Hair plays an important role in our lives. The hair on our head keeps us warm and acts as a cushion for our skull. Hair appearance can also help form our identity and self-image, which makes hair loss very troubling.
Most hair disorders aren’t serious, but they are often considered major cosmetic issues that require treatment. Androgenetic alopecia is the most common form of hair loss, although there are a number of other hair conditions that can affect the scalp and other parts of the body.
How Do You Diagnose Hair Loss?
When Does Hair Loss Become a Problem?
Wellness and Prevention
Most hair disorders are hereditary and cannot be prevented. However, there are some lifestyle factors that can help protect the scalp and hair. Follow a healthy diet and protect yourself from the sun to improve hair and skin quality. You should also avoid or minimize hairstyles or use of headgear that pulls or forces the hair.
The first visit to our clinic typically involves going over the history of your condition. This can include talking about visits to other doctors and other treatments you’ve tried. An exam of your scalp and your hair will be done, and your dermatologist may check other parts of your skin and body for clues to the cause of your condition. Photos may be taken so that we are able to see if things get better or worse with treatment. We may also talk about doing a scalp biopsy to make sure of your diagnosis.
There are numerous hair disorders that can be diagnosed and evaluated:
- Androgenetic alopecia is the most common form of hair loss. This disorder, also known as male-pattern or female-pattern hair loss, results in permanent hair loss from the scalp.
- Alopecia areata is caused by the immune system attacking hair follicles. As a result, hair falls out in round patches from anywhere on the body. It typically grows back but may fall out again.
- Traction alopecia describes gradual hair loss that is caused by chronic pulling. Hair that is forced in certain directions, typically through use of braids, ponytails, barrettes, weaves, dreadlocks or protective headgear, can result in significant hair thinning. It is particularly noticeable around the temples and behind the ears.
- Diffuse alopecia is hair loss from the scalp caused by nutritional deficiencies, imbalance of hormones or other physical or emotional stressors.
- Chemotherapy-induced alopecia is scalp hair loss that results from chemotherapy, a form of cancer treatment.
- Telogen effluvium (TE) is the second most common form of hair loss, though little is known about the condition. It is marked by a significant decrease in scalp hair. This condition is related to diffuse alopecia, and diagnosis can be made once other hair disorders have been ruled out. In some extreme cases TE can affect other areas such as the eyebrows or pubic region.
- Trichotillomania is a psychological condition where a person experiences an impulse to pull their hair out. Hair may be pulled from the scalp, eyebrows or other parts of the body.
- Lichen planopilaris is a rare inflammatory condition that leads to permanent hair loss, mainly on the scalp. It is usually seen in young adult women though it may also affect men. The cause of this hair disorder is unknown.
- Frontal fibrosing alopecia is a hair disorder that typically affects women over the age of 50. It causes even hair loss on the front and sides of the scalp, as well as loss of eyebrows. Skin in the affected area usually looks normal but may be pale, shiny or mildly scarred.
- Central centrifugal cicatricial alopecia is most commonly seen in African Americans. Hair loss begins at the crown of the scalp and progresses outward in a circular pattern. In advanced cases, the damaged hair follicles form scar tissue, preventing future hair growth. There is debate over the cause of this disorder, though use of certain styling agents such as hot hair oil or chemical relaxants are thought to play a role.
- Folliculitis decalvans can affect hair on any part of the body. Round oval patches of hair loss occur with pustules that surround hair follicles. As hair is shed, follicles are destroyed and scarring results. It affects both men and women and may begin during adolescence or at any in adulthood. The cause is unknown.
- Dissecting cellulitis is a very rare condition. Pustules develop over the scalp and permanent hair loss results. The disorder can affect anyone though is most commonly seen in African American men.
Treatment for hair disorders depends on the type of condition and its underlying causes. Not all disorders have medical treatments, but wearing hats or changing hairstyles may offer an improvement in cosmetic appearance.
A range of medications can be used to treat hair disorders:
- Vitamin supplements may be recommended for nutritional deficiencies.
- Hormone replacement therapy can correct hormone imbalances and restore hair growth.
- Oral steroids or anti-inflammatory antibiotics may be prescribed for hair disorders with skin irritation.
- SSRI medication may help to treat underlying mental health issues leading to impulsive hair pulling.
Minoxidil is a topical medication that promotes hair growth in people with androgenetic alopecia.
Some hair disorders cause permanent hair loss and damage the follicles, making future hair growth impossible. People who have these skin disorders can benefit from hair transplant surgery or wigs. In some disorders, hair replacement must wait until damaged hair follicles have healed.
Some hair disorders are caused by factors that can be controlled. The behaviors that lead to hair loss in traction alopecia and trichotillomania can be addressed through education or therapy.
Hair Loss in Men vs. Women
What are the Treatments for Hair Loss?
Instructions for care depends on the type of hair disorder and treatment plan prescribed by your dermatologist. Sun protection is always important. Keeping the scalp and other areas where skin is irritated out of the sun is crucial.