Hair Loss

What is baldness?

Baldness is loss or lack of hair, usually from the top of the head. It may also occur on other parts of the body where hair normally grows. Baldness is usually part of the aging process. Some diseases and drugs may also cause baldness.

Hair loss may be either temporary or permanent, depending on the cause.

How does it occur?

There are several types of baldness: male and female pattern, local, and general.

Male-pattern baldness runs in families. This hereditary baldness usually happens above the forehead, causing a receding hairline. It also happens at the crown of the head. Over time, the bald spots increase in size until the entire top of the head is bald and there is hair only on the sides of the head.

Sometimes female-pattern baldness occurs in women. Usually it causes the hair to thin in the front, on the crown, or on the sides.

Local hair loss is usually patchy and confined to certain areas. It may result from:

• alopecia areata, a condition in which hair is lost suddenly from a particular area, usually a small area of the scalp (the cause is unknown)
• ringworm, a fungus infection
• radiation therapy for cancer
• a hot comb or hair dryer
• hairstyles that pull on the hair, such as tight pigtails or cornrows
• nervous, repeated hair pulling
• permanent skin damage from burns or serious skin diseases.

General hair loss occurs when all of your hairs enter a resting phase at the same time and then fall out. This may be caused by:

• stressful situations or conditions, such as major surgery, high fever, or severe or chronic illness
• pregnancy.

Other causes of general hair loss are:

• drug treatment for cancer
• some prescription drugs and high doses of vitamin A
• thyroid disease.

Alopecia universalis is a rare and severe form of baldness that results in permanent loss of all body hair, including eyebrows, eyelashes, and hair in the pubic area and armpits. The cause is unknown.

How is it diagnosed?

Your healthcare provider will ask about your recent medical history and any history or patterns of hair loss in your family. Your provider will examine your scalp and skin. You may have blood tests or a skin scraping to check for fungus.

How is it treated?

Some baldness can be treated with medicine.

Your healthcare provider may recommend medicine to slow your hair loss and stimulate hair growth. Minoxidil (Rogaine) is a medicine you can put on bald spots daily. Finasteride (Propecia) is a tablet men can take daily. Although other medicines are being studied, these 2 medicines are the only FDA-approved medicines for treating hereditary baldness. They can improve hair growth or preserve hair in most people.

After several months of using minoxidil daily, you may have some hair regrowth, although the hair may not look exactly like the original hair. This treatment must be continued daily for the hair to remain.

After taking finasteride daily for at least 3 months, men may see some hair regrowth. Finasteride stops hair loss in over 80 percent of men, and starts new hair growth in about 50 percent. It may take up to a year to see results. The medicine must be taken daily for continued effect. If you stop the medicine, the effects will be entirely gone by 1 year. This medicine may cause some breast tenderness in a few men.

Only men should take finasteride. Pregnant women should not even touch the tablets because the medicine can be absorbed through the skin. The medicine can cause birth defects (abnormal growth of the genitals) in baby boys before they are born.

If an illness is causing you to lose hair, your healthcare provider may prescribe medicine to treat the illness. For example, your provider may prescribe an antifungal medicine if a fungus, such as ringworm, is the cause of your hair loss. Hair generally grows back in the affected areas.

If you have alopecia areata, the hair usually grows back naturally in 6 to 12 months. Your healthcare provider may try to speed up regrowth by injecting your scalp with steroids or by having you put minoxidil solution directly on the bald area. This problem can recur.

Hair transplant surgery involves moving sections of skin with hair from one part of the scalp to another. The results may last a few years or be permanent.

How long will the effects last?

Male-pattern baldness will continue for the rest of your life. Baldness that is the result of skin damage from a disease or burn is also likely to be permanent. Other types of baldness may be temporary and last only a few weeks or months.

How can I take care of myself?

If you have noticeable hair loss or a change in the condition of the skin of your scalp or other areas where hair normally grows, consult your healthcare provider. In the meantime, eat balanced meals, get plenty of rest, and try to reduce stress. This can help you recover faster if an underlying illness is the cause of baldness.

Avoid irritating the area affected by baldness. For example, don't use barrettes, elastic hair bands, blow dryers, hot combs, or hair dyes or other chemicals.

Avoid using nonprescription hair-growth products other than minoxidil. These products are generally not effective and may in fact harm the skin and hair.

What can be done to help prevent baldness?

There is nothing you can do to prevent most types of baldness.