Hair loss can start with a few extra hairs in the sink or in your comb. Later, it can progress to a bare scalp.
Baldness typically refers to excessive hair loss from your scalp and can
be the result of heredity, certain medications or an underlying medical
condition. Anyone — men, women and children — can experience hair loss.
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 and 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 hair loss.
The medical term for hair loss is alopecia. Pattern baldness
(androgenetic alopecia), the most common type of alopecia, affects
roughly one-third of men and women. It's typically permanent. Other
types of alopecia are temporary, including alopecia areata. It can
involve hair loss on your scalp or other parts of your body.
Permanent hair loss
* Male-pattern baldness (androgenetic alopecia). For men, pattern
baldness can begin early, even in the teens or early 20s. It's typically
characterized by a receding hairline at the temples and balding at the
top of the head. The end result may be partial or complete baldness.
* Female-pattern baldness (androgenetic alopecia). Women with
permanent hair loss usually have hair loss limited to thinning at the
front, sides or crown. Women usually maintain their front hairline and
rarely experience complete baldness.
* Cicatricial (scarring) alopecia. This rare condition occurs when
inflammation damages and scars hair follicles, causing permanent hair
loss. Sometimes the patchy hair loss is associated with itching or pain.
Temporary hair loss
* Alopecia areata. Hair loss usually occurs in small, round, smooth
patches about the size of a quarter. Usually the disease doesn't extend
beyond a few bare patches on the scalp, but it can cause patchy hair
loss on any area that has hair, including eyebrows, eyelashes and beard.
In rare cases, it can progress to cause hair loss over the entire body.
If the hair loss includes your entire scalp, the condition is called
alopecia totalis. If it involves your whole body, it's called alopecia
universalis. Soreness and itching may precede the hair loss, but
symptoms are often minimal.
* Telogen effluvium. This type of temporary hair loss occurs
suddenly, most often after a significant illness or major life stress.
Handfuls of hair may come out when combing or washing your hair or may
fall out after gentle tugging. This type of hair loss usually causes
overall hair thinning and not bald patches.
* Traction alopecia. Bald patches can occur if you regularly wear
certain hairstyles, such as pigtails, braids or cornrows, or if you use
tight rollers. Hair loss typically occurs between the rows or at the
part where hair is pulled tightly.
* Anagen effluvium. In this type of hair loss, actively growing
hairs in the anagen state are affected most often by chemotherapeutic
drugs given to fight cancer or lymphoma. Hair loss starts soon after
beginning therapy and is more extensive than in the telogen effluvium
state. In the weeks after the therapy has been completed, the hair
cycles re-establish themselves, although the hair may not return as
thickly as before chemotherapy.
When to see a doctor
Talk to your doctor if you notice sudden or patchy hair loss or more
than usual hair loss when combing or washing your hair. Sudden hair loss
can signal an underlying medical condition and may require medical
No cure is available for permanent hair loss or baldness. However, you
can talk to your doctor about medical treatments to slow the rate of
hair loss or to hide hair loss.
Due to hormonal changes, irritation or damage, some hair follicles have a
shorter growth phase and produce thinner, shorter hair shafts. Your
hair goes through a cycle of growth and rest. The course of each cycle
varies by individual. But in general, the growth phase of scalp hair,
known as anagen, typically lasts two to three years. During this time,
your hair grows just less than 1/2 inch (1 centimeter) a month. The
resting phase is called telogen. This phase typically lasts three to
four months. At the end of the resting phase, the hair strand falls out
and a new one begins to grow in its place. Once a hair is shed, the
growth stage begins again.
Most people normally shed 50 to 100 hairs a day. But with about 100,000
hairs in the scalp, this amount of hair loss shouldn't cause noticeable
thinning of the scalp hair.
Gradual thinning is a normal part of aging. However, hair loss may lead
to baldness when the rate of shedding exceeds the rate of regrowth, when
new hair is thinner than the hair shed or when hair comes out in
Causes of specific types of hair loss
* Pattern baldness (androgenetic alopecia). In male- and
female-pattern baldness, the time of growth shortens, and the hairs are
not as thick or sturdy. With each growth cycle, the hairs become rooted
more superficially and more easily fall out. Heredity likely plays a key
role. A history of androgenetic alopecia on either side of your family
increases your risk of balding. Heredity also affects the age at which
you begin to lose hair and the developmental speed, pattern and extent
of your baldness.
* Cicatricial (scarring) alopecia. This type of permanent hair loss
occurs when inflammation damages and scars the hair follicle. This
prevents new hair from growing. This condition can be seen in several
skin conditions, including lupus erythematosus or lichen planus. It's
not known what triggers or causes this inflammation.
* Alopecia areata. This is classified as an autoimmune disease, but
the cause is unknown. People who develop alopecia areata are generally
in good health. A few people may have other autoimmune disorders,
including thyroid disease. Some scientists believe that some people are
genetically predisposed to develop alopecia areata and that a trigger,
such as a virus or something else in the environment, sets off the
condition. A family history of alopecia areata makes you more likely to
develop it. With alopecia areata, your hair generally grows back, but
you may lose and regrow your hair a number of times.
* Telogen effluvium. This type of hair loss is usually due to a
change in your normal hair cycle. It may occur when some type of shock
to your system — emotional or physical — causes hair roots to be pushed
prematurely into the resting state. The affected growing hairs from
these hair roots fall out. In a month or two, the hair follicles become
active again and new hair starts to grow. Telogen effluvium may follow
emotional distress, such as a death in the family or a physiological
stress, such as a high fever, sudden or excessive weight loss, extreme
diets, nutritional deficiencies, surgery, or metabolic disturbances.
Hair typically grows back once the condition that caused it corrects
itself, but it usually take months.
* Traction alopecia. Excessive hairstyling or hairstyles that pull
your hair too tightly cause traction alopecia. If the pulling is stopped
before there's scarring of your scalp and permanent damage to the root,
hair usually grows back normally.
Other causes of hair loss
* Poor nutrition. Having inadequate protein or iron in your diet or
poor nourishment in other ways can cause you to experience hair loss.
Fad diets, crash diets and certain illnesses, such as eating disorders,
can cause poor nutrition.
* Medications. Certain drugs used to treat gout, arthritis,
depression, heart problems and high blood pressure may cause hair loss
in some people. Taking birth control pills also may result in hair loss
for some women.
* Disease. Diabetes and lupus can cause hair loss.
* Medical treatments. Undergoing chemotherapy or radiation therapy
may cause you to develop alopecia. Under these conditions, healthy,
growing (anagen) hairs can be affected. After your treatment ends, your
hair typically begins to regrow.
* Hormonal changes. Hormonal changes and imbalances can cause
temporary hair loss. This could be due to pregnancy, childbirth,
discontinuation of birth control pills, the onset of menopause, or an
overactive or underactive thyroid gland. The hair loss may be delayed by
three months following a hormonal change, and it'll take another three
months for new hair to grow back. During pregnancy, it's normal to have
thicker, more luxuriant hair. It's also common to lose more hair than
normal about three months after delivery. If a hormonal imbalance is
associated with an overproduction of testosterone, there may be a
thinning of hair over the crown of the scalp. Correcting hormonal
imbalances may stop hair loss.
* Hair treatments. Chemicals used for dying, tinting, bleaching,
straightening or permanent waves can cause hair to become damaged and
break off if they are overused or used incorrectly. Overstyling and
excessive brushing also can cause hair to fall out if the hair shaft
* Scalp infection. Infections, such as ringworm, can invade the hair
and skin of your scalp, leading to hair loss. Once infections are
treated, hair generally grows back. Ringworm, a fungal infection, can
usually be treated with a topical or oral antifungal medication.
* Trichotillomania (hair-pulling disorder). Trichotillomania is a
type of mental illness in which people have an irresistible urge to pull
out their hair, whether it's from the scalp, their eyebrows or other
areas of the body. Hair pulling from the scalp often leaves them with
patchy bald spots on the head, which they may go to great lengths to
disguise. Causes of trichotillomania are still being researched, and no
specific cause has yet been found.
Preparing for your appointment
You're likely to start by first seeing your family doctor or a general
practitioner. However, in some cases when you call to set up an
appointment, you may be referred immediately to a dermatologist. Because
appointments can be brief, and because there's often a lot of ground to
cover, it's a good idea to be well prepared for your appointment.
Here's some information to help you get ready for your appointment, and
what to expect from your doctor.
What you can do
* Be aware of any pre-appointment restrictions. At the time you make
the appointment, be sure to ask if there's anything you need to do in
advance, such as restricting your diet.
* Write down any symptoms you're experiencing, including any that
may seem unrelated to the reason for which you scheduled the
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Take a family member or friend along, if possible. Sometimes it
can be difficult to soak up all the information provided to you during
an appointment. Someone who accompanies you may remember something that
you missed or forgot.
* Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions
will help you make the most of your time together. List your questions
from most important to least important in case time runs out. For hair
loss, some basic questions to ask your doctor include:
* What is likely causing my symptoms or condition?
* Are there other possible causes for my symptoms or condition?
* What kinds of tests do I need?
* Is my condition likely temporary or chronic?
* What is the best course of action?
* What are the alternatives to the primary approach that you're suggesting?
* I have these other health conditions. How can I best manage them together?
* Are there any restrictions that I need to follow?
* Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
* Is there a generic alternative to the medicine you're prescribing me?
* Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?
In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to spend
more time on. Your doctor may ask:
* When did you first begin experiencing hair loss?
* Has your hair loss been continuous or occasional?
* Have you had a similar problem in the past?
* Has anyone in your immediate family experienced alopecia?
* What, if anything, seems to improve your hair loss?
* What, if anything, appears to worsen your hair loss?
Tests and diagnosis
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 (for example, if hairs are broken off), and accompanying
symptoms are considered when making the diagnosis.
Tests may be necessary if the cause isn't apparent after the examination. These include:
* Pull test. Several dozen hairs are gently pulled to see how many
come out. This helps determine the stage of the shedding process and can
help diagnose or rule out telogen effluvium.
* Skin scrapings. Samples taken from the skin or from a few hairs
plucked from the scalp can help verify whether an infection is causing
* Punch biopsy. When a diagnosis is difficult to confirm, especially
in the case of alopecia areata or scarring alopecia, 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.
* Screening tests for related diseases. Your doctor may perform
tests to determine if you have a medical condition that causes hair
loss, such as thyroid disease, diabetes or lupus. Your doctor may also
ask questions about the types of medications you're taking. Sometimes
hair loss is a side effect of certain drugs, such as those that treat
gout, arthritis, depression, heart problems and high blood pressure.
Treatments and drugs
Baldness, whether permanent or temporary, can't be cured. But hair loss
treatments are available to help promote hair growth or hide hair loss.
For some types of alopecia, hair may resume growth without any
The effectiveness of medications used to treat alopecia depends on the
cause of hair loss, extent of the loss and individual response.
Generally, treatment is less effective for more extensive cases of hair
The types of drugs for treatment of alopecia that are approved by the Food and Drug Administration include:
Minoxidil (Rogaine). This over-the-counter (nonprescription)
medication is approved for the treatment of androgenetic alopecia and
alopecia areata. Minoxidil is a liquid or foam that you rub into your
scalp twice daily to grow hair and to prevent further loss. Some people
experience some hair regrowth or a slower rate of hair loss or both.
Minoxidil is available in a 2 percent solution and in a 5 percent
New hair resulting from minoxidil use may be thinner and shorter
than previous hair. But there can be enough hair growth for some people
to hide their bald spots and have the new hair blend with existing hair.
New hair stops growing soon after you discontinue the use of minoxidil.
It may take 12 weeks for new hair to start growing. If you experience
minimal results within six months, your doctor may recommend
discontinuing use. Side effects can include irritation of the scalp.
Finasteride (Propecia). This prescription medication to treat
male-pattern baldness is taken daily in pill form. Many men taking
finasteride experience a slowing of hair loss, and some may show some
new hair growth. Positive results may take several months. Finasteride
works by stopping the conversion of testosterone into
dihydrotestosterone (DHT), a hormone that shrinks hair follicles and is
an important factor in male hair loss. Rare side effects of finasteride
include diminished sex drive and sexual function. As with minoxidil, the
benefits of finasteride stop if you stop using it.
Finasteride is not approved for use by women. In fact, it poses
significant danger to women of childbearing age. If you're a pregnant
woman, don't even handle crushed or broken finasteride tablets because
absorption of the drug may cause serious birth defects in male fetuses.
* Corticosteroids. Injections of cortisone into the scalp can treat
alopecia areata. Treatment is usually repeated monthly. Doctors
sometimes prescribe corticosteroid pills for extensive hair loss due to
alopecia areata. New hair may be visible four weeks after the injection.
Ointments and creams also can be used, but they may be less effective
* Anthralin (Dritho-Scalp). Available as either a cream or an
ointment, anthralin is a synthetic, tarry substance that you apply to
your scalp and wash off daily. It's typically used to treat psoriasis,
but doctors can prescribe it to treat other skin conditions. Anthralin
may stimulate new hair growth for cases of alopecia areata. It may take
up to 12 weeks for new hair to appear.
The goal of surgery is to efficiently use your existing hair to "cover lost ground."
* Hair transplant techniques, such as punch grafts, minigrafts,
micrografts, slit or strip grafts, are available to treat androgenetic
alopecia when more-conservative measures have failed. During these
techniques, a dermatologist or cosmetic surgeon takes tiny plugs of
skin, each containing one to a few hairs, from the back or sides of your
scalp. The plugs are then implanted into the bald sections. Several
transplant sessions may be needed, as hereditary hair loss progresses
* Scalp reduction, as the name implies, means decreasing the area of
bald skin on your head. Your scalp and the top part of your head may
seem to have a snug fit. But the skin can become flexible and stretched
enough for some of it to be surgically removed. 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. Scalp reduction can be combined with hair
transplantation to fashion a natural-looking hairline in those with more
extensive hair loss.
Surgical procedures to treat baldness are expensive and can be painful.
Possible risks include infection and scarring. It will take six to eight
months before the quality of the new hair can be properly evaluated.
If you're interested in these procedures, consider only board-certified
dermatologists, plastic surgeons or cosmetic surgeons, and check local
and state medical boards for a record of patient complaints before
choosing a doctor. Consult with this doctor to confirm the cause of your
hair loss and review all treatment options, including nonsurgical ones,
before proceeding with plans for surgery.
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
Coping and support
Chances are that the greatest challenge of losing your hair is coping
with the change in your appearance. You may be frustrated or upset by
other people's reactions or after trying various treatments with little
success. If you're having difficulty coping with baldness caused by
heredity, a medical condition or medical treatments, you may find some
of the following suggestions helpful:
* Learn about the cause of your baldness and treatment options. Be
wary of alternative treatments that have no proven track record or may
cause dangerous or unpleasant side effects.
* Educate those near to you. Your family and friends can be more
sympathetic if they understand the cause of your baldness or your
concerns about your looks. You may also learn that they are less
concerned about changes in your appearance than you are.
* Consider joining a support group. While support groups aren't for
everyone, they can be sources of information and comfort. Talking with
people who experience the same challenges or medical conditions and
learning how they cope can be reassuring.
The following tips can help keep your hair healthy and may minimize the appearance of hair loss:
* Eat a nutritionally balanced diet.
* Handle your hair gently. Whenever possible, allow your hair to air-dry naturally.
* Avoid tight hairstyles, such as braids, buns or ponytails.
* Avoid compulsively twisting, rubbing or pulling your hair.
* Check with hair care experts about hairpieces or styling techniques that help minimize the effects of balding.
* The over-the-counter (nonprescription) medication minoxidil
(Rogaine) promotes new hair growth and prevents further hair loss in a
small percentage of people. Other over-the-counter hair growth products
have no proven benefit.