Hair loss

Alopecia, under treatment

Trichotillomania - top of the head

Folliculitis, decalvans on the scalp

Hair loss

Definition:

Alopecia is the partial or complete loss of hair.

Alternative Names:

Loss of hair; Alopecia; Baldness

Considerations:

Baldness is determined by multiple genetic factors. It cannot be categorically stated that baldness follows the mother's line or anyone else's, or that it skips generations.

Both men and women lose hair density as they age. Men develop a typical pattern of baldness, associated with the presence of the male hormone testosterone. Men who do not produce testosterone (because of genetic abnormalities or castration) do not develop this pattern of baldness. Many women also develop a characteristic pattern of hair loss. See male-pattern baldness; female-pattern baldness.

Occurring most often on the scalp, alopecia usually develops gradually and may be all over (diffuse) or patchy.

Usually baldness is not caused by a disease, but is genetic. Inherited or "pattern baldness" affects many more men than women. About 25% of men begin to bald by the time they are 30 years old, and about two-thirds are either bald or have a balding pattern by age 60.

On average, about 100 hairs are lost from the head every day. The average scalp contains about 100,000 hairs (blondes 140,000, brunettes 155,000 and redheads only 85,000).

Each individual hair survives for an average of 4.5 years, during which time it grows about half an inch a month. Usually in its 5th year, the hair falls out and is replaced within 6 months by a new one. Genetic baldness is caused by the body's failure to produce new hairs and not by excessive hair loss.

Common Causes:

Heredity and aging (male-pattern baldness; female-pattern baldness)
Hormonal changes (for example, thyroid disease)
A serious illness
Fever
Medication such as cancer chemotherapy or too much Vitamin A
Excessive shampooing and blow-drying
Emotional or physical stress
Nervous habits such as continual hair pulling or scalp rubbing
Burns
Radiation therapy
Alopecia areata (a pattern of diminished hair on the head and beard areas)
Tinea capitis
Traction alopecia (a self-induced reduction of hair by pulling it out)
Trichotillomania

Home Care:

For hair loss caused by illness (such as fever), radiation therapy, or medication use, no treatment is necessary. The hair will usually grow back when illness has ended or therapy has stopped. A wig, hat, or other covering may be desired until the hair grows back.

For hair loss due to heredity, the topical medication Rogaine (minoxidil), which requires a prescription, has shown some positive effect. The oral medication Propecia (finasteride) is effective in some men.

Punch graft hair transfer done by a physician is a surgical approach to transferring hair from one part of the head to another. It is somewhat painful and expensive, but usually permanent.

Call your health care provider if:

Hair is lost in an unusual pattern.
Hair is lost unusually early or rapidly.
There is any pain or itching associated with the hair loss.
The skin under the involved area is abnormal.

What to expect at your health care provider's office:

The medical history will be obtained and a physical examination performed.

Medical history questions documenting hair loss in detail may include:

Location and pattern
- What part of the body is losing hair?
- Is there a pattern to the hair loss (male-pattern baldness; female-pattern baldness)?
Medical history
- Have you had a recent illness?
- Have you had a high fever recently?
Hair care habits
- Do you dye your hair?
- Do you blow dry your hair?
- How often do you shampoo your hair?
- What kind of shampoo, hair spray, gel, or other product do you put on your hair?
Emotional state
- Have you been under unusual stress?
- Do you have nervous habits that include hair pulling or scalp rubbing?
Accidents and emergencies history
- Have you ever been involved in an accident that affected your scalp or hair in any way?
Other
- What other symptoms are also present?
- What medications are being taken?

An examination of the hair and scalp are usually enough to diagnose the nature of the problem.

Diagnostic tests that may be performed (but are rarely needed) include:

Microscopic examination of a plucked hair
Skin biopsy (if skin changes are present)

Intervention:
Ringworm of the scalp may require the use of an oral drug, such as griseofulvin, because creams and lotions applied to the affected area cannot get into the hair follicles to kill the fungus.

After seeing your health care provider:
If a diagnosis was made by your health care provider related to hair loss, you may want to note that diagnosis in your personal medical record.

Review Date: 7/29/2001
Reviewed By: Michael Lehrer, M.D., Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2003 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.