Hair loss is when hair loss and treatment out continuously and does not grow back. Normally you lose about 70 to 100 hairs a day. They can then be found, for example, on the pillow, in the hairbrush or in the shower. They usually grow back. However, almost everyone’s hair thins as they age. – However, if you lose more than 100 hairs a day and over a longer period of time, this can indicate hair loss. Hair loss is first visible in a few hairless areas, which become larger over time. The cause of this so-called alopecia can usually be determined by a dermatologist.
Hair Loss Types
There are different types of hair loss. These are the most common forms:
- Hereditary hair loss (androgenetic alopecia)
- Circular hair loss (alopecia areata)
- Diffuse hair loss (alopecia diffusa)
- Other forms, for example due to inflammation or constant pressure and pulling on the hair
Causes of hair loss
Various triggers can be responsible for the loss of hair on the head. One of the most common causes, both in women and in men, is genetic hair loss. Almost two thirds of men and about every second woman are affected. In men, the roots of the hair on the head gradually shrink. They react hypersensitively to the hormone DHT (dihydrotestosterone), so that strong hair no longer develops.
It is not yet clear why women suffer from hereditary hair loss. An inherited high androgen sensitivity of the hair roots is also suspected.
Around one million people in Germany are affected by circular hair loss (alopecia areata) . Especially children and young adults (up to about 30 years) suffer from it. This type of hair loss is an autoimmune disease that attacks the body’s own tissues. These are either the hair roots on the scalp or elsewhere on the body. The disease occurs much more frequently in women of all ages than in men.
There are different triggers for diffuse hair loss (alopecia diffusa) . These include thyroid dysfunction and iron deficiency, but some medications and stress can also cause hair to thin. It is also known that hormone treatments such as hormone therapy during menopause or taking birth control pills can have an impact on hair loss. Women are affected much more often than men. Children can also get diffuse hair loss.
Hair loss due to inflammatory diseases: If the scalp is inflamed, this can also cause local hair loss. The sooner treatment is given, the better the chances that scarring and permanent hair loss will not occur.
Hair loss due to hair that is too tight in a ponytail: If pressure or tension is constantly exerted on the scalp when wearing a ponytail, this can promote hair loss.
Hair loss due to pathological pulling out (trichotillomania): In this disorder of impulse control, those affected pull out their own hair. This can lead to the hair on your head becoming very thin. In some cases, the scalp even becomes scarred, preventing hair from growing back there.
Pseudopelade Brocq Hair Loss: The cause of this rare form of hair loss is unknown. It mostly affects women between the ages of 30 and 55.
Hair loss – symptoms
Depending on the specific type of hair loss, different symptoms appear:
Hereditary hair loss
If the loss of scalp hair is hereditary, the symptoms are different in women and men.
Men lose their hair first in the area of the forehead (receding hairline) and in the upper temple region. The hair on the top of the head is thinning. In the long run, a bald head can form on the forehead and back of the head, leaving only a fringe of hair. The earlier the hereditary hair loss begins, the more pronounced the symptoms become with advancing age. Young people are often affected.
In women, the hereditary hair loss manifests itself particularly in the crown area, but can also continue backwards or to the sides. Rarely does this lead to bald spots like in men. However, the scalp can become visible. This so-called androgenetic hair loss usually only becomes evident after the menopause.
Circular hair loss
The symptoms are equally pronounced in women and men. However, women of all ages are more frequently affected by what is known as alopecia areata than men.
Circular hair loss usually starts suddenly. Bald spots then form on the head, sometimes also on the eyebrows, eyelashes or beard, within a short period of time. These round or oval bald spots then appear as if they have been punched out. Circular hair loss usually begins in childhood and adolescence.
Diffuse hair loss
The symptoms are the same for both sexes. However, women get the so-called diffuse alopecia much more often than men. Children are also affected. – The hair here often falls out at the same time. They first stop growing, go into a dormant state, and then go out. Certain areas are not affected, rather the hair on the head becomes thinner overall. Diffuse scarring is rare.
Hair loss – when to see a doctor?
If you notice severe hair loss, you should see a dermatologist (skin care clinic doctor) as soon as possible. With some forms of hair loss, the success of the treatment increases with an early diagnosis. Some hospitals also offer special hair consultations. Hair loss is only a concern if more than 100 hairs fall out every day. Regular hair loss is normal. However, this is usually limited to around 70 to 100 hairs per day. That doesn’t mean you have to count the hair that has fallen out. You usually notice on your own when the hair on your head is thinning.
Hair loss diagnosis
In order to treat hair loss, the dermatologist must first determine the cause. For this purpose, a detailed discussion is held with the patient (anamnesis). The doctor treating you will ask the following questions, among others:
- How long has the patient had hair loss?
- How bad is the hair loss?
- Have other symptoms occurred (e.g. itching)?
- What is the previous medical history?
- Do relatives also suffer from hair loss?
- What medications are taken?
- Is the patient suffering from particularly high levels of stress?
Female patients are also asked about their menstrual cycle, the use of contraceptives, pregnancy and childbirth and, if applicable, the onset of menopause.
The physical examination follows the detailed diagnostic discussion.
- The doctor will look at the area affected by hair loss. He may use a dermatoscope (illuminated magnifying glass) to help. The pattern left by the hair that has fallen out often provides information about the reason for the loss of hair on the head.
- Additional examinations, such as a blood or hair analysis, may be necessary. If there is a suspicion of a fungal disease of the scalp, it may be necessary to take a swab from the hair or the hair stumps and create a pathogen culture. In rare cases, the dermatologist will also take a tissue sample from the scalp (including the hair follicles).
- A pluck test is also possible. The dermatologist tests how much hair can be removed by gently pulling.
- The doctor will check the bald spots to see whether there are still pores in the hair follicles. If this is the case, scarring has not yet taken place and the hair could therefore grow back in principle.
Hair loss treatment
The treatment of hair loss depends on its specific cause.
Treatment of hereditary hair loss:
- For men: A minoxidil solution (2% or 5%) is usually prescribed, possibly a minoxidil foam (5%). The remedy is applied to the scalp and can stop hair loss in most users. Even thickening of the hair is sometimes possible. Minoxidil stimulates the hair roots, but after a few weeks it can temporarily increase hair loss. The effect is called shedding and indicates that the therapy is working well. Other side effects can include a reddened or scaly scalp, and allergic reactions can also occur. If minoxidil is stopped, the hair can fall out again.
Another therapy option is with finasteride tablets. They are reserved exclusively for men. Women, children and adolescents should not take the active ingredient. Finasteride reduces the conversion process from testosterone to DHT. It is ineffective against a receding hairline. Impotence can occur as a side effect. Here, too, the loss of scalp hair starts again as soon as the drug is discontinued.
In many cases, a hair transplant is also possible. The treating dermatologist can best assess the individual possibilities.
- in women: Minoxidil is also used in women, mostly as a hair tonic. The blood vessels dilate and blood circulation in the scalp is stimulated. However, a side effect can be increased hair growth on the face and forehead. When the drug is stopped, its effect also ends and the hair can fall out again.
Hair transplantation is also an option for women. It is best to consult your dermatologist.
Therapy of circular hair loss
Women are affected by circular hair loss significantly more often than men. The therapeutic approaches do not differ in relation to the respective gender.
Circular hair loss is usually treated with anti-inflammatory drugs such as cortisone. The targeted irritation of the scalp to improve blood circulation is also effective for many. Hair growth often starts again afterwards. However, the result only lasts as long as the treatment lasts. If it stops, the hair will fall out again.
So-called topical immunotherapy and light therapy are also used to strengthen the hair roots. Both can help stop hair loss.
Treatment of diffuse hair loss
Diffuse hair loss can be attributed to numerous causes. If a disease is the trigger, it must be treated first. If diffuse hair loss occurs as a side effect of a medication, the active ingredient should be changed if possible. But deficiencies, such as iron deficiency, can also be responsible. Then you can already stop the hair loss with a change in diet. Limiting nicotine and alcohol consumption usually has a positive effect. A 2% minoxidil solution for rubbing into the scalp is also often recommended.
Diffuse hair loss affects women more often than men. Hormone treatments, birth control pills and menopause all have an impact on this form of hair loss. If hormone changes are responsible for this, a solution can be sought together with the attending gynecologist or endocrinologist.