Hair loss: causes, types, treatment options and when to get help

Hair loss, called alopecia in medicine, affects many men, women and children at some point. Most of the time it is not dangerous, but it can affect confidence and wellbeing. This article explains common causes and types, and what care options exist, using information from the NHS and MedlinePlus.

1. Introduction

The NHS says that losing 50 to 100 hairs a day is normal and often goes unnoticed, and that hair loss is usually not serious although it occasionally points to an underlying medical condition ^[1]. MedlinePlus similarly notes that you can lose up to 100 scalp hairs every day, and most of that hair regrows ^[2]. The scalp holds about 100,000 hairs ^[3]. Hair loss can develop gradually and may be patchy or spread all over ^[3].

2. Types and causes

Pattern baldness

Pattern baldness is a permanent type of hair loss and usually runs in families. The NHS lists male and female pattern baldness as permanent causes ^[1]. MedlinePlus explains that it is linked with ageing, heredity and the hormone testosterone, affects far more men than women, and can start at any time after puberty ^[3].

Temporary shedding

Physical or emotional stress can cause a large amount of scalp hair to shed weeks to months later, a pattern called telogen effluvium. MedlinePlus lists triggers such as high fever or severe infection, childbirth, major surgery or illness, sudden blood loss, crash diets and some medicines ^[3]. The NHS adds cancer treatment, weight loss and iron deficiency ^[1]. Hair often comes out in handfuls when washing or combing, and this type usually settles over 6 to 8 months, though it can become long term in some people ^[3].

Alopecia areata

Alopecia areata is thought to be an autoimmune condition, meaning the immune system mistakenly attacks healthy hair follicles. It usually begins as one or several smooth, round bald patches, mostly on the scalp but sometimes on the beard, eyebrows or body, and nails may become pitted ^[4]. It can affect men, women and children, and some people have a family history ^[4].

Other causes

MedlinePlus lists thyroid disease, anaemia, diabetes, autoimmune diseases such as lupus, hormone changes, scalp infections, hair pulling habits, tight hairstyles, too much shampooing or blow-drying, radiation therapy and some medicines such as chemotherapy ^{[2, 3]}. Poor nutrition and a low-protein diet may also play a part ^[2].

3. Diagnosis and tests

For most people a medical history and a look at the hair and scalp are enough. A doctor may ask about the pattern of loss, family history, hair care habits, recent illness, surgery, stress or diet changes ^[3]. Tests are rarely needed but may include blood tests, a look at a plucked hair under a microscope or a scalp skin sample ^{[3, 4]}. For alopecia areata, blood tests may check for thyroid problems and other autoimmune conditions ^[4].

4. Treatment and management

Treatment depends on the cause. Hair loss from illness, radiation or medicine usually needs no treatment and often grows back when the cause ends, and hair loss after childbirth or menopause often settles within six months to two years ^[3]. Treating an underlying condition can sometimes help ^[2]. The NHS says most hair loss does not need treatment because it is temporary or a normal part of ageing, and that no treatment is fully effective ^[1].

Options described by the NHS and MedlinePlus include ^{[1, 3, 4]}:

• Medicines applied to the scalp or taken as tablets for pattern baldness. These do not work for everyone, usually work only while being used, and one of the main medicines is not suitable for women ^[1].
• Steroid creams or injections into bald patches, and light treatment, for alopecia areata ^{[1, 4]}.
• Newer tablets that target the immune system, for severe alopecia areata ^[4].
• Treating a scalp fungal infection with prescription antifungal medicines when that is the cause ^[3].
• Wigs, some of which are available on the NHS ^[1]. MedlinePlus calls hair weaves, hairpieces and hairstyle changes generally the least expensive and safest way to disguise hair loss, and says hairpieces should not be sewn to the scalp ^[3].
• Hair transplant and similar procedures, some of which may not be available through public health services ^{[1, 3]}.

The NHS advises seeing a doctor first to understand the cause before turning to a commercial hair clinic ^[1].

5. Prevention and self-care

Not all hair loss can be prevented. MedlinePlus lists some contributing factors that people can influence, such as tight hairstyles, nervous habits like hair pulling, excessive shampooing or blow-drying, and crash diets, especially low-protein diets ^[3]. It also lists poor nutrition as a possible cause ^[2], and says a vitamin supplement is likely to be recommended if a deficiency is found ^[3]. Ask your doctor before starting any supplement.

6. Emotional wellbeing

Hair loss can be distressing. The NHS says to tell your doctor if it affects your wellbeing, ask about counselling, and consider support groups or online forums ^[1]. MedlinePlus notes that outcomes for alopecia areata are often good, as full regrowth is common, but may be poorer if it starts young, covers a large area or has been present a long time ^[4].

7. When to see a doctor

The NHS advises seeing a GP, a family doctor, if you are worried about your hair loss ^[1]. MedlinePlus says to contact a provider about ^[3]:

• hair loss in an unusual pattern
• rapid loss, or loss at an early age such as the teens or twenties
• pain or itching with hair loss
• red, scaly or abnormal scalp skin
• bald spots in the beard or eyebrows
• hair loss with acne, extra facial hair or irregular periods, or male pattern baldness in a woman
• hair loss with weight gain, muscle weakness, feeling cold or tiredness
• signs of a scalp infection

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Some daily hair shedding is normal, and many types of hair loss are temporary or related to ageing. Patchy, rapid, early or painful hair loss, or hair loss with other symptoms, deserves a medical check because the cause may be treatable. Your doctor decides which approach is right for you, and you should tell them about every medicine and supplement you take.