There are many causes of alopecia – genetic, emotional, physiological and certain medications. We have between 100 000 and 150 000 hairs on our heads and typically lose on average 100 hairs per day.
The first sign of hair thinning might be finding more than usual hairs in your hairbrush, or in the basin after shampooing. You might also notice widening of a parting or a thinning crown. Approximately one in four men will have noticeable hair loss by age 30, increasing by age 60 to two in three men. Very rarely, hair loss can occur at age 12.
Psychological Impact of hair loss
The effect of hair thinning or baldness on appearance can cause psychological stress due to the association of physical attractiveness with success and happiness. Hair is considered an essential part of identity, particularly for women. The psychology of hair thinning is complex, especially for women, for whom it often represents femininity and attractiveness. Men typically associate a full head of hair with youth and vigour. Although they may be aware of pattern baldness in their family, many are uncomfortable talking about the issue. Hair thinning is therefore a sensitive issue for both sexes. People experiencing hair thinning can worry that they appear older or less attractive to others.
Androgenetic alopecia or Male-pattern hair loss
Male-pattern hair loss is the most common cause of hair loss affecting up to 70% of men and 40% of women, at some point in their lifetimes. It occurs as a result of an underlying susceptibility of the hair follicles to shrink, due to the influence of androgenic hormones. The trigger for this type of baldness is dihydrotestosterone (DHT), a potent form of testosterone. DHT initiates a process of the hair follicle shrinking and beginning to deteriorate. As a consequence, the hair’s growth phase (anagen) is reduced and young, unpigmented vellus hair is prevented from growing and maturing into pigmented terminal hair that makes up 90% of the hair on the head. Over time, hair becomes thinner and its overall volume reduces so that it resembles ‘peach fuzz’ until finally, the follicle becomes dormant and ceases producing hair altogether.
Men typically lose hair progressively at the temples (receding hairline) and top of the head (thinning crown), eventually meeting and leaving a ring of hair around the back of the head.
Women will have more generalised hair loss over the entire scalp. The hair loss in female pattern baldness is permanent if not treated. However, in most cases, hair loss is mild to moderate.
Alopecia areata is an autoimmune disease in which hair is lost from some or all areas of the body, but typically from the scalp. The body’s failure to recognise its own body cells causes the destruction of its own tissue, resulting initially in bald spots on the scalp. The condition can spread to the entire scalp (alopecia totalis) or to the entire body (alopecia universalis).
Possibly the second most common form of hair loss, this is a temporary condition typically triggered by stress or medication and resulting in an excessive loss of telogen hairs. Following either medication or a stressful event, hair roots are prematurely pushed into the resting state.
Emotional or physiological stress, including eating disorders, fever, childbirth, chronic illness, major surgery, anemia, severe emotional disorders, crash diets, hypothyroidism and drugs may cause the disorder.
The condition also presents as a side effect of chemotherapy: while targeting dividing cancer cells, this treatment also affects hair’s growth phase with the result that almost 90% of hairs fall out soon after chemotherapy starts. Radiation to the scalp can cause baldness of the irradiated areas.
This can be an acute or chronic condition resulting as many as 70% of the scalp hairs shedding in large numbers about 2 months after the ‘shock’.
The individual afflicted with hypotrichosis usually has normal hair growth after birth, but shortly thereafter it is replaced with sparse, fine, short and brittle hair, which may lack pigmentation. The individual would typically become bald by age 25.
Hypotrichosis is a common feature of Hallermann–Streiff syndrome, as well as other conditions. It can also be used to describe the lack of hair growth due to chemotherapy.
During pregnancy, the hair becomes thicker due to increased circulating estrogens. After birth, the estrogen levels reduce and the additional hair falls out. This can also occur when women take certain fertility-stimulating drugs.
Other causes of hair loss may include fungal infection, traumatic damage such as through compulsive pulling (trichotillomania), nutritional deficiencies, and radiotherapy or chemotherapy.
Hair loss explained
Diagnosis and tests
The Ludwig scale and the Savin scale track the progress of hair thinning in women.
For male pattern baldness, the Hamilton–Norwood scale tracks the progress of a receding hairline and/or a thinning crown.
Hair loss is usually diagnosed by:
Ruling out other causes of hair loss (medication, stress)
The pull test – gentle traction is exerted on a group of hairs on three areas of the scalp and the number of hairs extracted are counted and examined. The root of the plucked hair is examined under a microscope to determine the phase of growth, and is used to diagnose a defect of telogen, anagen, or systemic disease.
Scalp biopsy is used to determine scarring and non-scarring forms. Hair samples are usually taken from around the border of the bald patch.
The appearance and pattern of hair loss
Your medical history
The doctor will examine you for other signs of excess male hormone (androgen), such as:
Abnormal new hair growth, such as on the face or between the belly button and pubic area.
Changes in menstrual periods and enlargement of the clitoris
Your doctor may ask you to count the number of hairs from first morning combing or hair wash.
There are a number of treatment options for hair loss. Topical treatment with individually defined dosages and ingredients offer many patients a solution to this problem. Fagron provides medical practitioners with treatment options for alopecia based on the latest scientific knowledge, along with comfortable, skin-friendly bases and applicators. Each patient is offered individualised therapy and care, based on their skin type and the specific cause. In almost all cases of thinning, and especially in cases of severe hair loss, it is recommended to seek advice from a doctor. Many types of thinning have an underlying genetic or health-related cause, which a qualified professional will be able to diagnose.