Hair loss is a very common concern and affects up to 50% of people in their lives. It can occur anywhere on the body, but is the most cosmetic problem on the scalp. Hair loss is divided into the major categories of focal or diffuse hair loss.
Focal Hair Loss
This type of hair loss is due to an underlying problem that may cause scarring or nonscarring patches of hair loss. Scarring alopecia (lack of hair) causes permanent hair loss from destruction of hair follicles from severe immune diseases like lupus.
Alopecia Areata: This is single to multiple patches of hair loss which an occur equally in men and women at any age (the most common age is young adult) and it can be from genetic predisposition in 20 – 40 percent of cases or from an autoimmune cause(such as lupus, rheumatoid arthritis, diabetes, vitiligo, or thyroid disease). The classic finding is a smooth hairless patch surrounded by small broken hairs. Treatment is usually topical cortisone, and 30-50% of people recover within 1 year.
Tinea Capitus: Children are most likely to be affected by this fungal infection, usually presenting with a round patch of hair loss with some scaling and surrounding redness. Treatment is usually with an oral fungal medicine, though topical lamisil cream can be tried at first.
Traction Alopecia: Hair loss from pulling on hair from tight braids, curlers, bleaching/coloring, and wigs. Treatment involves eliminating the source of stress.
Trichotillomania: This is a psychiatric hair loss from repeated hair plucking.
Diffuse Hair Loss
Female Pattern Hair Loss
About 50% of women will experience this during their lifetime, and it is characterized by hair thinning over the top of the scalp but with preservation of the front hairline. Women should be evaluated for excess testosterone, anemia, or thyroid problems. Topical minoxidil 2% twice daily is the only approved treatment, but some women with a high level of testosterone can be treated with a water pill spironolactone. Treatment of any anemia and thyroid problems can improve this hair loss.
Male Pattern Hair Loss
This affects up to 50% of all white men by age 50, and a little less percentage of African American men. Hair loss starts in the temporal regions and then spreads to thinning in the vertex and frontal regions in a classic M pattern. Treatments include topical minoxidil 2% (the 5% is no better and can cause more side effects, it is applied twice daily to the scalp), oral Propecia once daily (less side effects in men younger than 40 – can cause decreased libido and impotence and erection disorders), and in some men Nizoral shampoo and Head and Shoulders shampoo 2 to 4 times per week can help. Some studes have shown increased efficacy with combined treatments.
This type of hair loss results when an increased number of hair cells enter the resting phase rather than the growing phase. Usually an average of 100 hairs are lost each day, but in this type of hair loss 30 to 50 percent of body hair can be rapidly lost. This can be precipitated by severe illness, injury, infection, surgery, crash diets, psychological stress, giving birth, thyroid disorders, iron deficiency, anemia, or drugs (especially can be seen with hormones, antithyroid drugs, anticoagulants, seizure medicines, blood pressure medicines – b-blockers and ACE inhibitors like lisinopril, and lithium). No cause is found in about 1/3 of cases. A hair pull test can help diagnose this (positive if greater than 10 percent of 40-60 hairs being pulled come out with steady traction). Treatment involves removing the underlying stressor and correction of any underlying medical problem.
This is abrupt loss of 80 – 90 percent of body hair. The main cause is chemotherapy.
Total hair loss on the scalp and or body presumed from autoimmune disorders or family history.
Generally a balanced life and diet with adequate sleep, manageable stress, healthy diet, plenty of water intake (1/2-1 gallon per day), regular exercise, and general supplements (fish oil, vitamin D, multivitamin, calcium for women) will help avoid excessive hair loss. Biotin supplement has been shown to help some people with hair loss, and in some can help grow longer and thicker hair. Biotin is vitamin B7 and is water soluable, so your body will eliminate any unneeded amount. Adults require 30mg/day in their diet (found in grain, peas, nuts, vegetables), and supplements range from 1000 – 2000mg/day.