Your hair is your crowning glory. Hence, it might be alarming to experience hair loss.

But hair loss is inevitable, especially when we age. Typically, we lose 50 to 100 hairs every day – that’s a normal part of the hair cycle. New hair may replace the lost hair. If you start losing more hair or if the normal process of hair growth isn’t up to speed, then your hair may begin to look thinner. Sometimes, an underlying condition may trigger complete or partial hair loss.

 

Common Types of Hair Loss

Hair loss may appear in different patterns, depending on the underlying cause. It can come on suddenly or gradually. Some types of hair loss are permanent, while others are temporary.

Gradual thinning on top of the head

Androgenic alopecia, otherwise known as androgenetic alopecia, is due to a combination of hereditary (genetic) and hormonal factors. It is the most common type of hair loss that occurs over time with age.

This condition begins with the hypersensitivity of hair follicles to dihydrotestosterone (DHT), a by-product of testosterone (1). When exposed to DHT for an extended period, the hair follicles begin to shrink, and the hair falls off, eventually resulting in noticeable hair loss.

Often, people who have androgenic alopecia have family members with the same condition. It could be inherited from either your mother’s or father’s side of the family.

The condition may occur in both men (male-pattern baldness) and women (female-pattern baldness). The pattern of androgenic alopecia hair loss is predictable. In men, hair often recedes on the top of the head in a line that resembles the letter “M.” On the other hand, in women, the hairline on the forehead typically remains intact but is instead marked by thinning hair all over the scalp.

Male-pattern baldness. Men typically experience a gradual receding of hairline in the form of an M-shaped pattern. In addition to thinning, men may also notice their hair becoming more delicate and shorter. The condition can start as early as in the 20s.

Female-pattern baldness. Women tend to develop general thinning all over the scalp, particularly at the hairline behind the bangs. Hair thinning becomes noticeable only after the 40s following menopause. Polycystic ovary syndrome (PCOS) is another possible cause of hair thinning in women.

Circular or patchy bald spots

Some people have smooth, coin-sized bald patches on the scalp. It is due to an autoimmune condition known as alopecia areata.

Alopecia areata often starts suddenly in children and young adults. It usually occurs in people with a family history of other autoimmune diseases, including those that affect the skin and hair.

Alopecia areata hair loss is spontaneous and unpredictable. The hair may regrow within three to six months and then may fall again. The extent of hair loss and regrowth fluctuates significantly between individuals. For some people, balding can persist and become more severe, causing complete hair loss on the scalp (alopecia totalis) or complete loss of body hair (alopecia Universalis). Some people note that they felt tingling or irritation in the affected area before hair fall.

There is no cure for alopecia areata. Nevertheless, some treatments may slow down future hair loss or help speed up hair regrowth. It is most commonly treated with intralesional corticosteroids.

Sudden thinning of hair due to shock

Physical or emotional trauma can cause hair to fall suddenly – a condition known as telogen effluvium. During telogen effluvium, hair sheds faster than usual. At its peak, handfuls of hair may fall when brushing or shampooing. This type of hair loss causes temporary hair thinning over the scalp.

Types of trigger include hormonal imbalance, pregnancy, childbirth, nutritional deficiency, crash dieting, excessive weight loss, chronic illness, or major surgery. The stress can disrupt the hair growth process by exiting the growth lifecycle (telogen phase) prematurely, causing hair to fall out.

The hair loss tends to stop after the stressful situation passes without any treatment.

Patches of scaling all over the scalp

Fungal infection can cause red patches of scaling throughout the scalp. It may be accompanied by broken hair, swelling, redness, and oozing. The condition is known as tinea capitis.

It usually affects school-age children. Sharing hats or combs may transmit tinea capitis.

Permanent loss of hair

Scarring alopecia (cicatricial alopecia) refers to a collection of disorders that results in permanent loss of hair. Most forms of scarring alopecia first develop as small patches of hair loss that enlarges with time.

Sometimes, the hair loss is gradual without obvious symptoms and may go unnoticed. In other cases, hair loss is associated with severe itching and burning pain that worsens rapidly.

Inflammatory skin conditions (e.g., folliculitis, cellulitis) and lupus may contribute to scarring alopecia. More specifically, these skin conditions cause scarring that destroy the ability of hair follicles to regenerate.

The bald patches from scarring alopecia look different to that from alopecia areata in that the edges of the patchy spots are less smooth.

Hair loss associated with tight hairstyles that pull the hairline

Traction alopecia refers to small or localized hair loss that results from repetitive traction on the hair roots.

Tight braids, up-do, cornrows, and ponytails can contribute to traction alopecia. They tug on your hair and break it from the follicles, causing hair to fall out over time. Likewise, the tension and weight of hair extensions can also cause traction alopecia.

Choose hairstyles that put less tension on the hair to prevent permanent hair loss. If you need to place your hair up in a ponytail, use an elastic that doesn’t have metal so that your hair won’t get tangled in the elastic when removing it.

Hair Pulling

Trichotillomania is a psychological disorder whereby a person – usually a child – habitually pull or twist their hair. The scalp and eyelashes are the most susceptible.

Treatment is predominantly behavioral. One has to acknowledge the behavior and consciously stop.

 

 

Diagnosis

Your doctor will give you a physical exam and interview you regarding your pre-existing medical and family history. Following that, he will perform diagnostic tests, such as:

  • Blood test. This may help uncover underlying medical conditions related to hair loss. The blood test may measure complete blood count (CBC), iron level, vitamin B, and thyroid function test (TFT).
  • Pull test. Your doctor gently pulls dozens of hairs to see how comes out to help determine the stage of the shedding process.
  • Scalp biopsy. Your doctor scrapes skin samples or plucks a few hairs from the scalp to examine the hair roots to determine whether an infection is causing hair loss.
  • Light microscopy. Your doctor uses a microscope to examine possible hair shaft disorders.

 

Treatment

Some hair loss conditions are treatable. However, if your hair loss is due to an underlying disease, treatment for that particular disease may be necessary.

Treatment depends on several factors, including your age, extent of hair loss, and your willingness to endure any treatment-related side effects.

Topical agents

You can rub medications into your scalp to help stimulate hair growth. Several medications are available, both over the counter (OTC) and by prescription:

  • Minoxidil (Rogaine). Minoxidil comes in 2% and 5% treatments; it’s also available in either liquid or foam. This is a safe and effective FDA-approved treatment for both men and women (2). Minoxidil can be used for androgenic alopecia or alopecia areata. It works by accelerating the speed of hair cycle and by preventing the shrinkage of hair follicles. Apply it directly to the hair loss areas twice a day. It is most effective in younger people with recent onset of balding. Results may take 6-12 months.
  • Anthralin (Dritho-Scalp, Drithocreme, Micanol). When applied to the scalp, anthralin causes scalp irritation that may stimulate hair regrowth. It may be used in conjunction with minoxidil.
  • Topical immunotherapy. A chemical such as a diphenylcyclopropenone (also called diphencyprone or DCP) or square acid dibutyl ester (SABDE) is applied to the scalp to trigger an allergic rash, which may neutralize the turned-on autoimmune cells. The rash may induce new hair growth within six months, but you’ll have to continue the treatment to maintain regrowth.

Oral Medication

Finasteride (Propecia). Finasteride is an anti-androgen. It’s a prescription drug for men with male-pattern baldness who have already tried minoxidil without success. Women should avoid finasteride – especially when pregnant or nursing. Side effects may include erectile dysfunction, decreased libido, and gynecomastia.

Spironolactone (Aldactone). Spironolactone is also an anti-androgen. It is prescribed for people who have thinning hair related to androgen production. In women with female-pattern hair loss, this medication may help treat thinning hair and subsequent hair loss related to hormonal fluctuations.

Prednisone. Prednisone can be used to reduce inflammation and suppress the immune system. Common side effects of prednisone include confusion, restlessness, headache, nausea, vomiting, sleep problems, and weight gain.

Corticosteroid injections

Steroid injections are a standard option for mild, patchy alopecia areata. The steroid is injected into the bald spots to help hair regrowth.

The treatment is repeated once every one to two months. It may be somewhat painful and may cause skin thinning in the injected sites.

Laser therapy

Dermatologists typically use laser therapy to stimulate hair growth in people with androgenic alopecia. Laser therapy is also known as photochemotherapy or phototherapy. Laser treatment may reduce the inflammation of hair follicles that keep them from regrowing.

Now, the FDA has given clearance for some laser therapy products to be used at home (3). At-home laser therapy is intended to help regrow your hair while also making it thicker. Laser devices are available in the form of helmet, combs, and cap.

Other names of laser therapy are:

  • Cold laser
  • Red light therapy
  • Soft laser
  • Photobiomodulation
  • Biostimulation

Platelet-rich plasma (PRP) therapy

Platelet-rich plasma (PRP) therapy involves three steps: drawing blood, processing it, and then injecting it back into the scalp.

PRP treatment is relatively new. There isn’t much research to support its efficacy. That said, some studies have suggested that it is a simple, cost-effective treatment option. PRP therapy involves several sessions within a four to six week period with maintenance every four to six months.

Possible risks include:

  • Injury to blood vessels or nerves
  • Infection
  • Scar tissue or calcification at injection pints

Hair transplant surgery

Hair transplant, or restoration surgery, involves the relocation of patches of skin containing active hair follicles to the bald spots. You may need to implant several hundred plugs – 10 to 60 per session. It works well for people with androgenic alopecia.

Follicular unit transplantation (FUT). FUT is a “classic” hair transplantation method. It involves removing some patches of skin from the back of your scalp where the hair is abundant. Hair follicles are removed from the skin patches and then reinserted into the bald part of the scalp.

Follicular unit extraction (FUE). The hair follicles are carefully removed from the scalp and transplanted to the bald areas.

Scalp reduction. The doctor removes part of the balding scalp and then closes it with a piece of your scalp that has hair.

Alternative therapies

Most alternative therapies for hair loss haven’t been tested in clinical trials, so their effectiveness is unknown.

Essential oil. Essential oils like rosemary, tea tree, lavender, spikenard, and peppermint may help reduce hair loss. Rosemary is an excellent essential oil for hair thickness and growth; research showed that rosemary oil appears to effectively as well as minoxidil (4). Peppermint oil is also capable of stimulating blood circulation and is, therefore, a promising treatment for thinning hair. Spikenard oil and pumpkin seed oil also promote hair growth. Likewise, coconut oil contains fatty acids that penetrate inside the hair shaft and reduce protein loss from hair.

Microneedle. There is evidence that micro-needling can help hereditary hair loss (5). It helps induce stem cells in the scalp that lead to hair growth. It also helps to strengthen hair follicles.

Vitamins. Vitamin deficiencies are linked to hair loss. The best vitamins for hair growth include vitamin A, B, C, D, and E. Other nutrients such as iron, zinc, and protein are also beneficial.

Aloe vera. Aloe vera has long been used as a hair loss remedy. It can reduce dandruff and unclog hair follicles. Furthermore, it also soothes the scalp and condition hair. Apply pure aloe vera gel to your scalp and hair several times per week. Alternatively, you may also use shampoo and conditioner that contain aloe vera.

Scalp massage. Use a handheld scalp massager to encourage blood flow in the scalp and also remove dead skin cells. Not only do massages feel amazing, but they can help with your hair regrowth, too. Massaging the scalp stimulates the hair follicles. A convenient way to incorporate a scalp massage into your hair regimen is to do it while in the shower, following shampoo or conditioner.

Hair thinning shampoo. Hair thinning shampoo works in two ways. First, they volumize and thicken your hair. This can be beneficial for people with thin or fine hair. Secondly, shampoos for thinning hair loss also contains vitamins and amino acids that promise a healthy scalp to generate more hair over time.

Onion juice rubbed onto the scalp. Applying onion juice directly to the scalp might help hair regrow in some people. Nutrient in the onion juice may nourish the hair follicles, which increase volume, shine, and improve hair strength. The extra nutrition may also minimize breakages and thinning. As well as conditioning, using onion juice may also promote new hair growth in some people.

 

The Bottom Line

While the process of hair loss can be alarming at first, it’s likely treatable. Prescription medication, topical treatments, and natural remedies can help slow down or reverse hair loss. In some cases, treating an underlying condition will solve hair loss.