Hair Loss | Cigna

Topic Overview

How much hair loss is common?

Everyone loses some hair
every day. Losing up to 100 hairs a day is normal.

But if hair
loss runs in your family, you could lose a lot more hair. With this kind of hair loss, you may
end up with bald spots if you are a man. If you are a woman, you may find that the hair on the top of your head is slowly thinning. About half of all
people have this type of hair loss by around age 50.

Although hair loss is fairly common, it can be a tough
thing to live with, especially when it changes how you look. But there are ways
you can treat your hair loss.

What causes hair loss?

Common causes of hair loss
include:

  • Family history. In most cases, hair loss is
    inherited, which means it’s passed down from one or both of your parents. This
    is called male-pattern or female-pattern hair loss.
  • Stress,
    including physical stress from surgery, illness, or high
    fever.
  • Chemotherapy, which is powerful
    medicine that destroys cancer cells.
  • Damage to your hair from
    pulling it back too tightly, wearing tight braids or ponytails, or using
    curling irons or dyes.
  • Age. You grow less hair as you get
    older. Hair also gets thinner and tends to break more easily as you age.
  • Poor diet, especially not getting enough protein or
    iron.
  • Thyroid diseases, such as

    hypothyroidism
    and

    hyperthyroidism
    .

  • Ringworm of the scalp
    , which is common in
    children.

What are the symptoms?

Your symptoms will depend
on what kind of hair loss you have.

If your hair is thinning, it
happens slowly over time, so you may not notice the hairs falling out. If your
hair is shedding, then clumps of hair fall out. You may lose hair all over your
scalp, which is called general hair loss. Or you may lose hair only in one
area, which is called focal hair loss.

With
inherited hair loss
,
men usually get bald spots around the forehead or on the top of the head, while
women have some thinning all over the scalp, but mostly on the top of the head.

Since your hair has a lot to do with your
appearance, losing it may cause you to have lower self-esteem if you don’t like
how you look. This is especially true in women and teens.

How is hair loss diagnosed?

Your doctor will ask
you some questions, like how much hair you’re losing, when it started, and
whether your parents have hair loss. He or she will look closely at your scalp
and hair loss pattern and may gently pull out a few hairs for tests.

If it’s not clear what’s causing you to lose your hair, your doctor may
do a blood test or look at a sample of your hair or scalp with a
microscope.

How is it treated?

How you choose to treat your
hair loss depends on the cause. It also depends on your feelings. You may
decide that you need treatment, or you may not be worried about thinning hair
or baldness. The choice is up to you.

If hair loss is caused by something that won’t last or can be treated, your hair is likely to grow back. For example, if an underactive thyroid is causing the problem, taking thyroid medicine may help. And most hair lost during chemotherapy will grow back after the treatment ends.

Hair loss that runs in the
family can be treated with medicines or hair
transplant surgery. Some people choose to wear hairpieces, like wigs or toupees (say
“too-PAYZ”). Finding different ways of styling your hair, like dyeing or
combing, also can help.

If hair loss is caused by something you can control,
like stress or medicines, you can treat it by getting rid of the cause.

When you are deciding about treatment, think about these
questions:

  • Which treatment is most likely to work?
  • How
    long will it take?
  • Will it last?
  • What are the side
    effects and other risks?
  • How much will it cost, and will insurance
    cover it?

Will your hair grow back?

When your hair loss is
inherited, your hair won’t grow back naturally. Treatment can help some hair
grow back and prevent more from falling out, but you probably won’t get all
your hair back. And treatment doesn’t work for everyone.

When
medicines, stress, or hair damage cause you to lose your hair, it often will
grow back after you take away the cause. If this doesn’t help, you may need
other treatment.

If you’re unhappy with how hair loss makes you
look, treatment may help you feel better. It’s natural to want to like the
way you look.

Frequently Asked Questions

Cause

Losing a lot of
hair (more than 100 hairs a day) can be caused by
inherited factors, disease, stress, medicines, injury, aging, or hair care.

Inherited hair loss

The most common cause of hair
loss is
genetics-you inherit the tendency to lose hair from
either or both of your parents. This is called male-pattern hair loss or
female-pattern hair loss. The medical term for this type of hair loss is
androgenetic alopecia.

In this type of
hair loss, your
genes affect how your hair grows. They trigger a
sensitivity to a class of hormones called
androgens, including testosterone, which causes

hair follicles
to shrink. Hair follicles are the openings that hair grows from.

Shrinking follicles produce
thinner hair and eventually none at all. Men generally develop bald spots on
the forehead area or on the top of the head, while women often have thinning of the hair on the top of the head. About half of all people have

inherited hair loss
by about 50 years of age.

Other causes of hair loss

Different types of hair loss may have different
causes. Common causes of hair
loss include:

  • Age. As you age, your hair tends to break more easily, and hair
    follicles do not grow as much hair.
  • Mental stress or physical stress, such as recent surgery,
    illness, or high fever. You may have a lot of hair loss 1 to 3 months
    after severe physical or emotional stress. Your hair usually will grow back
    within a few months.
  • Hair styling and products. Pulling your hair back too
    tightly or wearing tight braids or ponytails can cause hair loss. You may lose
    hair around the edge of the hairline, especially around the face and forehead.
    Using curling irons or dyes a lot can also result in hair loss. Hair
    usually grows back when you stop doing these things.

  • Ringworm of the scalp
    , which is common in
    children.
  • Poor nutrition, especially lack of
    protein or
    iron in the diet. Hair returns after you change your
    diet to get enough of these nutrients.
  • Thyroid diseases, including

    hypothyroidism
    and

    hyperthyroidism
    .

Other causes of hair loss include:

  • Alopecia areata , an
    autoimmune disease in which your immune system attacks
    hair follicles, resulting in round hairless patches on any area of the
    scalp or body. Severe cases involve many bald patches of hair or complete loss
    of hair on the scalp or body, although in some cases there is hair thinning
    without distinct patches of baldness. The hair loss usually is not permanent. Hair grows back within 1 year for many people.
  • Diseases , such as
    lupus,
    syphilis, or cancer. Hair may grow back on its own. In some cases, treatment may help.
  • Side effects of
    medicines or medical treatments , such as blood
    thinners (anticoagulants) or
    chemotherapy. Hair usually grows back after you stop
    using the medicines or when the treatment is over.

  • Trichotillomania
    , a compulsive behavior in which a
    person pulls hair out of the scalp, eyelashes, or eyebrows. There is usually
    mounting tension before pulling and a feeling of relief afterward.
    Trichotillomania often results in noticeable hair loss.
  • Injury to
    the scalp, including scarring.
  • Changes in hormone levels. Childbirth, taking birth control
    pills, or changes in a woman’s

    menstrual
    cycle can affect the hair growth cycle and
    cause hair loss. Hair usually will grow back.

Symptoms

Hair loss can
occur as thinning, in which you may not notice hair falling out, or as
shedding, in which clumps of hair fall out.

In the most common
type of hair loss,
inherited hair loss
(androgenetic alopecia), men tend to lose hair on the front hairline and forehead and
on top of the head. Eventually, only hair around the ears, the sides, and the back
of the head remains. Women with this condition typically have gradual
thinning throughout the scalp, but mostly on the top of the head.

Other causes of hair loss may also show distinct
patterns. For example, conditions such as

trichotillomania
(compulsively pulling at the hair) or

alopecia areata
(in which the immune system attacks

hair follicles
) result in obvious patches of hair loss, while stress and some
medicines result in clumps of hair falling out.

Because hair is an
important part of appearance, hair loss can also result in loss of self-esteem
and feeling unattractive, especially in women and teens.

What Happens

Inherited hair loss

Inherited hair loss affects about half of men by the time they are 50 years of age. And it affects almost half of women by the time they reach 60 years of age.

footnote 1

With inherited hair loss (
androgenetic alopecia
), men tend to lose hair on the front hairline and temples
and on top of the head. Eventually, they may go completely bald.

Women generally lose less hair than men, but they have a similar pattern of hair loss. Women may have slight, moderate, or even severe hair loss, but they don’t usually lose all their hair.

For both men and women,
inherited hair loss
can be treated early to slow down or stop hair loss.

Other causes of hair loss

Alopecia areata is
hair loss caused when the immune system attacks

hair follicles
, where hair growth begins. It usually starts with one or more
small, round, smooth bald patches on the scalp, and can progress to total scalp
hair loss or complete body hair loss. It often begins in childhood. The hair
usually grows back within 1 year. But hair loss in alopecia areata can come and go-the hair often will grow back over several months in one area but will fall
out in another area.

With hair loss caused by stress,
disease, medicines or medical treatments, clumps of hair may fall out. But after the cause is stopped, the hair usually
grows back, although sometimes treatment may be needed.

What Increases Your Risk

Factors that increase the
risk of
hair loss include:

  • Genetics (inherited tendency). If one or both of your parents have hair loss, it is likely
    that you will also.
  • Disease or illness.
    Certain diseases or an illness can cause hair loss. The diseases may include

    ringworm of the scalp
    (tinea capitis), thyroid diseases such as

    hyperthyroidism
    and

    hypothyroidism
    , or

    lupus
    . The illness may include a severe infection or
    high fever.
  • Age. Many people have some hair
    loss by the age of 50.
  • Medicines and medical treatments. Certain
    medicines or medical treatments can cause scalp
    problems and hair loss.
  • Hair care and styling. Some methods of hair care or hair styles can damage hair and
    cause hair loss.

If you have alopecia areata , you are
more likely to have permanent hair loss if:

  • You have a family history
    of the condition.
  • You have the condition at a young age.
  • You have an

    autoimmune disease
    .
  • You have allergies (
    atopy
    ).
  • You have a lot of hair loss.
  • You have abnormal
    color, shape, texture, or thickness of the fingernails or toenails.

When To Call a Doctor

Call your doctor if:

  • Your
    hair loss is sudden, rather than
    gradual.
  • You notice hair shedding in large amounts after combing or
    brushing, or if your hair becomes thinner or falls out.
  • You are
    concerned that a medicine may be causing your hair loss.
  • Your skin is scaly or has a rash, or you have any change on your skin or scalp with hair
    loss.
  • Your hair is gradually thinning and balding, and
    you want to discuss treatment options with your doctor.

Who to see

Health
professionals who can give you advice and treatment on hair loss
include:

Hair transplant surgery is usually done by:

To prepare for your appointment, see the topic Making the Most of Your Appointment .

Exams and Tests

Hair loss is
diagnosed through a medical history and physical exam. Your doctor will
ask you questions about your hair loss, look at the pattern of your hair loss,
and examine your scalp. He or she may also tug gently on a few hairs or pull
some out.

The most common cause of hair loss-inherited hair
loss-is easily
recognized. Men tend to lose hair from the forehead area and top of the head
with normal amounts of hair on other areas of the scalp. Women tend to keep their front hairline, but have thinning of the hair on the top of the head.

Hair loss history

To determine the cause of your
hair loss, your doctor may ask you about:

  • Characteristics of your hair loss. Is your
    hair thinning, with your scalp becoming more visible, but your hair is not
    noticeably falling out? Or is your hair shedding, with lots of hair falling
    out?
  • How long your hair loss has been occurring. How long has it
    been since you had your normal amount of hair?
  • Your family history
    of hair loss. Does your mother or father, brother or sister, or any other
    relative have hair loss? If so, what caused their hair loss?
  • Your
    hairstyling habits. Has your hair become fragile from pulling it too tight or
    from other hairstyling habits? Have you had any chemical treatments to your
    hair, such as permanents (perms) or bleaching? Do you use a blow-dryer that may
    be too hot? Is a curling iron damaging your hair?
  • Any
    recent
    illness . Have you had any skin rashes, such as
    ringworm, recently?
  • Medicines you are
    taking. Are you taking blood thinners (anticoagulants)
    or medicines for
    arthritis,
    depression, or heart problems? Have you had any
    cancer treatment?
  • Your diet. Are you
    getting enough
    protein and
    iron in your diet?

Tests

If the reason for your hair loss is not
clear, your doctor may do tests to check for a disease that may be causing your
hair loss. Tests include:

  • Hair analysis . Your doctor will take a sample of your
    hair and examine it under a microscope. A scalp sample might also be
    taken.
  • Blood tests, including testing for a specific condition,
    such as an overactive or underactive thyroid gland (
    hyperthyroidism

    or

    hypothyroidism
    ).

Hair loss in women

Hair loss in women is more difficult to diagnose than
it is in men because the pattern of hair loss is not as noticeable as it is in
men.

Testing to
diagnose hair loss usually is not done in women with mild to moderate hair thinning who are otherwise healthy. But in women who have irregular
menstrual cycles, continued episodes of
acne, or too much body hair (hirsutism), testing for a
class of hormones called

androgens
, including
testosterone, is sometimes done.

Treatment Overview

How you treat hair loss depends on the cause. You may decide not to treat hair loss if it doesn’t bother you.

Some people choose to treat
hair loss with medicines or hair
transplant surgery. Others choose to wear hairpieces (wigs or toupees) or use
different methods of hair styling (dyeing or combing).

If a disease, medicine, or stress is the cause, then treating the
disease, changing medicines, or managing stress
may stop the hair loss.

Treatment for hair loss may help you feel better about how you look. But some medicines may have harmful side effects, and surgery
may carry certain risks.

Inherited hair loss

Treatment for inherited hair
loss aims to prevent
hair loss, promote hair growth, and cover bald areas of the scalp. But
treatment is not successful for everyone, and you should not expect to regrow a
full head of hair.

Medicines

Medicines include:

  • Minoxidil. Minoxidil (Rogaine) is
    available without a prescription and is sprayed on and/or rubbed into the scalp
    twice a day.
  • Finasteride. Finasteride (Propecia) is available by
    prescription and is taken once a day in pill form.

Hair Loss: Should I Take Medicine to Regrow Hair?

Surgery

Surgery includes hair transplants and procedures such as scalp reduction and scalp flaps.

Hairpieces and hair products

Cosmetic approaches to hair loss include:

  • Wearing hairpieces.
    Hairpieces are made from human or synthetic hair that is implanted into a nylon
    netting. Hairpieces may be attached to the scalp with glue, metal clips, or
    tape. Hair weaving, which involves sewing or braiding pieces of long hair into
    existing hair, is not recommended because it may cause permanent hair loss.
  • Using certain hair care products and styling
    techniques. Hair care products or perms may make hair appear thicker. Dyes may
    be used to color the scalp. But continual use of perms or dyes may result in
    more hair loss.

Other concerns with hair loss

Treating the
cause often stops hair loss, and hair grows back. In some cases, other treatment
is needed.

Hair care for cancer treatment

Hair loss caused by
cancer treatment
requires special care: Use mild
shampoos. Do not use a hair-dryer.

Alopecia areata

Alopecia areata
occurs when the

immune system
attacks hair follicles, where hair
growth begins. Because hair often grows back within a year, you may decide
not to have treatment. Understanding the come-and-go nature of hair loss with
this condition can help you make the best treatment decision. Children and
teens may need counseling to help them adjust to the hair loss.

Medicines, such as
corticosteroids
, can be used to treat alopecia areata.

Women taking birth control pills

Women with inherited hair loss who wish to take birth
control pills should use a pill type that does not add to hair loss, such as a
norgestimate or desogestrel.

footnote 2

Success of treatment

How successful your treatment
is depends on your expectations and the cause of hair loss. Treatment for hair
loss caused by an illness, medicine, or damage to the hair usually is more
successful than treatment for inherited hair loss.

Prevention

Hair loss that
is caused by
medicines , stress,
lack of protein or
iron , or
hair care may be prevented.

Avoiding certain
medicines, reducing stress, getting adequate protein and iron in your diet, and
using hairstyles that don’t damage your hair may reduce or prevent hair
loss.

Inherited hair loss (
androgenetic alopecia
) cannot be prevented.

Home Treatment

Home treatment for
hair loss includes hair care and hairstyling
techniques that may help you cover thinning or bald spots on the scalp. This
may be easier for women because inherited hair loss causes a general thinning that
is usually not as severe as it is in men.

Hair care products

In women with inherited hair loss,
hair care and the occasional use of grooming products, hair sprays, hair color,
teasing, permanents, or frequent washing won’t increase hair loss. But if
your hair loss is caused by hair care, then perms and dyes may contribute to
more hair loss.

You may want to try:

  • Scalp concealers or hair thickeners such as Couvre or Toppik. These products give the appearance of having fuller hair until the next time you wash your hair.
  • A hairpiece. Hairpieces are made from
    human or synthetic hair that is implanted into a nylon netting. Hairpieces may
    be attached to the scalp with glue, metal clips, or tape. But hair weaving, which involves
    sewing or braiding pieces of long hair into existing hair, is not recommended because it may cause permanent hair loss.
  • Hair
    care products and styling techniques. Hair care products or perms may make hair
    appear thicker. Dyes may be used to color the scalp.
  • Laser phototherapy combs. These combs use low levels of light to increase hair growth on the scalp. They are designed for use at home.

Skin cancer protection

For both men and women, hair thinning and baldness
increase the risk of sunburn and skin cancer on the scalp. When in the sun,
wear a hat or use a sunscreen with an SPF of 30 or more to prevent sun damage
to the scalp.

Medications

Medicines for
hair loss can slow thinning of hair and increase
coverage of the scalp by growing new hair and enlarging existing hairs. But
they need to be taken regularly. If you stop the medicine, hair loss returns. Do not expect to regrow a full head of hair. Hair coverage
is improved on the top of the head, but not on the forehead area.

Hair Loss: Should I Take Medicine to Regrow Hair?

Medicine choices

Medicines often used to treat inherited hair loss include:

  • Minoxidil (Rogaine), which is
    available without a prescription. It is sprayed on and/or rubbed into the scalp
    twice a day.
  • Finasteride (Propecia), which is a prescription medicine. It is taken once a day in pill form.

Medicines used to treat
alopecia areata , which is caused when the immune
system attacks

hair follicles
, include:

footnote 3

  • Corticosteroids injected into the scalp. The corticosteroid is
    injected many times about
    1 cm (0.4 in.) apart every 4 to
    6 weeks. This is the most common treatment in adults and is best used for
    treating patchy hair loss.

  • Corticosteroid
    ointments or creams you put on the
    scalp. Corticosteroids may be used along with
    injected steroids or with other medicines such as minoxidil
    (Rogaine).
  • Corticosteroids you take by mouth (oral). Although this
    does result in hair growth, it is rarely used because of the side effects of
    oral corticosteroids.
  • Contact immunotherapy , which triggers an allergic reaction on the scalp that may help hair to grow.

Surgery

Surgery to cover bald areas of the scalp may
be used to treat
hair loss. If successful, surgery may be a permanent
treatment for hair loss.

Surgery choices

The most common types of surgery to treat hair loss
include:

  • Hair transplant surgery . During this surgery, your doctor will move small grafts (pieces
    of skin with hair follicles) from areas of your scalp with full hair to areas
    of your scalp that are bald or thinning. The grafts may include single hairs or
    up to 30 hairs in one graft. This is the most common type of surgery used to
    treat hair loss.
  • Scalp reduction. Scalp reduction involves removing
    large areas of bald scalp from the head. Sections of the scalp with growing
    hair are then stretched and sewn together to fill in the bald
    areas.
  • Scalp flaps. Scalp flaps involve moving a large section of
    scalp containing hair from the side and back of the head to a bald area. One
    side of the flap remains attached to the scalp as the section of scalp with
    hair is moved to cover a bald area. The complication rate of this procedure is
    higher than other procedures because of bleeding, scarring, and infection after
    surgery.

What to think about

Surgery may be a more permanent
solution than medicines to treat hair loss, but it is expensive, it involves
surgical risks, and there is a chance that not all hair follicles will remain
healthy.

Other Treatment

Other treatment for
hair loss includes counseling, if hair loss is caused by compulsive pulling of your hair (
trichotillomania
).

Other Places To Get Help

Organizations

American Academy of Dermatology

www.aad.org

National Alopecia Areata Foundation

www.naaf.org

References

Citations

  1. Nguyen J, Cotsarelis G (2013). Disorders of hair. In EG Nabel et al., eds., Scientific American Medicine, chap. 58. Hamilton, ON: BC Decker. https://www.deckerip.com/decker/scientific-american-medicine/chapter/58/pdf. Accessed November 21, 2016.
  2. Habif TP, et al. (2011). Hair and nail diseases. In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 562-589. Edinburgh: Saunders.
  3. Hague J, Berth-Jones J (2010). Alopecia areata. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 31-35. Edinburgh: Saunders Elsevier.

Other Works Consulted

  • Kestenbaum TM (2010). Diseases affecting the hair. In JC Hall, ed., Sauer’s Manual of Skin Diseases, 10th ed., pp. 337-347. Philadelphia: Lippincott Williams and Wilkins.
  • Wolff K, Johnson RA (2009). Disorders of hair follicles and related disorders. In Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 962-986. New York: McGraw-Hill.

Credits

ByHealthwise Staff

Primary Medical Reviewer
Adam Husney, MD – Family Medicine


Martin J. Gabica, MD – Family Medicine


Kathleen Romito, MD – Family Medicine


Specialist Medical Reviewer
Ellen K. Roh, MD – Dermatology

Current as ofOctober 5, 2017

Source

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