP concentration gradually. Less common side effects include a rash and patchy-coloured skin (vitiligo). In many cases, the hair falls out again when treatment is stopped.

Immunotherapy is only available in specialised centres. You will need to visit the centre once a week for several months. After DPCP has been applied, you will need to wear a hat or scarf over the treated area for 24 hours because light can interact with the chemical.

Dithranol cream

Similar to immunotherapy, dithranol cream is applied regularly to the scalp before being washed off. It causes a skin reaction, followed by hair regrowth in some cases.

However, it has not been proven that dithranol cream is significantly effective in the long term. It can also cause itchiness and scaling of the skin and can stain the scalp and hair. For these reasons, dithranol is not widely used.

Ultraviolet light treatment

Two to three sessions of light therapy (phototherapy) are given every week in hospital. The skin is exposed to ultraviolet (UVA or UVB) rays. In some cases, before your skin is exposed to UV light you may be given a medicine called psoralen, which makes your skin more sensitive to the light.

The results of light therapy are often poor. The treatment can take up to a year to produce maximum results and responses vary, with a high relapse rate. It is often not a recommended treatment because side effects can include:
  • nausea (feeling sick)
  • pigment changes to the skin
  • an increased risk of skin cancer

Wigs and hairpieces


If you would like an alternative to medical treatment for your baldness or if you don't respond to treatment, you may want to consider wearing a wig or hairpiece. They can be used to cover either permanent or temporary hair loss. Quality, natural-looking wigs and hairpieces are available.

Surgery


In the most common type of permanent hair loss, only the top of the head is affected. Surgical procedures can make the most of the hair you have left.

  • Hair transplants. This type of procedure removes tiny plugs of skin, each containing a few hairs, from the back or sides of your scalp. The plugs are then implanted into the bald sections of your scalp. Several transplant sessions may be needed, as hereditary hair loss progresses with time.
  • Scalp reduction. This procedure surgically removes some of the bald skin on your head. After hairless scalp is removed, the space is closed with hair-covered scalp. Doctors can also fold hair-bearing skin over an area of bald skin in a scalp reduction technique called a flap.
Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring.

Complementary therapy


Aromatherapy, acupuncture and massage are often used for alopecia, but there is not enough evidence to support their use as effective treatments.

Herbs


The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs should only under the supervision of a health care provider.

Massage


Therapeutic massage increases circulation (helping bring more blood to the scalp) and reduces stress. Scalp massage using essential oils of rosemary, lavender, thyme, and cedarwood may help increase circulation.

Who is a candidate for hair replacement?


Men with male-pattern baldness.

Some women with thinning hair.

A person who has lost some but not all hair as a result of burns or other scalp injuries.

Who is not a candidate for hair replacement?


Hair replacement is not recommended for the following patients:

  • Women with a diffuse, or wide-spread, pattern of hair loss
  • Those who do not have sufficient "donor" sites (hair-bearing portions of the head from which hair-bearing skin is taken)
  • People who form keloid scars or thick fibrous tissue that can result from trauma, burning, or radiation injury
  • Those whose hair loss is due to medication.

Lifestyle and home remedies for Hair loss (Alopecia)


These tips may help you avoid preventable types of hair loss:


Common hair replacement procedures


Grafting: Grafting is an outpatient procedure performed in the dermatologic surgeon’s office. Micro-grafts contain only one to two hairs per graft, while slit grafts contain between four and 10, and punch grafts hold 10 to 15 hairs. A local anesthetic is injected into the scalp and sedation is available, if needed, for relaxation and comfort.

What happens during and after the procedure?


The dermatologic surgeon first removes a disc-shaped portion of the hair-bearing scalp from the back of the head. Then, the surgeon cuts the removed scalp into small segments with varying amounts of hair in each graft to achieve a very subtle thickening and "natural" look with this technique.

With each session, 100 to 1,000 hair-bearing segments are transplanted. "Donor" sites are closed with stitches, which usually are then concealed by the surrounding hair. After the grafting session is complete, the scalp is cleaned and covered with gauze and, if necessary, a bandage. Stitches will be removed approximately 10 days later.