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Diseases and Conditions
Special to CNN.com
Your hair loss may have started with a few extra hairs in the sink or in your comb. But now you can't look in the mirror without seeing more of your scalp.
Baldness typically refers to excessive hair loss from your scalp and can be the result of heredity, certain medications or an underlying medical condition. Anyone — men, women and children — can experience hair loss.
Some people prefer to let their baldness run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the medications and surgical procedures that are available to treat baldness. Before pursuing any of these treatment options, talk with your doctor about the cause of and best possible treatments for your hair loss.
Signs and symptoms
The medical term for hair loss is alopecia. Pattern baldness (androgenetic alopecia), the most common type of alopecia, affects roughly one-third of men and women. It's typically permanent. Another type of alopecia, alopecia areata, can be temporary. It can involve hair loss on your scalp or other parts of your body.
Having androgenetic alopecia may mean you experience hair loss as early as during your teen years. For men, this type of baldness is typically characterized by hair loss that begins at the temples and crown. The end result may be partial or complete baldness. Women with androgenetic alopecia usually have hair loss limited to thinning at the front, sides or crown. Complete baldness rarely occurs in women.
With alopecia areata, baldness usually occurs in small, round, smooth patches. You may lose only scalp hair, or you may lose body hair as well.
About 90 percent of the hair on most people's scalps is in a two- to six-year growth (anagen) stage at any given time. The other 10 percent is in a two- to three-month resting (telogen) phase, after which time it is shed. Most people shed 50 to 150 hairs a day. Once a hair is shed, the growth stage begins again as a new hair from the same follicle replaces the shed hair. New hair grows at a rate of approximately one-half inch each month.
Hair loss may lead to baldness when the rate of shedding exceeds the rate of regrowth, when new hair is thinner than the hair shed or when hair comes out in patches.
What causes androgenetic alopecia
Androgenetic alopecia is caused by heredity. Although it's most common among men, it can also affect women. A history of androgenetic alopecia on either side of your family increases your risk of balding. Heredity also affects the age at which you begin to lose hair and the developmental speed, pattern and extent of your baldness.
What causes alopecia areata
Alopecia areata is classified as an autoimmune disease, but the cause is unknown. People who develop this type of baldness are generally in good health. Some scientists believe that some people are genetically predisposed to develop alopecia areata and that a trigger, such as a virus or something else in the environment, sets off the condition. A family history of alopecia areata makes you more likely to develop it. With alopecia areata, your hair generally grows back, but you may lose and regrow your hair a number of times.
Other causes of temporary hair loss include:
- Disease. Diabetes, lupus and thyroid disorders can cause hair loss.
- Poor nutrition. Having inadequate protein or iron in your diet or poor nourishment in other ways can cause you to experience hair loss. Fad diets, crash diets and certain illnesses, such as eating disorders, can cause poor nutrition.
- Medications. Certain drugs used to treat gout, arthritis, depression, heart problems and high blood pressure may cause hair loss in some people. Taking birth control pills also may result in hair loss for some women.
- Medical treatments. Undergoing chemotherapy or radiation therapy may cause you to develop alopecia. After your treatment ends, your hair typically begins to regrow.
- Recent high fever, severe flu or surgery. You may notice you have less hair three to four months after events such as an illness or surgery. These conditions cause hair to shift rapidly into a resting phase (telogen effluvium), meaning you'll see less new hair growth. A normal amount of hair typically will appear after the growth phase resumes.
- Infancy. Newborns often lose hair during the first several months of life. This baby hair (vellus) is eventually replaced by more permanent hair. It's also common for babies to lose a patch of hair on the back of their heads from rubbing against mattresses, playpens and car seats. Hair will grow back once a baby begins to spend more time sitting up.
- Childbirth. Some women experience an increase in hair loss several months after delivering a baby. This is because during pregnancy the hair is shifted into an active growth state that then goes back to baseline soon after delivery. This increased hair loss usually corrects itself.
- Hair treatments. Chemicals used for dying, tinting, bleaching, straightening or perming can cause hair to become damaged and break off if they are overused or used incorrectly. Excessive hairstyling or hairstyles that pull your hair too tightly also can cause some hair loss. This is known as traction alopecia.
- Scalp infection. Infections such as ringworm can invade the hair and skin of your scalp, leading to hair loss. Once infections are treated, hair generally regrows. Ringworm, a fungal infection, can usually be treated with a topical or oral antifungal medication.
Baldness, whether permanent or temporary, can't be cured. But treatments are available to help promote hair growth or hide hair loss. For some types of alopecia, hair may resume growth without any treatment.
The effectiveness of medications used to treat alopecia depends on the cause of hair loss, extent of the loss and individual response. Generally, treatment is less effective for more extensive cases of hair loss.
The types of drugs for treatment of alopecia that are approved by the Food and Drug Administration include:
Minoxidil (Rogaine). This over-the-counter medication is approved for the treatment of androgenetic alopecia and alopecia areata. Minoxidil is a liquid that you rub into your scalp twice daily to regrow hair and to prevent further loss. Some people experience some hair regrowth or a slower rate of hair loss or both. Minoxidil is available in a 2 percent solution and in a 5 percent solution.
New hair resulting from minoxidil use may be thinner and shorter than previous hair. But there can be enough regrowth for some people to hide their bald spots and have it blend with existing hair. New hair stops growing soon after you discontinue the use of minoxidil. If you experience minimal results within six months, your doctor may recommend discontinuing use. Side effects can include irritation of the scalp.
Finasteride (Propecia). This prescription medication to treat male-pattern baldness is taken daily in pill form. Many people taking finasteride experience a slowing of hair loss, and some may show some new hair growth. Positive results may take several months. Finasteride works by inhibiting the conversion of testosterone into dihydrotestosterone (DHT), a hormone that shrinks hair follicles and is an important factor in male hair loss. Rare side effects of finasteride include diminished sex drive and sexual function. As with minoxidil, the benefits of finasteride stop if you stop using it.
Finasteride is not approved for use by women. In fact, it poses significant danger to women of childbearing age. If you're a pregnant woman, don't even handle crushed or broken finasteride tablets because absorption of the drug may cause serious birth defects in male fetuses.
- Corticosteroids. Injections of cortisone into the scalp can treat alopecia areata. Treatment is usually repeated monthly. Doctors sometimes prescribe corticosteroid pills for extensive hair loss due to alopecia areata. Ointments and creams can also be used, but they may be less effective than injections.
- Anthralin (Drithocreme). Available as either a cream or an ointment, anthralin is a synthetic, tarry substance that you apply to your scalp and wash off daily. It's typically used to treat psoriasis, but doctors can prescribe it to treat other skin conditions. Anthralin may stimulate new hair growth for cases of alopecia areata.
Hair transplants and scalp reduction surgery are available to treat androgenetic alopecia when more conservative measures have failed. During transplantation a dermatologist or cosmetic surgeon takes tiny plugs of skin, each containing one to several hairs, from the back or side of your scalp. The plugs are then implanted into the bald sections. Several transplant sessions may be needed as hereditary hair loss progresses with time.
Scalp reduction, as the name implies, means decreasing the area of bald skin on your head. Your scalp and the top part of your head may seem to have a snug fit. But the skin can become flexible and stretched enough for some of it to be surgically removed. After hairless scalp is removed, the space is closed with hair-covered scalp. Doctors can also fold hair-bearing skin over an area of bald skin in a scalp reduction technique called a flap. Scalp reduction can be combined with hair transplantation to fashion a natural-looking hairline in those with more extensive hair loss.
Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring. If you're interested in these procedures, consider only board-certified dermatologists, plastic surgeons or cosmetic surgeons, and check local and state medical boards for a record of patient complaints before choosing a doctor. Consult with this doctor to confirm the cause of your hair loss and review all treatment options, including nonsurgical ones, before proceeding with plans for surgery.
Wigs and hairpieces
If you would like an alternative to medical treatment for your baldness or if you don't respond to treatment, you may want to consider wearing a wig or hairpiece. They can be used to cover either permanent or temporary hair loss. Quality, natural-looking wigs and hairpieces are available.
Chances are that the greatest challenge of losing your hair is coping with the change in your appearance. You may be frustrated or upset by other people's reactions or after trying various treatments with little success. If you're having difficulty coping with baldness caused by heredity, a medical condition or medical treatments, you may find some of the following suggestions helpful:
Stress and hair loss: Are they related?
- Learn about the cause of your baldness and treatment options. Be wary of alternative treatments that have no proven track record or may cause dangerous or unpleasant side effects.
- Educate those near to you. Your family and friends can be more sympathetic if they understand the cause of your baldness or your concerns about your looks. You may also learn that they are less concerned about changes in your appearance than you are.
- Consider joining a support group. While support groups aren't for everyone, they can be sources of information and comfort. Talking with people who experience the same challenges or medical conditions and learning how they cope can be reassuring.