Home Hair and Scalp Hair loss: Sign & Symptoms, Etiology, Treatment Options
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Hair loss: Sign & Symptoms, Etiology, Treatment Options

by Dr.Bahman Sotoodian

Hair loss in the typical healthy person can be as high as 100 hair strands each day. Hair loss (also known as hair fall) happens when you start to lose more strands, and few or none of them regrow. There are various types of hair loss with different symptoms, and it can affect both adults and children. 

Hair loss can be limited to your scalp or spread throughout your body, and it can be temporary or permanent. Though anyone can experience hair loss on their scalp, men are more prone to extensive hair loss. Baldness is typically defined as excessive hair loss from the scalp, and the most common cause of baldness is hereditary hair loss with age (Androgenic alopecia).

However, before initiating treatment for your hair loss, you must consult with a dermatologist who can properly diagnose the type of your hair loss and its underlying cause. He or she can discuss treatment options to address your ongoing hair loss.

Type of hair Loss (hair fall)
Hair Loss image

To give you a better outlook on hair loss (hair fall), in this article, we will go through definition, sign & symptoms, underlying causes, and treatments options for hair loss.

Different Types of hair loss

Alopecia can be localized or widespread, permanent or reversible as well as scarring or nonscarring. The most common non-scarring types of alopecia diagnosed by dermatologists are:

  • Androgenetic alopecia (male- and female-pattern hair loss)
  • Telogen effluvium
  • Alopecia areata
  • Lichen planopilaris (frontal fibrosing alopecia)

Androgenetic Alopecia

Androgenetic alopecia, a common type of hair loss, affects both men and women. Hair loss begins above both temples in a distinct pattern. Male-pattern baldness is another name for this condition. The hairline recedes to form a distinctive โ€œMโ€ shape over time, and hair thins at the crown, often progressing to partial or complete baldness.

Androgenetic Alopecia image
Androgenetic Alopecia Image in Women and men

Womenโ€™s hair thins throughout the head, but the hairline does not recede. Women with androgenetic alopecia rarely experience total baldness. Women tend to notice that their hair starts to widen which is described as a christmas tree pattern. 

Androgenetic alopecia is caused by an underlyinggenetic predisposition and it is due to modified response of hair follicles to a male sex hormones known as androgen. A variety of other factors, including emotional stress, can also cause and contribute to hair loss.

Telogen Effluvium

Telogen effluvium is a form of hair loss that is characterized by hair thinning or an increase in hair shedding. It more frequently affects women and is brought on by a disruption in the hair cycle on the scalp.

There is no clinical or historical evidence of inflammation, and it is a non-scarring type that diffusely affects the entire scalp.Increase in hair fall is observed 2 to 4 months after the triggering event as the new hairs pushing through the scalp push out the dormant club hairs.

Telogen Effluvium image
Type of Hair Loss: Telogen Effluvium

Long-term COVID patients may experience symptoms of chronic telogen effluvium. This is most likely due to the fact that their bodies are still recovering from a great deal of stress and are not fully recovered.

Telogen effluvium can develop one to five months after giving birth. Hair loss during pregnancy is not uncommon, affecting 40 to 50% of women; however, like most changes during pregnancy, it is only temporary.

Telogen effluvium can also occur after weight loss, and appears approximately three months after the initial weight loss. The condition is typically caused by nutrient deficiencies caused by severely restrictive dieting or weight loss surgery. It usually goes away after about 6 months as the body adjusts to the weight loss.

It is important to note that many other conditions including mental stress, losing job, a loss in family as well as physician distress including having severe fever, being hospitalized, suffering from a chronic medical condition including lupus can trigger Telogen Effluvium. 

Alopecia Areata 

Alopecia areata is a common autoimmune disorder characterized by irregular hair loss. It affects approximately 6.8 million people in the United States and 147 million people worldwide. Hair typically falls out in quarter-sized patches. Alopecia areata can affect larger areas of the scalp than just a few patches.

Alopecia Areata
Alopecia Areata image

Alopecia totalis is defined as complete hair loss on the scalp. Alopecia universalis is a condition that causes hair loss all over the body including eyebrows and eyelashes. Anyone, regardless of age, gender, or race, can develop alopecia, though the majority of cases appear before the age of 30.

Patients with limited alopecia areata, few small patches, tend to have a better chance to completely recover from it. There are new topical (cream) as well as oral (by mouth) Jak inhibitor medications that can play a significant role in complete resolution of even widespread alopecia areata including Totalis & Universalis. 

Alopecia areata can also be associated with other autoimmune conditions including vitiligo (a condition that Mickel Jackson suffered from), autoimmune thyroid disease, type 1 diabetes, rheumatoid arthritis as well as lupus. 

Lichen Planopilaris (Frontal Fibrosing Alopecia)

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary scarring alopecias with clinical and trichoscopy features that can be very valuable in assisting to make their diagnosis, particularly in the early stages, but scalp biopsy is the gold standard for its definitive diagnosis.

Lichen Planopilaris
Hair Loss: Type Lichen Planopilaris image

Frontal fibrosing alopecia is considered a variant of lichen planopilaris because the histopathological findings are similar, with a perifollicular lymphohistiocytic infiltrate and a lichenoid pattern. A thorough clinical examination, trichoscopy, and photographic documentation are required to assess the evolution and therapeutic response.

Frontal fibrosing alopecia (FFA) is a primary lymphocytic scarring alopecia that is histopathologically similar to lichen planopilaris (LPP). Clinically, FFA causes slow hair loss in the frontotemporal implantation hairline.

Patients with FFA present with receding hairline which is reflected as widening for their forehead. The forehead becomes shiny and sometimes a single isolated hair away from the hair line is visible (โ€œlonely hair signโ€). The area can be very itchy and some patients notice red dots affecting their forehead. 

Patients with LPP present with intensely itchy and red scalp and notice diffuse scalp hair loss. Hair loss is more concerning than hair shedding. They also express concern regarding scalp burning sensation. LPP can be associated with lichen planus that can present as white patches inside the mouth or sores (erosions) affecting genitalia. Patients may also experience purple flat itchy bumps affecting their wrist area (lichen planus). 

Sign & Symptoms associated with Hair Loss 

Depending on the underlying cause, hair loss symptoms can manifest in a variety of ways. It can strike suddenly or gradually, and it can affect your entire body or just your scalp. Some warning signs and symptoms of hair loss include:

Hair falling out

Physical or emotional shocks can yield excessive hair loss. Handfuls of hair may fall out as you comb or wash your hair, or even as you gently tug on it. This type of hair loss causes general hair thinning but is only temporary.

Top of the head starts thinning

This is the most common symptom of hair loss that patients experience as they age. Menโ€™s hair frequently starts to regress at the hairline on the forehead. Typically, a womanโ€™s hair part is wider than a manโ€™s hair part. An increasingly prevalent hair loss pattern in older women is a receding hairline (frontal fibrosing alopecia).

Patchy or round bald spots

Some people experience hair loss in the form of patchy or round bald spots on the scalp, beard, or brows. Your skin may become painful or itchy before the hair starts to fall out.

Large patches of scaling all over the scalp

This is due to fungus overgrowth. Broken hair shafts, scalp redness, swelling, and occasionally oozing may also be present.

Hair loss throughout the body

Hair loss can occur all over your body as a result of underlying medical conditions or due to recent medicalย treatments, such as chemotherapy for cancer. The hair usually regrows.

Hair Loss Etiologies

Hair loss occurs when new hair does not replace lost hair and is typically caused by one or more of the following factors:

Hereditary

Hereditary hair loss that coincides with the aging process is one of the most common causes of hair loss. Androgenic alopecia, female and male-pattern baldness are all titles that have been used for this type of hair loss. Men typically experience a receding hairline and bald spots, while women experience thinning hair along the crown of the scalp.

Hormonal fluctuations and medical conditions

Hair loss can be either temporary or permanent depending on the underlying cause, which can include thyroid issues, hormonal changes brought on by pregnancy, childbirth, menopause, and more. Alopecia areata, an immune-related condition that causes patchy hair loss, scalp infections such as ringworm, and trichotillomania, a hair-pulling disorder, are examples of medical conditions that can contribute to hair loss. 

Drugs and dietary supplements

Hair loss can occur as a side effect from some medications, including those prescribed for cancer (chemotherapy), arthritis, depression, heart problems, gout, and high blood pressure.

Scalp Radiation

Hair loss is inevitable with brain radiotherapy, patients may also experience hair loss on the opposite side of their heads, where the radiotherapy beams pass. This is known as the exit site. Scalp radiation can potentially induce telogen effluvium (transient hair loss) as well as potentially permanent hair loss.

The type of radiotherapy received determines whether or not your hair grows back. If the patient is undergoing whole-brain radiotherapy, their hair will most likely regrow. Whereas in cancer treatment that uses a high dose of radiation, permanent hair loss is more common.

Emotional Stress โ€“ Mental Health 

Many people experience general hair thinning several months after a traumatic event, whether it be physical or emotional. This causes temporary hair loss. If you are suffering from anxiety, depression or going through a difficult time, the status of your mental health can play a significant role in the well being of your hair conditions. Most patients notice an increase in hair shedding a few months after the stressful life events which can last for 3-4 months on average. 

Hair treatments and styles

Excessive styling and tight-pulling hairstyles such as pigtails and cornrows can cause traction alopecia, a type of hair loss. Permanent hair dye and hot oil treatments can both cause hair to become brittle and fall out. Scarring has the potential to cause permanent hair loss.

How to treat Hair Loss?

Most hair loss does not require treatment and is either temporary (it grows back) or a normal part of aging. 

How To Treatment Hair Loss
Hair Loss Treatment

In some conditions, such as patchy hair loss (alopecia areata), hair may regrow without treatment within a year. On the other hand, medication and surgery are both options for treating hair loss. Moreover, with effective treatments, you may even be able to reverse or at least slow the hair loss process.

Medication

Rogaine (Minoxidil) is an over-the-counter product that is the first line of treatment for thinning hair. Minoxidil is a generic version of Rogaine and much more affordable than Rogaine. It comes in the form of foam and solution. The foam is less irritating for the scalp. It is also marketed as 5% for Men and 2% for Women.

However, the 2% is not as effective enough and most dermatologists recommend the 5% for both Men & Women. Most patients have to use it twice a day for at least 6-12 months prior seeing any significant benefits. The medication has few side effects including causing scalp irritation, lower blood pressure causing lightheadedness or dizziness as well as facial hair growth if it is used inappropriately over the face. 

Finasteride, also known as Propeciaยฎ, is an oral medication available only by prescription for men and women that can provide considerable benefits for hair loss. The medication has few considerable side effects that your dermatologist needs to discuss in detail with you.

Oral Minoxidil is also an alternative option to topical (foam, solution) minoxidil that can be used for patients who donโ€™t have any history of low blood pressure. It is much easier for patients to take it instead of topical solution and tends to be more effective. 

Hair transplant

Hair transplant is a great way to keep some of the hair you have left on your scalp.Dermatologist removes the hair from back of the scalp andย transplants them into the bald area. Although the treatment is performed in an outpatient setting, patients receiving topical as well as oral anesthetics are able to tolerate the treatment.ย Possible risks of the procedure include bleeding, bruising, swelling and infection. It is crucial to note that prior and post hair transplant patients need to continue using the topical and oral medications so they would have a better outcome post hair transplant procedure.ย 

Low Light Laser Therapy 

Laser therapy is another option for hair loss treatment. This may help with hereditary hair loss, Alopecia areata, chemotherapy-induced hair loss, and stimulating healing and hair growth after a hair transplant. According to published medical research, laser therapy is safe and painless, but it requires a number of treatment sessions. To see some hair growth, you may need several treatments per week for several months.

Platelet-rich plasma (PRP)

PRP therapy can slow hair loss and promote hair regrowth. Your healthcare professional separates the platelet-rich plasma after taking your blood. Most patients come back once every month for the first three months, then once every three to six months. The entire process takes about 10 minutes, and there is typically no downtime with the procedure.

When is it Time to See a Doctor for Hair Loss?

As soon as you notice any of the early signs of increased hair shedding or hair thinning, you should consult a dermatologist. Acting quickly can help you prevent further hair loss and keep more of your hair.

The best time to act on hair loss varies from person to person. Some men may notice signs of hair loss in their 20s or 30s. Others may have noticed them earlier. Even young men can make early changes to prevent hair loss.

Here are some common signs that it might be time to see a dermatologist โ€“ and what to look out for:

Hairline is visibly receding

Male pattern baldness frequently begins at the hairline. The Norwood scale is used by experts to assess the severity of hair loss. The scale ranges from a full hairline to severe horseshoe pattern hair loss. The hair on your scalp may still be thick in the early stages, but it may show visible signs of recession.

If youโ€™ve noticed your hairline becoming thinner, higher, and more M-shaped, itโ€™s time to see a doctor who specializes in hair loss.

Rapid and Sudden Hair Loss

If youโ€™ve developed a large bald spot overnight, or if your hair is falling out in large amounts, itโ€™s usually a sign that youโ€™re experiencing significant hair loss. This could be due to androgenic alopecia, or it could be hair shedding caused by an illness or other health issue.

Late Stages of Hair Loss

The more severe your hair loss becomes, the more difficult it is to treat. Itโ€™s always a good idea to act before your hair develops the classic horseshoe or cul-de-sac pattern. If you are experiencing late-stage hair loss, it is critical that you consult with a hair loss specialist as soon as possible.

Ineffective Hair Loss Treatment Program

If your hair loss treatment program isnโ€™t working, itโ€™s possible that youโ€™re missing something crucial. Often, the missing ingredient is a prescription hair loss treatment, such as finasteride. You can find out whatโ€™s missing from your current hair loss protocol by visiting a dermatologist.

How to Prevent Hair Loss?

Hair loss not only affects your appearance but can also cause emotional stress and undermine your confidence. There are, however, a few things you can do to help prevent hair loss.

How to Prevent Hair Loss?
hair loss prevention

Pay attention to your diet

A Mediterranean diet rich in fresh herbs and raw vegetables may reduce the risk of androgenic alopecia (pattern baldness) or slow its onset, according to a study. Eating a diet high in protein and vitamins A could also help prevent hair loss. Healthy choices include foods like: eggs, beans, peas, fish, low-fat dairy products, and chicken.

Take Supplements

A lack of vitamin D has been linked to nonscarring alopecia. Biotin, also known as vitamin H or B7, helps the body synthesize fatty acids. This process is essential to the hair life cycle, and a lack of it can lead to hair loss. Deficiency treatment may improve hair regrowth.

Saw palmetto may benefit those suffering from Androgenetic Alopecia, telogen effluvium, and self-perceived hair thinning. A review of seven studies discovered that 100-320 mg could improve hair quality and count. Furthermore, Ginseng contains phytochemicals that may promote hair growth on the scalp.

Hair care

A 2018 study found that coconut oil may help prevent hair damage caused by grooming and exposure to ultraviolet (UV) light. Massage coconut oil into your scalp to improve blood flow and hair growth. Deep conditioning hair with olive oil can help to prevent dryness and breakage,apply a few tablespoons of olive oil to your hair and leave it on for 30 minutes before shampooing. .

Daily hair washing can keep the scalp healthy and clean, which can help to prevent hair loss. Harsher formulas may dry out and split hair, giving rise to hair loss.

Avoid wearing your hair in tight braids or ponytails, which can cause your hair to pull at the roots. Allow your hair to dry naturally to avoid irritating your scalp. If possible, avoid using heat styling tools such as curling or straightening irons, which can also damage or break the hair shaft.

Perms and hair dyes can also be damaging to the hair and scalp. Inquire with your stylist about organic hair dyes and other non-ammonia, peroxide, or para-phenylenediamine-containing alternatives (PPD).

Final thoughts

Itโ€™s well known that both men and women are prone to hair loss and balding. Hair loss is unavoidable as you get older; Other factors that contribute to hair loss symptoms include genetics, stress, medication, and illnesses such as cancer. Though it is not possible to completely prevent hair fall, there are some preventative measures you can take. In addition to following the diet tips and using the appropriate hair care products, ensure that you are in good physical health. Keep in mind that if you notice severe hair loss, you should see a dermatologist.

FAQ

What are the causes of hair loss in men?

The vast majority of balding men have androgenetic alopecia, also known as male pattern baldness. Androgenetic alopecia is responsible for 95% of male hair loss, according to the American Hair Loss Association. This inherited trait, which causes menโ€™s hairlines to recede and crowns to thin, is caused by a genetic sensitivity to a byproduct of testosterone known as dihydrotestosterone (DHT).

What causes hair loss in women?

Temporary hair loss is caused by extreme physical stress or shock to the body. Traction alopecia is a type of hair loss caused by tight ponytails, braids, or cornrows pulling on your hair roots. Genetics causes womenโ€™s hair to thin along the top of their heads. Baldness may result from aging-related hormonal changes or menopause, and toxic substances such as chemotherapy and radiation.

Is hair loss contagious?

No, you cannot catch hair loss. Some people catch a contagious disease, which can lead to hair loss. For example, if you catch the fungus that causes ringworm, the fungus could grow on your scalp. Left untreated, scalp ringworm can cause hair loss and eventually lead to permanent bald spots.

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