Hair loss

Considerations:
Baldness is determined by multiple genetic factors. It cannot be categorically stated that baldness follows the mother's line or anyone else's, or that it skips generations.

Both men and women lose hair density as they age. Men develop a typical pattern of baldness, associated with the presence of the male hormone testosterone . Men who do not produce testosterone (because of genetic abnormalities or castration) do not develop this pattern of baldness. The use of steroids during adolescence and young adulthood may accelerate the effects of testosterone on baldness. Women also develop a characteristic pattern of hair loss. See male-pattern baldness ; female-pattern baldness .

Occurring most often on the scalp, alopecia usually develops gradually and may be all over (diffuse) or patchy.

Usually baldness is not caused by a disease but is genetic and permanent. Inherited or "pattern baldness" affects many more men than women. About 25% of men begin to bald by the time they are 30 years old, and about two-thirds are either bald or have a balding pattern by age 60.

On average, about 100 hairs are lost from the head every day. The average scalp contains about 100,000 hairs (blondes 140,000, brunettes 155,000 and redheads only 85,000).

Each individual hair survives for an average of 4.5 years, during which time it grows about half an inch a month. Usually in its 5th year, the hair falls out and is replaced within 6 months by a new one. Genetic baldness is caused by the body's failure to produce new hairs and not by excessive hair loss.

Common Causes:

Note: There may be other causes of hair loss. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of hair loss can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics such as location, quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for hair loss, occurring alone or in combination with other problems.

Home Care:
For hair loss caused by illness (such as fever ), radiation therapy , or medication use, no treatment is necessary. The hair will usually grow back when illness has ended or therapy has stopped. A wig, hat, or other covering may be desired until the hair grows back.

For hair loss due to heredity, the medication Rogaine (minoxidil), which requires a prescription, has shown some positive effect. However, results are mixed and there are good results in less than 10% of the cases. Also, Rogaine can be expensive.

Punch graft hair transfer done by a physician is a surgical approach to transferring hair from one part of the head to another. It is somewhat painful and expensive, but usually permanent.

Call Your Healthcare Provider If:

  • hair is present in the involved area but fails to grow out normally.
  • continual hair-pulling is suspected.
  • the skin under the involved area is abnormal.



What to Expect:
The medical history will be obtained and a physical examination performed.

Medical history questions documenting hair loss in detail may include:

  • location and pattern

  • medical history
    • Have you had a recent illness?
    • Have you had a high fever recently?

  • hair care habits
    • Do you dye your hair?
    • Do you blow dry your hair?
    • How often do you shampoo your hair?
    • What kind of shampoo, hair spray, gel, or other product do you put on your hair?

  • emotional state

  • accidents and emergencies history
    • Have you ever been involved in an accident that affected your scalp or hair in any way?

  • other
    • What other symptoms are also present?
    • What medications are being taken?

An examination of the hair and scalp are usually enough to diagnose the nature of the problem.

Diagnostic tests that may be performed (but are rarely needed) include:

  • microscopic examination of a plucked hair
  • skin biopsy (if skin changes are present)

Intervention:
Ringworm of the scalp may require the use of an oral drug, such as griseofulvin, because creams and lotions applied to the affected area cannot get into the hair follicles to kill the fungus.

After seeing your health care provider:
If a diagnosis was made by your health care provider related to hair loss, you may want to note that diagnosis in your personal medical record.


Alopecia totalis: This form of alopecia (hair loss) is characterized by complete loss of scalp hair. Alopecia totalis is a severe form of alopecia areata, a condition caused by the bodies immune attack on normal hair follicles. This attack usually results in a patchy loss of hair. Patchy hair loss on the scalp is alopecia areata. Hair loss from the entire body, including the eyebrows, eyelashes, and body hair is alopecia universalis.



Alopecia areata is patchy areas of hair loss with normal surrounding hair pattern.



Baldness appears to be a heritable trait, although the exact mode of inheritance is still in question. Typically it begins with recession of the hairline high on each side of the forehead backward across the scalp. The crown of the head may begin to bald shortly thereafter.



This area of the scalp was not developed at the time of birth, and has closed-over by scarring. No hair follicles are present within the area of the scar. This condition is known as aplasia cutis congenita, and will remain bald throughout the individual's life.



In the scalp, fungal infections often form circular, scaly, inflamed patches. Many times there is temporary hair loss (hair returns when infection clears). This is a classical example of scalp ringworm (tinea capitis) in a young child.



Patchy hair loss is called alopecia areata. The surrounding hair is normal.



Alopecia, trichotillomania is a nervous habit of twisting and pulling at the hair. Persistent traction and twisting breaks the hair off at the level of the skin, producing patches of baldness and a "moth-eaten" appearance. If the behavior is stopped, the hair will re-grow. Permanent hair loss may result if the pattern is not interrupted.



Alopecia areata is patchy, loss of hair that can occur on any hair-covered area of the body. This is alopecia areata of the beard area.







Trichotillomania is a nervous habit of twisting and pulling at the hair. Persistent traction and twisting breaks the hair off at the level of the skin, producing patches of baldness and a "moth-eaten" appearance. If the behavior is stopped, the hair will re-grow. Permanent hair loss may result if the pattern is not interrupted.



Alopecia



Hair loss is referred to as alopecia. Traction alopecia is a specific type of hair loss that results from repeated traction or tension on the hair. This has been caused by repeatedly pulling the hair into a tight barrette. Traction alopecia may also result from pulling the hair. This picture shows loss of hair along a well-defined line.



Male pattern baldness - thinning: Male pattern baldness is typified by a receding hairline in front, and thinning of the hair on the crown of the head.



Male pattern baldness in a female: Male pattern baldness can develop in women, as evidenced by this receding hairline.



In the scalp, fungal infections often form circular, scaly, inflamed patches. Frequently, there can be temporary hair loss (hair returns when infection clears but if treatment is delayed and scarring results, permanent hair loss can be seen). This is a classical example of ringworm (tinea capitis) in a young child.



Pus-filled lesions (pustules) are unusual in alopecia areata, but can occur, as in this picture. The pustules are infected where medication was injected into the area.



Hair loss is referred to as alopecia. Patchy hair loss on the scalp is called alopecia areata. Complete scalp hair loss is alopecia totalis. Loss of all body hair is called alopecia universalis.



Hair loss is referred to as alopecia. Patchy hair loss on the scalp is called alopecia areata. Complete scalp hair loss is alopecia totalis. Hair loss from the entire body, including the eyebrows, eyelashes, and body hair, is alopecia universalis.



This picture shows alopecia areata, under treatment. The hair loss is being treated with anthralin, which causes the brownish hyperpigmentation and can induce hair regrowth. It is very unlikely regrowth will occur when hair is lost along the scalp margin (ophiasis).



Trichotillomania is repetitive twisting and twirling of the hair. The hair loss is usually in a well-defined area with shortened, broken-off hairs and early regrowth of hair. The scalp is the most commonly involved site, but eyelashes and eyebrows may also be involved. The hair loss can also be patchy and poorly defined.



Folliculitis, decalvans causes scarring with hair loss (alopecia). There are areas of "corn stalking" (grouped hairs arising within the area of alopecia), redness (erythema), crusting, and pustules. Due to severe scarring, permanent hair loss occurs in the involved sites.



Folliculitis, decalvans causes scarring with hair loss (alopecia). There are areas of "corn stalking" (grouped hairs arising within the area of alopecia), redness (erythema), crusting, and pus-filled blisters (pustules). Due to severe scarring, permanent hair loss may occur.