Hair loss

Hair Loss (Alopecia)

Hair loss, also known as alopecia, refers to partial or complete loss of hair from the scalp or other parts of the body. It can be temporary or permanent, depending on the underlying cause. While shedding 50–100 hairs daily is normal, excessive or patchy loss often indicates a medical, genetic, or lifestyle-related condition.

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Types of Hair Loss

• Androgenetic alopecia (male/female pattern baldness):

  • Most common type, caused by genetic and hormonal factors.

  • Men: receding hairline, thinning at crown.

  • Women: diffuse thinning, usually sparing the frontal hairline.

• Alopecia areata:

  • Autoimmune condition causing patchy, round bald spots.

  • Can progress to total scalp hair loss (alopecia totalis) or body hair loss (alopecia universalis).

• Telogen effluvium:

  • Temporary shedding triggered by stress, illness, childbirth, surgery, nutritional deficiencies, or medications.

• Traction alopecia:

  • Caused by hairstyles that pull on the hair (tight braids, ponytails, extensions).

• Scarring alopecia:

  • Permanent hair loss due to damage of follicles from lupus, lichen planopilaris, or infections.

• Other causes:

  • Fungal scalp infections (tinea capitis).

  • Endocrine disorders (thyroid disease, polycystic ovary syndrome).

  • Nutritional deficiencies (iron, zinc, vitamin D, biotin).

  • Chemotherapy or radiotherapy.

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Symptoms

• Gradual thinning on scalp (most common).

• Patchy bald spots.

• Sudden loosening of hair (handfuls of hair shed).

• Full-body hair loss (chemotherapy).

• Scaling or redness with itching (in fungal infections).

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Diagnosis

• Medical history: recent stress, illness, medications, family history.

• Physical exam: pattern of hair loss, scalp condition.

• Pull test / tug test: to check shedding severity.

• Blood tests: thyroid function, ferritin (iron), vitamin D, hormones.

• Scalp biopsy: if scarring or autoimmune cause suspected.

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Treatment

Treatment depends on the cause and type of hair loss.

1. Medications:

• Minoxidil (topical):

  • Over-the-counter solution or foam.

  • Applied twice daily to scalp.

  • Stimulates follicles, prolongs growth phase.

• Finasteride (oral, men only):

  • 1 mg daily.

  • Blocks conversion of testosterone to dihydrotestosterone (DHT).

  • Not recommended for women of childbearing age (teratogenic).

• Spironolactone (oral, women):

  • 50–200 mg daily.

  • Anti-androgenic effect, used in female pattern hair loss.

• Corticosteroids (topical, oral, injections):

  • Used in alopecia areata.

• Other systemic agents for autoimmune alopecia:

  • Methotrexate, cyclosporine, JAK inhibitors (in severe cases).

2. Non-pharmacological approaches:

• Platelet-rich plasma (PRP) therapy.

• Low-level laser therapy (LLLT).

• Microneedling with growth factors.

3. Surgical options:

• Hair transplant (follicular unit transplantation or extraction).

• Scalp reduction or flap surgery (less common now).

4. Lifestyle and supportive care:

• Balanced diet rich in protein, iron, zinc, omega-3.

• Gentle hair care (avoid harsh chemicals, heat, and tight hairstyles).

• Stress management (yoga, meditation, therapy).

• Wigs, hairpieces, or cosmetic camouflage if permanent loss.

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Precautions

• Avoid self-medicating with steroids or unregulated supplements.

• Minoxidil should be continued long-term; stopping leads to renewed loss.

• Finasteride requires monitoring for sexual side effects and prostate health.

• Address underlying conditions (thyroid, anemia, PCOS) before cosmetic treatment.

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When to See a Doctor

• Sudden or patchy hair loss.

• Hair loss accompanied by redness, scaling, or pain.

• Loss following new medications or medical treatments.

• In women with signs of hormonal imbalance (acne, irregular periods, hirsutism).

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Drug Interactions

• Minoxidil (topical): few systemic interactions, but avoid combining with topical irritants.

• Finasteride: interacts with drugs affecting hormonal pathways; contraindicated in women of childbearing age.

• Spironolactone: interacts with potassium-sparing diuretics, ACE inhibitors, and ARBs → risk of hyperkalemia.

• Systemic immunosuppressants (methotrexate, cyclosporine): interact with hepatotoxic and nephrotoxic drugs.