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Hair loss

Partial or complete loss of hair is called alopecia.

Alternative Names

Loss of hair; Alopecia; Baldness;

Considerations

Hair loss usually develops gradually. It may be patchy or all over (diffuse). You lose roughly 100 hairs from your head every day. The scalp contains about 100,000 hairs.

Causes

Heredity

Both men and women tend to lose hair thickness and amount as they age. This type of baldness is not usually caused by a disease. It is related to aging, heredity, and changes in the hormone testosterone. Inherited, or pattern baldness, affects many more men than women . Those with inherited hair loss show signs of hair loss before age 40. About half of all men show signs of hair loss by age 50.

Physical or Emotional Stress

Physical or emotional stress may cause one-half to three-quarters of scalp hair to shed. This kind of hair loss is called Telogen effluvium. Hair tends to come out in handfuls while you shampoo, comb, or run your hands through your hair. You may not notice this for weeks to months after the episode of stress. Hair shedding decreases over 6 to 8 months. Telogen effluvium is usually temporary. But it can become long-term (chronic).

Causes of this type of hair loss are:

  • High fever or severe infection
  • Childbirth
  • Major surgery, major illness, sudden blood loss
  • Severe emotional stress
  • Crash diets, especially those that do not contain enough protein
  • Medications, including retinoids, birth control pills, beta-blockers, calcium channel blockers, certain antidepressants, NSAIDs (including ibuprofen).

Some women ages 30 to 60 may notice a thinning of the hair that affects the entire scalp. The hair loss may be heavier at first, and then gradually slow or stop. There is no known cause for this type of telogen effluvium.

Others Causes

Other causes of hair loss, especially if it is in an unusual pattern, include:

Home Care

Hair loss from menopause or childbirth often goes away after 6 months to 2 years.

For hair loss due to illness (such as fever), radiation therapy , medication use, or other causes, no treatment is needed. Hair usually grows back when the illness ends or the therapy is finished. You may want to wear a wig, hat, or other covering until the hair grows back.

Hair weaves, hair pieces, or changes of hair style may disguise hair loss. This is generally the least expensive and safest approach to hair loss. Hair pieces should not be sutured (sewn) to the scalp because of the risk of scars and infection.

When to Contact a Medical Professional

Call your doctor if:

  • You are losing hair in an unusual pattern
  • You are losing hair rapidly or at an early age (for example, in your teens or twenties)
  • You have any pain or itching with the hair loss
  • The skin on your scalp under the involved area is red, scaly, or otherwise abnormal
  • You have acne, facial hair, or an abnormal menstrual cycle
  • You are a woman and have male pattern baldness
  • You have bald spots on your beard or eyebrows
  • You have been gaining weight or have muscle weakness, intolerance to cold temperatures, or fatigue

What to Expect at Your Office Visit

A careful medical history and examination of the hair and scalp are usually enough to diagnose the cause of your hair loss.

Your doctor will ask detailed questions such as:

  • Are you losing hair only from your scalp or from other parts of your body as well?
  • Is there a pattern to the hair loss, like a receding hairline or thinning or bald areas on the crown, or is the hair loss throughout your head?
  • Have you had a recent illness or high fever?
  • Do you dye your hair?
  • Do you blow dry your hair? How often?
  • How often do you shampoo your hair?
  • What kind of shampoo, hair spray, gel, or other product do you put on your hair?
  • Have you been under unusual stress lately?
  • Do you have nervous habits that include hair pulling or scalp rubbing?
  • Do you have any other symptoms like itching, flaking, or redness of your scalp?
  • What medications do you take, including over-the-counter drugs?

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

  • Blood tests to rule out disease
  • Microscopic examination of a plucked hair
  • Skin biopsy

If you have ringworm on the scalp, your doctor may prescribe an oral medicine for you to take. Applying creams and lotions may not get into the hair follicles to kill the fungus.

Your doctor may prescribe a solution, such as Minoxidil that is applied to the scalp to stimulate hair growth. Other medicines, such as hormones, may be prescribed to decrease hair loss and promote hair growth.

References

Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5th ed. Philadelphia, PA: Elsevier Mosby; 2009:chap 24.

Sperling LC, Sinclair RD, El Shabrawi-Caelen L. Alopecias. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 69.

Updated: 5/15/2013

Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial Team.


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