Losing hair, especially over time, is normal. But when it happens suddenly or without clear explanation, it may be quite distressing. In some cases, it may be due to an illness or underlying condition. Dermatologists are experts in the skin and its structures — including hair. Often they can get to the root of the problem and recommend the best hair loss treatment approach.
“There are a number of things you can do to slow or stop hair loss,” says Daniel Zelac, MD, a dermatologist at Scripps Clinic. “But before deciding what to do, it’s important to identify the type of hair loss you are experiencing.”
It is normal for individuals to lose 50 to 300 hairs each day, often without noticing. New hair usually replaces lost hair, but even this can result in a loss of overall hair length and a sense of fullness. When hair loss increases suddenly, it can be alarming, especially if it appears to be happening rapidly.
“Some types of hair loss are linked specifically to correctable causes while others are not,” Dr. Zelac says. “Your dermatologist can determine if your hair loss is caused by things like thyroid gland issues, stress, scalp infections, genetics or simply aging.”
When hair loss is temporary, often no treatment is needed and the hair may regrow on its own. Other times, treatment may be needed to slow the rate of the hair loss. In particular cases, hair loss treatment may allow the thinned hair to be regrown.
When hair loss appears to be permanent and stable, some interventions may simply make the thinned area appear more full and acceptable to the patient. “In these cases, there are several ways to address the hair loss, including simple cosmetic camouflage, styling, hair appliances and surgical intervention, such as hair transplantation,” Dr. Zelac says.
The medical term for hair loss is alopecia. This includes the loss of visible hair or hair shaft, and the loss of the skin structure that makes hair, which is called the hair follicle.
“When the loss is centered around the hair shaft without affecting the health, size, or density of hair follicles, there may be a physical or structural cause, such as damage to the hair from traction, hair treatment activities or infection,” Dr. Zelac explains.
When the follicles are affected, the hair loss is often related to conditions in the scalp, such as irritation, scale and scarring.
When alopecia happens gradually, it may just be due to aging. Hereditary hair loss is the most common cause of hair loss. This type of alopecia is known as androgenic alopecia, better known as female or male-pattern baldness. Age and family history are often factors. However, in some cases, a biopsy of the skin is needed to confirm the diagnosis.
More than 50 percent of men over the age of 50 will be affected by male-pattern baldness, which is often characterized by a receding hairline or thinning of the hair on the back or vertex of the scalp. Women tend to keep their hairline, but experience thinning hair, with the first sign of hair loss being a widening part.
“Both men and women experience hair loss as a result of the aging process. The extent, distribution, rate of development and age of onset are all individually determined,” Dr. Zelac says.
Hair loss can be caused by medical conditions, such as thyroid gland disease, anemia, autoimmune diseases and vitamin deficiencies.
Alopecia areata is an autoimmune condition that targets hair follicles. It is marked by fast growing circular patches of complete hair loss. “In most cases, this is a straight forward diagnosis for a dermatologist and fortunately in many cases, it is self-limiting,” Dr. Zelac says.
Scalp infections, such as ringworm, are easily diagnosed and treated, he adds. By treating the condition, hair loss often can be stopped or reversed.
Hormonal changes from pregnancy, childbirth and menopause can cause hair to thin or fall out.
Medications, such as those used for cancer, high blood pressure, depression, arthritis, heart problems, birth control and athletic performance (anabolic steroids) can have side effects that include hair loss.
Too much vitamin A-containing supplements and medications can also cause hair loss.
Crash dieting and poor nutrition, including extreme weight loss, protein and iron deficiency and eating disorders, such as anorexia and bulimia, can contribute to hair loss.
Significant emotional stress, which could come from the death of a loved one or divorce, could be a trigger for hair loss.
Hairstyles that pull tightly can lead to hair loss. This includes frequently wearing tight ponytails or cornrows; frequently using hair products, such as hair dyes, gels, relaxers, hair sprays, and frequent use of a hair dryer.
Before making a diagnosis, a dermatologist will likely perform a physical exam, ask about family and personal medical history and maybe run some tests, including a blood test or even a scalp biopsy, a procedure where a small sample of skin and hair are removed for laboratory testing.
“In some cases, simple dietary or lifestyle changes or switching or modifying medications can help lessen or correct hair loss,” Dr. Zelac explains. “In other cases, medical treatment or surgical intervention may be recommended depending on the underlying cause.”
A treatment plan to get your hair growing again may include one or more of the following:
Medication, either topical or oral. Some require a prescription while others are over-the-counter products.
Laser treatment, or treatment with colored light emitting medical devices are available without prescription. In some cases, they have been shown to help control hair loss.
Procedures, such as hair restoration or hair transplantation, where hair-bearing skin, usually from the back of the head, is removed and transplanted to bald parts of the scalp. “These are great procedures that provide a near permanent solution for specific individuals,” Dr. Zelac says.
While treatments for hair loss abound, it’s important to first find out what is possible. “Your physician can discuss which options best suit your individual needs,” Dr. Zelac says.