Hair loss, or alopecia, is a common condition that affects men, women, and children. Hair loss, per se, is a normal body process wherein old strands of hair are shed and are replaced by new ones. It is in fact normal to lose about 50 to 100 strands of hair every day. However, when the shedding of hair becomes excessive or is a sign of an underlying condition, it can lead to hair thinning or baldness and can be very distressing.
Hair loss can come in many forms or patterns:
- In male-pattern baldness (androgenetic alopecia):
- the baldness can start from the midline of the forehead and proceed towards the vertex, creating an A-like pattern that gradually spreads to the entire top of the head
- the baldness can start from the both sides of the forehead and proceed towards the vertex, creating an M-like pattern that gradually spreads to the entire top of the head
- the baldness can start from the vertex of the head and proceed towards the forehead, creating an O-like pattern that gradually spreads to the entire top of the head
- Or it can be a combination of these patterns.
- In female-pattern baldness (also androgenetic alopecia), the thinning of the hair starts on the top of the head and continues to spread diffusely until the mid-part line of the hair becomes so visibly bald. Eventually, the baldness spreads to the entire top of the head.
- In alopecia areata: the baldness appears as multiple patches of round bald spots and can be on scalp or face.
- Some can types of baldness can start as diffuse thinning of hair that evenly progress to baldness (like in those who lose hair due to chemotherapy).
There are many different causes of baldness.
- Genetics and age - The most common cause of hair loss is still aging and genetics. Male-pattern baldness and female-pattern baldness are hereditary forms of hair loss that can cause an individual to get bald at an earlier age.
- Hormones - Changes in the hormones of the body can affect the growth of hair. This is especially visible in women who grow thick and full hair during pregnancy and lose lots of strand after giving birth.
- Auto-immune disorders - Autoimmune disorders (wherein the body’s immune system targets itself) like alopecia areata can cause round patchy bald spots scattered over the head.
- Medications - Some medications can cause hair loss. A very common example of this is chemotherapeutic drugs for cancer patients.
- Infection - Fungal scalp infections like ringworms can cause patchy localized bald spots in the scalp.
- Hairstyling - Some chemicals for hair treatment can damage the scalp and cause hair fall. Other hairstyles that are too tight can pull out the hair strands and lead to hair loss.
Treatment of hair loss depends on the cause of the problem. Fungal infections should be treated with anti-fungal antibiotic creams. Alopecia areata (autoimmune) is treated with steroid creams and if resistant steroid injections. Chemicals and medications related hair-loss will resolve once the chemical or medication. Generally, addressing the underlying cause of hair loss will lead to growth of new hair strands.
However, for androgenetic hair loss medications might be helpful. This include:
- Minoxidil - Minoxidil is a topical scalp treatment in a variety of forms and doses. The treatment must be a minimal 6 months with stable hair growth pattern after 18 months and must be continued as a maintenance medication. 30 to 40 percent of men and women report significant results. People with heart disease must be cautious with this drug.
- Finasteride - Finasteride (tablets) that alters hormone production improving hair presence but side effects can include decreased sex drive and erectile dysfunction. Finasteride should be avoided in women as it has not shown any benefit in treating women with alopecia and is dangerous to the fetus if pregnant.
- Spironolactone - Spironolactone can be used in women but again should be avoided in pregnant women. The drug also lowers the production of hormones that contribute to the hair loss.
For hair loss that is unresponsive to therapy, surgical transplant of hair can be done. However, if someone is not willing to undergo all of these treatments, a good quality wig or hairpiece is a very convenient way to go.