What is alopecia? | Hair loss diagnosis | Hair loss treatment options | Hair loss medications | Best hair loss medications | Side effects of hair loss | Hair loss home remedies | FAQ | Resources
It’s normal to lose 50-100 hairs on your scalp each day, but what happens when you lose more than that? Hair loss ranges from a mild thinning of the hair, a receding hairline to total baldness. Hair loss can happen on the scalp or all over the body. There are many causes of hair loss and it is important to know what is causing hair loss in order to treat it. Let’s take an in-depth look at what causes hair loss and ways to treat it.
What is alopecia?
Hair loss, also known as alopecia, is excessive loss of hair from your body, typically on your head. While hair loss sometimes leads to baldness, other times it can just cause overall thinness of the hair. Common types of hair loss include:
- Androgenetic alopecia: This type of hair loss is the most common, known as male pattern hair loss or female pattern hair loss. In the United States, it affects over 50 million men and 30 million women.
- Alopecia areata: This autoimmune condition causes hair from all over the body to fall out and not grow back due to the body’s immune system attacking hair follicles. This condition may result in total hair loss.
- Anagen effluvium: This is rapid hair loss due to medical treatments that shut down hair follicle production, such as chemotherapy. Hair will typically grow back on its own after treatment.
- Cicatricial alopecia: This type of alopecia, also known as scarring alopecia, causes hair to fall out when the hair follicles become inflamed. Then the follicle becomes scarred and is unable to produce new hair. There are a few types of this rare condition: central centrifugal cicatricial alopecia, dissecting cellulitis of the scalp, discoid lupus erythematosus, folliculitis decalvans, lichen planopilaris, and frontal fibrosing alopecia.
- Hair shaft abnormalities: This type of hair loss does not occur at the follicle, but rather when hair is breaking off somewhere in the hair shaft. They include:
- Loose anagen syndrome, which causes children’s hair to fall out easily and not grow past their shoulders, typically in lighter hair colors and it clears up during puberty.
- Trichotillomania is a behavior where the person pulls out their own hair which can lead to permanent hair loss if the behavior lasts over a long period of time.
- Traction alopecia is another type of hair shaft abnormality, in which the hair falls out due to a hairstyle that is too tight, like braids or a ponytail, and results in damaging the hair
- Hypotrichosis: This is a rare genetic condition in which a person grows very little hair and typically has no hair by the age of 25.
- Telogen effluvium: This condition causes hair follicles to go into a resting phase and not produce new hair. It often leads to thinness, but necessarily baldness. A person with telogen effluvium may lose 300-500 hairs daily. It may happen due to thyroid imbalance, fever, childbirth, change in birth control, a vitamin deficit or surgery.
- Tinea capitis: This condition, also known as scalp ringworm, is a fungal infection that causes hair loss and is most commonly the reason for hair loss in children.
The most common cause of hair loss is genetics and age. By 35, two-thirds of men are affected with some degree of hair loss or balding. By the age of 50, 85% of men have notable hair loss. Alopecia affects 40% of women by the age of 50. There are many treatment options for hair loss depending on the cause. These can include shampoos, topical medication, hair transplant surgery, and natural remedies.
How is alopecia diagnosed?
There are a variety of reasons for hair loss, so it is important to have it diagnosed by a doctor to find the root cause. While a primary care physician can do some tests for hair loss, such as a blood test to determine thyroid levels, a more complete diagnosis will be done by a dermatologist. There are a variety of tests your dermatologist may perform, some of which may include:
- A physical examination will help a dermatologist look at the pattern of hair loss and if there are any scalp conditions, i.e., redness or scarring. The hair loss may also be measured on either the Ludwig or Salvin Scale which is a hair loss density rating scale. During this time your doctor may ask you questions, such as:
- When did you first notice your hair loss/thinning hair?
- Are you losing hair from a specific area or is it all over hair loss?
- Has anyone in your family experienced hair loss?
- What medications are you taking?
- Does anything improve/worsen your symptoms?
- Pull test may be performed, where the doctor will tug on a section of hair and see how many hairs come loose from the root.
- Tug test is another test, in which the doctor hangs on to the root end of the hair with one hand and pulls from the ends of the hair with the other hand to see if there are any breaks in the middle of the strands.
- Card test may be performed where the doctor holds a felt-covered card, that contrasts with the hair color, to the hair roots to see the thickness of hair, if there is breakage in the hair, and to see if there is new growth.
- Folliscope, a new device that is a handheld microscopic camera, can automatically assess the hair density and hair shaft diameter. It also gives an up-close look of the scalp and hair follicles.
- Fungal culture is performed for anyone who is showing signs of a fungus in the scalp cells. This is done by taking a scrape or a swab of the scalp cells.
- Punch biopsy is rarely performed, but will sometimes be done when a diagnosis needs to be confirmed. This is when a small size of tissue is biopsied and sent to the lab, the incision is then stitched.
- Blood tests may be done to test for iron deficiency, thyroid disease, or androgen excess (a cause of hormone imbalance in women).
- VDRL which is a screening for syphilis, since one of the side effects of syphilis is hair loss.
- Photographs will likely be taken to assess current hair loss and to document changes or progress in hair growth once treatment starts.
During the appointment with your doctor or dermatologist, it is important to ask questions you may have. Questions to ask your doctor may include:
- What is causing my hair loss?
- Is my hair loss permanent?
- What are my treatment options?
- Are there any lifestyle changes I can make to improve my hair loss?
- How long will it take for my hair to grow back?
Hair loss cures
Currently, there are no cures for hair loss. Medications for hair loss typically do not completely reverse hair loss. Hair loss caused by chemotherapy or fungal infection can be resolved once chemotherapy has ended or the fungal infection has been treated. There is promising research in 3D printing and stem cells for curing hair loss in the future.
Hair loss treatment options
Treatment aims to help prevent more hair loss and regrow hair when possible. Possible treatments include medications, hair transplant surgery, laser therapy, or natural and home remedies. There are a few differences in medications to treat hair loss between males and females. The most common medication for hair loss prescribed to men and women is topical minoxidil, or Rogaine, which comes in liquid or foam and is rubbed into the scalp.
Rogaine helps prevent hair thinning and encourages new hair growth. Home remedies may include supplements that encourage hair growth, such as Omega-3, or changing hairstyles that may be damaging to the hair. Scientists are currently working on new treatments in hair loss, such as laser treatment or finding breakthroughs in treating hair loss for cancer patients.
Hair loss medications
Depending on the type of hair loss it is possible your doctor will prescribe medication. Common medications for hair loss include:
- Topical minoxidil, commonly known as Rogaine, prevents hair loss and can promote new hair growth. It comes in liquid or foam and is rubbed into the scalp twice a day. This medication may cause scalp redness and irritation and takes 4 months to a year to show improvement in the hair. If treatment stops, hair loss typically starts again. It is used for multiple types of hair loss including male and female pattern hair loss, alopecia areata, telogen effluvium, hypotrichosis, and scarring alopecia.
- Finasteride is a prescription medication for men with male pattern hair loss, specifically loss at the crown and middle of the scalp. It decreases the rate of hair loss and promotes new hair growth by stopping the body’s production of a hormone, dihydrotestosterone (DHT), that destroys hair follicles. Progress will not be seen for 4 months to a year. Once treatment stops, hair loss may recur. This medication can cause erectile dysfunction in some patients.
- Antiandrogens, or medications that inhibit sex hormones, may be prescribed to women exhibiting female pattern baldness when sex hormones may be damaging the hair follicles. These medications include spironolactone and birth control pills. This medication can cause irregular periods and should not be used for women trying to become pregnant, therefore contraception is mandatory especially with spironolactone
- Corticosteroids are used when hair loss is caused by an autoimmune disease, such as alopecia areata, discoid lupus erythematosus, and lichen planopilaris. Corticosteroids stop the autoimmune disease from attacking hair follicles and allow hair to grow. Corticosteroids may come in a topical solution, oral tablet, or in a steroid shot given at the doctor’s office. Corticosteroids may cause skin on the scalp to thin.
- Antifungal medications are given when hair loss is caused by scalp ringworm. Once the fungus is cleared hair typically regrows back. Antifungal medications can sometimes cause a rash.
- Dutasteride, while not currently approved by the FDA for hair loss, has been shown to improve hair growth in some men. This medication is said to more effectively block DHT than Finasteride in some studies. Dutasteride can also cause erectile dysfunction.
What is the best medication for hair loss?
The best medicine for hair loss should be determined by a doctor and depends on your medical condition, medical history, and the current prescriptions you may be taking.
||How it works
||Most common side effects
||Rogaine comes in foam or liquid and is rubbed on to the scalp.
||Liquid: 20 drops or one milliliter rubbed on scalp
Foam is typically 1/2 a cap.
|Evidence is unclear but believed to work by enlarging and elongating hair follicles
||5-alpha reductase inhibitors
||One 1 mg tablet per day
||Blocks the body’s production of DHT, a hormone that causes hair loss
||Impotence, abnormal ejaculation,
hypotension (low blood pressure)
||Daily dose of 100 – 200 mg
||Slows down the production of male hormones
||Lightheadedness, little to no urination
||One oral tablet each day
||Reduces inflammation in hair follicles
||Sleep problems, weight gain, high blood sugars
||1% topical cream rubbed gently into the affected area
||Kills fungus causing hair loss
||Dryness, redness, itching
||5-alpha reductase inhibitors
||One .5 mg capsule each day
||Blocks the body’s production of DHT, a hormone that causes hair loss
||Impotence, decreased libido
Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of hair loss medication?
Side effects of hair loss medications will depend on the drugs being prescribed. Topical creams, like Rogaine and Lamisil, may cause skin irritation such as burning, itching, and redness.
Medications in the drug class 5-alpha reductase inhibitors, which are medications specifically for male hair loss, may cause low blood pressure (hypotension), impotence and decreased libido. Women’s hair loss medication, in the drug class antiandrogens, may cause breast tenderness and irregular periods. This is not a complete list of side effects and you should always discuss possible side effects and possible drug interactions with your healthcare provider.
How can I stop hair loss and regrow hair naturally?
While medication is one option for hair loss, there are ways to combat hair loss through lifestyle changes, natural treatment options, and diet changes. These options may include:
- Scalp massages have been shown to improve hair thickness if performed 4 minutes each day.
- Moisturizing the scalp with oils like jojoba oil and coconut oil is said to promote healthy growth and improve the health of hair.
- Aloe vera can remove dandruff and excess oils potentially blocking the hair follicles, allowing hair to regrow. Aloe can be directly applied to the scalp or added to shampoo and conditioner.
- Viviscal, an oral marine supplement, has been shown to increase in new hair growth in women when taken twice daily for sixth months.
- Omega 3 & 6 supplements, such as fish oil, have been shown to improve the density of hair in women suffering from hair loss.
- Onion juice, when applied directly to the scalp 2 times a day, was found to help around 85% of people improve hair regrowth in a 2002 study. Men had higher rates of growth when compared to women.
- Essential oils have been said to help strengthen hair and improve growth when applied to the scalp. Essential oils for hair loss include rosemary oil, lavender oil, sandalwood oil, cedarwood oil, geranium oil, safflower oil, and peppermint oil.
- Garlic, when combined with a steroid treatment, is shown to improve regrowth of hair, according to the findings of dermatology researchers in a 2007 study.
- An egg hair mask strengthens hair and encourages growth due to its high levels of keratin which is the main component of hair. Mix one egg and olive oil together and apply it to wet hair, rinse after 10 minutes.
- Red ginseng supplements may promote hair growth according to a 2015 study.
Frequently asked questions about hair loss
Can you grow back thinning hair?
For most causes of hair loss, including thinning, there are medications and natural treatment options to promote new hair growth.
What is the best hair loss treatment?
The best treatment for hair loss depends on the underlying cause of the hair loss. It is best to have a conversation with your doctor to find the best treatment for you. One of the most widely used treatments for hair loss is Rogaine.
What is the best hair loss treatment for female hair loss?
Since there are multiple reasons for female hair loss, it is best to discuss with your doctor the most effective treatment for hair loss. Common treatments for female hair loss are Rogaine or antiandrogens, which slow down the production of male hormones.
What is the latest hair loss treatment?
There are exciting developments in 3D printing and stem cells for hair loss treatment. However, they are not yet available to the public.
Is there a pill to make your hair grow back?
Depending on the type of hair loss, there are oral tablets that may be prescribed by your doctor to help with hair loss. For men, the most common pills to treat hair loss are Finasteride and Dutasteride. For women, the most common pills to treat hair loss include Spironolactone and birth control.
How long does it take for hair to regrow after medication?
For most treatments, it takes 4 months to a year to see regrowth and thicker hair.
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