March 30, 2021 0

What is hair loss?

The American Academy of Dermatology (AAD) notes that 80 million men and women in America have hereditary hair loss (alopecia). This can affect only the hair on the scalp or the entire body. Although baldness is more common in older adults, excessive hair loss can also occur in children. It is normal to lose 50 to 100 hairs per day. With about 100,000 hairs on your head, this small loss is not noticeable.

New hair usually replaces the lost hair, but this is not always the case. Hair loss can develop gradually over years or happen suddenly. Hair loss can be permanent or temporary. It is impossible to count the amount of hair lost on any given day. You may lose more hair than usual if you notice a large amount in the drain after washing your hair or clumps on your brush. You may also notice thinning hair or baldness. If you notice that you are losing more hair than usual, you should discuss the problem with your doctor. He or she can determine the underlying cause of your hair loss and suggest appropriate treatment plans.

What causes hair loss?

First, your doctor or dermatologist (a doctor who specializes in skin problems) will try to determine the underlying cause of your hair loss. The most common cause of hair loss is hereditary male or female pattern baldness. If you have a family history of baldness, you may have this type of hair loss. Certain sex hormones can cause hereditary hair loss. It can start as early as puberty.

In some cases, hair loss can occur with a simple stop in the hair growth cycle. Serious illness, surgery or traumatic events can cause hair loss. However, hair usually begins to grow back without treatment. Hormonal changes can cause temporary hair loss.

Examples include:

  • Pregnancy
  • childbirth
  • discontinuation of birth control pills
  • menopause

Medical conditions that can cause hair loss include:

  • thyroid disease
  • alopecia areata (an autoimmune disease affecting hair follicles)
  • scalp infections like ringworm
  • Scarring diseases such as lichen planus and some types of lupus can lead to permanent hair loss due to scarring.

Hair loss can also be caused by medications used to treat:

  • cancer
  • high blood pressure
  • arthritis
  • Depression
  • heart problems

Physical or emotional shock can cause noticeable hair loss. Examples of this type of shock are:

  • death in the family
  • extreme weight loss
  • high fever
  • People suffering from trichotillomania (hair pulling disorder) have the urge to pull their hair out, usually from their head, eyebrows or eyelashes.

Traction hair loss can be caused by hairstyles that put pressure on the hair follicles by pulling the hair back very tightly. A diet devoid of protein, iron and other nutrients can also lead to thinning hair.

How is hair loss diagnosed?

Persistent hair loss often indicates an underlying health problem. Your doctor or dermatologist can determine the cause of hair loss based on a physical exam and health history. In some cases, simple dietary changes may help. Your doctor may also change your prescription medications. If your dermatologist suspects an autoimmune or skin disease, he or she may do a scalp biopsy. This will involve carefully removing a small piece of skin for laboratory testing. It is important to remember that hair growth is a complex process. It may take some time to determine the exact cause of hair loss.

What are the treatment options for hair loss?

Medications will likely be the first course of treatment for hair loss. Over-the-counter (OTC) medications typically consist of topical creams and gels that are applied directly to the scalp. The most common products contain an ingredient called minoxidil (Rogaine).

According to the AAD, your doctor may recommend minoxidil in combination with other hair loss treatments. Side effects of minoxidil include scalp irritation and hair growth in adjacent areas, such as the forehead or face.

Prescription medications can also treat hair loss. Doctors prescribe oral finasteride (Propecia) for male pattern baldness. This medication is used daily to slow hair loss. Some men experience new hair growth while taking finasteride.

Rare side effects of finasteride include decreased sex drive and impaired sexual function. According to the Mayo Clinic, there may be a link between finasteride use and a more serious (high-grade) type of prostate cancer.

Your doctor will also prescribe corticosteroids like prednisone. People with alopecia areata may use this to reduce inflammation and suppress the immune system. Corticosteroids mimic the hormones produced by your adrenal glands.

Large amounts of corticosteroids in the body reduce inflammation and suppress the immune system.

You should carefully monitor the side effects of these medications. Possible side effects include:

  • glaucoma, a collection of eye diseases that can lead to optic nerve damage and vision loss
  • fluid retention and swelling in the lower legs
  • higher blood pressure
  • cataracts
  • high blood sugar levels

There is evidence that the use of corticosteroids may also put you at greater risk for the following conditions:

  • infections
  • loss of calcium from bones, which can lead to osteoporosis
  • thin skin and easy bruising
  • sore throat
  • hoarseness

Medical Procedures

Sometimes medication is not enough to stop hair loss. There are surgical procedures to treat baldness.

Hair transplant surgery

Hair transplant surgery involves moving small plugs of skin, each with a few hairs, to the bald parts of the scalp.

This works well for people with hereditary alopecia, as they usually lose hair on the top of the head. Since this type of hair loss is progressive, you would need multiple surgeries over time.

Scalp reduction

During a scalp reduction, the surgeon removes the part of the scalp that is missing hair. The surgeon then closes that area with a piece of scalp that has hair on it. Another option is a flap, in which the surgeon folds the scalp with hair over the bald spot. This is a type of scalp reduction. Tissue expansion can also include baldness. It requires two surgeries. In the first operation, the surgeon places a tissue expander under the part of the scalp that has hair and is next to the bald spot. After a few weeks, the expander extends to the part of the scalp that has hair.

In the second procedure, the surgeon removes the expander and pulls the expanded scalp area with hair over the bald spot. These surgical remedies for baldness are usually expensive and carry risks.

These include:

  • uneven hair growth
  • bleeding
  • extensive scarring
  • Infection
  • Your transplant may also fail to take, which means you will have to repeat the surgery.

How can I prevent hair loss?

There are things you can do to prevent further hair loss. Do not wear tight hairstyles such as braids, ponytails or buns that put too much pressure on your hair. Over time, these hairstyles will permanently damage your hair follicles.

Try not to pull, twist or rub your hair. Make sure you are eating a balanced diet that contains adequate amounts of iron and protein. Certain cosmetic procedures can worsen or cause hair loss. If you are currently losing hair, use a gentle baby shampoo to wash your hair. Unless you have extremely oily hair, consider washing your hair only every other day. Always blow dry your hair and avoid rubbing it. Styling products and tools are also common culprits for hair loss.

Examples of products or tools that can affect hair loss include

  • blow dryers
  • Heated combs
  • hair straighteners
  • Colouring products
  • bleaching agents
  • Perms
  • relaxers

If you decide to style your hair using heated tools, do so only when your hair is dry. Also use the lowest possible setting.

What is the long-term perspective?

You can stop or even reverse hair loss with aggressive treatment, especially if it is caused by an underlying condition. Hereditary hair loss can be more difficult to treat. However, some procedures, such as hair transplants, can help reduce baldness. Talk to your doctor to explore all options for reducing the effects of hair loss.

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