Hair Loss Information

• Common causes of hair loss
  
  
  • Male pattern baldness
    
    
  • Trauma
    
    
  • Chemicals
    
    
  • Medications such as allopurinol (Zyloprim) and warfarin (Coumadin)
    
    
  • Poor nutrition
    
    
  • Stress, for example, during a major illness
  
  
• Uncommon causes of alopecia
  
  
  • Poor blood flow
    
    
  • Infections such as syphilis
    
    
  • Skin diseases such as lupus
    
    
  • Cancers
    
    
  • Hormone problems
    
    
  • Kidney failure
    
    
  • Liver failure

Hair Loss Symptoms

• Most people notice hair loss when looking at themselves in a mirror.
  
  
• You may also find many hairs on your pillow in the morning or in your hairbrush or comb.
  
  
• A woman may notice a decrease in the size of her ponytail.
  
  
• Aside from the thinning hair itself, most people do not have other problems associated with hair loss.

When to Seek Medical Care

• If you have hair loss, you may want to see a doctor if you want to prevent balding.
  
  
• See your doctor if you are losing large amounts of hair every day, and if you are not feeling well at the same time you are losing hair.
  
  
• Most often hair loss occurs without other signs of illness.
  
  
• If the following symptoms occur at the same time as hair loss, you may have a serious medical condition and you should see a doctor right away.
  
  
  • Confusion
    
    
  • Poor appetite
    
    
  • Constipation
    
    
  • Diarrhea
    
    
  • Trouble breathing
    
    
  • Weight loss
    
    
  • Vomiting
    
    
  • Fever
    
    
  • Pain
    
    
  • Skin problems

There is no reason to seek emergency medical care for hair loss.

Exams and Tests

Physicians diagnose hair loss by looking at hair amount and hair distribution. Men usually lose hair in an easily recognized pattern. Women usually have about equal hair loss from all parts of the scalp.

• Charts with pictures of hair loss help to classify the amount and type of hair loss. These include the Hamilton and Ludwig classification charts.
  
  
  • Extra tests usually are not needed unless the diagnosis is uncertain.
    
    
  • You can do a pull test, examining the pulled hair for different thickness and length.
  
  
• Different thickness and length confirm the most common type of hair loss, androgenic alopecia.
  
  
• Skin problems leading to hair loss may be diagnosed by taking a sample of skin and hair from the affected area. A doctor looking at this under a microscope might find skin irritation or infection as the cause.
  
  
• If hair loss is severe or other signs of illness are present, many tests might be used, including x-rays and blood tests.

Hair Loss Treatment

If hair loss is caused by another illness, treatment of the illness is the best treatment for hair loss. If hair loss is the only problem, then there are many ways to treat it depending on how severe the loss is.

The most important consideration to make when deciding the type of treatment is how much your hair loss bothers you.

Treatment options include grooming techniques, wigs and hairpieces, medications, and surgery.

• Styling hair to cover the areas with the most hair loss is effective for mild cases. Washing and styling the hair will not cause further hair loss.
  
  
• For more severe hair loss, wigs and hairpieces can provide good results if you are willing to try them. Either of these options can be used in combination with medications or surgery if the results of styling or the hairpiece alone are not satisfying.

Self-Care at Home

Treatment of this problem at home is difficult.

• Decreasing the amount of pulling and tugging of the hair will prevent loose hair from falling out, but only for a short time.

• Most people will need to see their doctor to determine if there is a medical problem causing hair loss and to consider if treatment is indicated.

Medical Treatment

• Finasteride (Propecia, Proscar): A pill taken once daily that blocks the effects of testosterone on hair growth. Testosterone is a hormone found in higher concentrations in men. Finasteride is not currently used for the treatment of hair loss in women.
  
  
• Minoxidil (Rogaine, Loniten): A medication you rub directly onto your scalp. This medication enlarges hairs and makes them grow for a longer period.
  
  
  • It works for both men and women.
    
    
  • It works best for balding at the top and back of the head and less well for the front area of the scalp.
    
    
  • Stopping this medication can result in loss of the hair that developed during its use.

Surgery

• Hair transplant: A doctor takes plugs of hair from areas on your scalp where hair is thick and puts them on areas where your hair is thin.
  
  
  • These hair plugs can have a bothersome checkerboard appearance.
    
    
  • Follicular transplants, which move individual hairs from one place to another, are replacing hair plug transplants.

• Scalp rotation: A doctor moves a piece of your scalp that has good hair growth to an area of poor growth. The procedure is effective in children, but adults do not respond well to this type of treatment.

Next Steps & Follow-Up

During treatment for hair loss, you can expect to return to the doctor periodically to determine the response to treatment and to monitor for side effects from the medications being used.

Prevention

Prevention can be accomplished only by early treatment. Sometimes what you think may be hair loss is actually just hair breakage from overuse of hair dryers, curling irons, dyes, and styling products. 

Outlook

The ability to stop hair loss most often depends on the underlying cause.

• If taking a certain medication was the cause, stopping the medication would stop the hair loss.
  
  
• The most common type of hair loss, androgenic alopecia, usually follows a pattern with hair thinning in the front of the scalp first and progressing on to involve the back and top of the head. This type tends to be progressive.
  
  
• Finasteride helps stop hair loss in about 60% of men, and minoxidil decreases hair loss in about 50% of men and women.
  
  
  • The best prevention of hair loss is early treatment. Research has shown that minoxidil is most useful for people who have been losing hair for less than 5 years.
    
    
  • A doctor who can help determine if the medications are working and who can watch for side effects of the medications should follow up with people who are being treated with minoxidil or finasteride.