ALOPECIA, SIGNS AND PREVENTION

Many people who develop alopecia areata are otherwise healthy. They have hair loss and sometimes nail changes, but they remain in good health.
The hair loss tends to be unpredictable. Hair may regrow without treatment. This happens more often when someone has a few bald patches. When the hair regrows, it may fall out again—or it may not.

If alopecia areata affects the nails, you may see dents, ridges, or brittle nails. Some people develop red nails.

DEFINITION

Hair loss can affect just your scalp or your entire body. It can be the result of heredity, hormonal changes, medical conditions or medications. Anyone — men, women and children — can experience hair loss.

Baldness typically refers to excessive hair loss from your scalp. Hereditary hair loss with age is the most common cause of baldness. 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 treatments available to prevent further hair loss and to restore growth.

Before pursuing hair loss treatment, talk with your doctor about the cause of the hair loss and the best treatment options.

SYMPTOMS

Hair loss can appear in many different ways, depending on what's causing it. It can come on suddenly or gradually and affect just your scalp or your whole body. Some types of hair loss are temporary, and others are permanent.

Signs and symptoms of hair loss may include:

Gradual thinning on top of head. This is the most common type of hair loss, affecting both men and women as they age. In men, hair often begins to recede from the forehead in a line that resembles the letter M. Women typically retain the hairline on the forehead but have a broadening of the part in their hair.
Circular or patchy bald spots. Some people experience smooth, coin-sized bald spots. This type of hair loss usually affects just the scalp, but it sometimes also occurs in beards or eyebrows. In some cases, your skin may become itchy or painful before the hair falls out.
Sudden loosening of hair. A physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing your hair or even after gentle tugging. This type of hair loss usually causes overall hair thinning and not bald patches.
Full-body hair loss. Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over your body. The hair usually grows back.
Patches of scaling that spread over the scalp. This is a sign of ringworm. It may be accompanied by broken hair, redness, swelling and, at times, oozing.

When to see a doctor

See your doctor if your child or you are distressed by hair loss and want to pursue treatment. Also talk to your doctor if you notice sudden or patchy hair loss or more than usual hair loss when combing or washing your or your child's hair. Sudden hair loss can signal an underlying medical condition that requires treatment.

CAUSES

Most people normally shed 50 to 100 hairs a day. This usually doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair loss occurs when this cycle of hair growth and shedding is disrupted or when the hair follicle is destroyed and replaced with scar tissue.

The exact cause of hair loss may not be fully understood, but it's usually related to one or more of the following factors:

Family history (heredity)
Hormonal changes
Medical conditions
Medications

Family history (heredity)

The most common cause of hair loss is a hereditary condition called male-pattern baldness or female-pattern baldness. It usually occurs gradually and in predictable patterns — a receding hairline and bald spots in men and thinning hair in women.

Heredity also affects the age at which you begin to lose hair, the rate of hair loss and the extent of baldness. Pattern baldness is most common in men and can begin as early as puberty. This type of hair loss may involve both hair thinning and miniaturization (hair becomes soft, fine and short).

Hormonal changes and medical conditions

A variety of conditions can cause hair loss, including:

Hormonal changes. Hormonal changes and imbalances can cause temporary hair loss. This could be due to pregnancy, childbirth or the onset of menopause. Hormone levels are also affected by the thyroid gland, so thyroid problems may cause hair loss.
Patchy hair loss. This type of nonscarring hair loss is called alopecia areata (al-o-PEE-she-uh ar-e-A-tuh). It occurs when the body's immune system attacks hair follicles — causing sudden hair loss that leaves smooth, roundish bald patches on the skin.
Scalp infections. Infections, such as ringworm, can invade the hair and skin of your scalp, leading to scaly patches and hair loss. Once infections are treated, hair generally grows back.
Other skin disorders. Diseases that cause scarring alopecia may result in permanent loss at the scarred areas. These conditions include lichen planus, some types of lupus and sarcoidosis.
Hair-pulling disorder. This condition, also called trichotillomania (trik-o-til-o-MAY-nee-uh), causes people to have an irresistible urge to pull out their hair, whether it's from the scalp, the eyebrows or other areas of the body.

Medications

Hair loss can be caused by drugs used for cancer, arthritis, depression, heart problems, high blood pressure and birth control. Intake of too much vitamin A may cause hair loss as well.

Other causes of hair loss

Hair loss can also result from:

Radiation therapy to the head. The hair may not grow back the same as it was before.
A trigger event. Many people experience a general thinning of hair several months after a physical or emotional shock. This type of hair loss is temporary. Examples of trigger events include sudden or excessive weight loss, a high fever, surgery, or a death in the family.
Certain hairstyles and treatments. Excessive hairstyling or hairstyles that pull your hair tight, such as pigtails or cornrows, can cause traction alopecia. Hot oil hair treatments and permanents can cause inflammation of hair follicles that leads to hair loss. If scarring occurs, hair loss could be permanent.

RISK FACTORS

A number of factors can increase your risk of hair loss, including:

Family history
Age
Poor nutrition
Certain medical conditions, such as diabetes and lupus
Stress

PREPARING FOR YOUR APPOINTMENT

You're likely to first bring your concerns to the attention of your family doctor. He or she may refer you to a doctor who specializes in the treatment of skin problems (dermatologist).

What you can do

List key personal information, including any major stresses or recent life changes.
Make a list of all medications, vitamins and supplements that you're taking.
List questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For hair loss, some basic questions to ask your doctor include:

What is likely causing my symptoms or condition?
Are there other possible causes for my symptoms or condition?
What kinds of tests do I need?
Is my condition likely temporary or chronic?
What is the best course of action?
Will my hair grow back? How long will it take?
Are there any restrictions that I need to follow?
Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
Is there a generic alternative to the medicine you're prescribing me?
Do you have any brochures or other printed material that I can take home with me?
What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

When did you first begin experiencing hair loss?
Has your hair loss been continuous or occasional?
Have you noticed poor hair growth? hair breakage? hair shedding?
Has your hair loss been patchy or overall?
Have you had a similar problem in the past?
Has anyone in your immediate family experienced hair loss?
What medications or supplements do you take regularly?
What, if anything, seems to improve your hair loss?
What, if anything, appears to worsen your hair loss?

TESTS AND DIAGNOSIS

Before making a diagnosis, your doctor will likely give you a physical exam and ask about your medical history and family history. He or she may also perform tests, such as the following:

Blood test. This may help uncover medical conditions related to hair loss, such as thyroid disease.
Pull test. Your doctor gently pulls several dozen hairs to see how many come out. This helps determine the stage of the shedding process.
Scalp biopsy. Your doctor scrapes samples from the skin or from a few hairs plucked from the scalp to examine the hair roots. This can help determine whether an infection is causing hair loss.
Light microscopy. Your doctor uses a special instrument to examine hairs trimmed at their bases. Microscopy helps uncover possible disorders of the hair shaft.

TREATMENTS AND DRUGS

Effective treatments for some types of hair loss are available. But some hair loss is permanent. With some conditions, such as patchy alopecia, hair may regrow without treatment within a year.

Treatments for hair loss include medications, surgery, laser therapy, and wigs or hairpieces. Your doctor may suggest a combination of these approaches in order to get the best results.

The goals of treatment are to promote hair growth, slow hair loss or hide hair loss.

Medication

If your hair loss is caused by an underlying disease, treatment for that disease will be necessary. This may include drugs to reduce inflammation and suppress your immune system, such as prednisone. If a certain medication is causing the hair loss, your doctor may advise you to stop using it for at least three months.

Medications are available to treat pattern baldness. Two medications approved by the Food and Drug Administration (FDA) to treat hair loss are:

Minoxidil (Rogaine). Minoxidil is an over-the-counter liquid or foam that you rub into your scalp twice a day to grow hair and to prevent further hair loss. It may be used by men and women. With this treatment, some people experience hair regrowth, a slower rate of hair loss or both. The effect peaks at 16 weeks and you need to keep applying the medication to retain benefits.
Possible side effects include scalp irritation, unwanted hair growth on the adjacent skin of the face and hands, and rapid heart rate (tachycardia).
Finasteride (Propecia). This prescription drug is available only to men. It's taken daily in pill form. Many men taking finasteride experience a slowing of hair loss, and some may show some new hair growth. You need to keep taking it to retain benefits.
Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer. Women who are or may be pregnant need to avoid touching crushed or broken tablets.

Surgery

In the most common type of permanent hair loss, only the top of the head is affected. Hair transplant or restoration surgery can make the most of the hair you have left.

During this procedure, your surgeon removes tiny plugs of skin, each containing a few hairs, from the back or sides of your scalp. He or she then implants the plugs into the bald sections of your scalp. You may be asked to take a hair loss medication before and after surgery to improve results.

Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring.

Laser therapy

A low-level laser device is available to treat men and women with pattern baldness. It has been cleared by the FDA. A study of 128 male and 141 female subjects indicated the device resulted in an overall improvement of hair loss condition and thickness among those who used the device. The researchers said no side effects were noted but that further study is needed to consider the long-term effects of this therapy.

Wigs and hairpieces

You may want to try a wig or a hairpiece as an alternative to medical treatment or if you don't respond to treatment. It can be used to cover either permanent or temporary hair loss. Quality, natural-looking wigs and hairpieces are available.

If your hair loss is due to a medical condition, the cost of a wig may be covered by insurance. You'll need a prescription for the wig from your doctor.

LIFESTYLE AND HOME REMEDIES

These tips may help you avoid preventable types of hair loss:

Eat a nutritionally balanced diet.
Avoid tight hairstyles, such as braids, buns or ponytails.
Avoid compulsively twisting, rubbing or pulling your hair.
Treat your hair gently when washing and brushing. A wide-toothed comb may help prevent pulling out hair.
Avoid harsh treatments such as hot rollers, curling irons, hot oil treatments and permanents.

ALTERNATIVE MEDICINE

If you are otherwise well-nourished, taking nutritional supplements has not been shown to be helpful.

Some studies report that the patchy hair loss caused by alopecia areata may be helped by lavender oil combined with oils from thyme, rosemary and cedar wood. Further study is needed.