Hair loss (alopecia) affects most men and women at some stage in their lives. Causes of hair loss include acute illness, chemotherapy, infections, burns, rough handling of the hair, autoimmune disease and inflammation of the scalp. Hereditary hair loss is the result of genetic and hormonal factors, and occurs when cells that normally control hair regeneration are lost. There are treatments for some types of hair loss.
Hair loss (also known as alopecia) can ‘just happen’ or it may be linked to some medical conditions or use of medicines. It can be patchy or widespread, and may range from mild to severe.
Male pattern baldness (androgenic alopecia) is the most common cause of hair loss in men and is the result of genetic and hormonal factors. Hereditary baldness is so common that many people think it is a normal part of the ageing process.
Many men and women will be affected by hair loss at some stage in their lives. For most people, hair loss is mild and occurs later in life. However, when hair loss is premature or severe, it can cause distress. A range of treatments is available to slow or reduce hair loss, and stimulate partial regrowth.
How hair grows
The human body is completely covered with hair follicles, except on the palms of the hands, soles of the feet and lips. Hair follicles are pouch-like tubes of skin cells that contain the hair root. Most follicles are tiny, and many of the hairs they produce do not grow long enough to stick out from the pore.
Hair is made from a protein called keratin. The only living part of the hair is the root (sometimes known as the bulb), which is attached to the base of the follicle. The follicle supplies oxygen and nutrients to the root, and lubricates the hair shaft with an oily substance called sebum.
Hair is in a constant cycle of growth, rest and renewal – it is natural for everybody to lose some hair each day. Hair grows in phases. The colour, curl, length, thickness and amount of hair depend on genetic factors.
Causes of hair loss
There are many possible causes of hair loss. Some result in temporary hair loss (known as telogen effluvium), while others may have longer-term effects. Breaking or damaging the hair shaft has no effect at all on the health of the hair root.
It is likely that several genes determine your susceptibility to baldness. Some of these genes come from your mother’s side and some from your father’s side of the family. Identical twins lose hair at the same age, at the same rate and in the same pattern. This indicates that genetic factors are more important than environmental factors in causing hair loss.
Androgenetic hair loss is caused by androgen hormones (produced in different amounts by both men and women) and occurs in people with a genetic susceptibility.
Some causes of hair loss include:
- Severe illness, major surgery or high fever, which may lead to a period of excess hair shedding
- Hormonal changes caused by thyroid disease, childbirth or the birth-control pill
- Alopecia areata, an autoimmune disorder
- Medications such as those used in cancer chemotherapy or oral retinoids (strong medication used to treat skin conditions)
- Nervous habits such as continual hair pulling or scalp rubbing
- Rough handling – brushing too vigorously, tight rolling of hair curlers
- Over-bleaching, or use of harsh dyes and chemicals
- Burns or injuries
- Tinea capitis (ringworm of the scalp)
- Certain skin diseases such as lichen planus or lupus
- Long-term illness, major surgery and high fever may cause temporary hair loss.
Some people think that stress, diet, wearing hats, frequent washing, smoking cigarettes and drinking alcohol are causes of hair loss, but these are usually not the cause.
Male pattern baldness (androgenic alopecia)
While there are a number of treatments available for male pattern baldness, there is no cure. Treatments include minoxidil lotion and finasteride tablets, which are available on prescription. Cosmetic options include camouflage sprays, wigs and hair transplant surgery.
Hair loss in women (androgenetic alopecia)
Hair loss in women produces scattered thinning over the top of the scalp rather than a bald spot. Minor patterned hair loss occurs in over 55 per cent of women as they age, but only about 20 per cent of women develop moderate or severe hair loss.
A number of treatments are available for female pattern hair loss, including topical minoxidil lotion (not recommended for pregnant or breastfeeding women) and tablets such as spironolactone, which have antiandrogen properties (they lower the levels of male hormones). These are available on prescription and require a doctor’s supervision.
Hair loss treatments
Although there is no cure for hair loss, a number of treatments can slow or reduce hair loss, stimulate partial regrowth or replace damaged hair. Surgical hair transplantation can help some men who have advanced balding.
Despite advances in our understanding of hair loss, there are limits to current treatment. In particular, age-related hair loss and inherited forms of hair loss are difficult to reverse, although treatment may prevent further loss. There are also limits to controlling alopecia areata. In many conditions, hair loss or thinning will stabilise and may not progress to baldness.
Non-surgical treatments include lotions and tablets. These generally need to be used continuously to maintain regrowth. If you stop the treatment, regrowth will cease and your hair loss will start again.
Cosmetic options include wigs and hairpieces.
A number of other treatments have been suggested for hair loss including massage, vitamin supplements, herbal remedies (such as saw palmetto), zinc, amino acids, hair lotions and tonics. None of these has been shown to promote hair growth or prevent hair loss. There is also no scientific evidence that the use of lasers is effective.
If unsure, consult with your doctor before starting treatment.
Minoxidil lotion has been available in Australia since the 1970s. A number of different brands are available from pharmacies without a prescription. Drops are applied to the scalp morning and night and rubbed in. There is also a new foam preparation that appears to be easier to use and just as effective. Hair regrowth generally takes six months to appear. People considering using Minoxidil should tell their pharmacist if they are taking any other medicines, especially high-blood-pressure medication.
Pregnant or breastfeeding women should not use Minoxidil.
Finasteride is the active ingredient in the men’s hair-loss treatment Propecia, which has been available in Australia since the late 1990s. One tablet a day will stop further hair loss in over 90 per cent of men and stimulate partial hair regrowth in over two-thirds of men. Regrowth may be visible at six months, but can take up to two years to be visible. Side effects are uncommon, although Propecia does require a prescription from your doctor.
Women should not use Finasteride.
This medication has been widely used in Australia since the 1960s to treat high blood pressure and fluid retention. It blocks the effect of androgen hormones. In women, androgens can cause oily skin, acne, unwanted facial and body hair, and hair loss on the scalp. Women can use Spironolactone to treat all of these conditions, but you need a prescription from your doctor.
Men, and pregnant or breastfeeding women, should not use Spironolactone.
This medication was also developed in the 1960s. It blocks the effect of androgen hormones. It is also a weak progestogen and is in some oral contraceptives (the pill). Cyproterone acetate can also be used to treat acne, unwanted facial and body hair, and hereditary hair loss in women. Cyproterone acetate requires a prescription from your doctor.
Cyproterone acetate is not recommended as a treatment for hair loss in men.
Hair transplantation surgery
Hair transplantation is a surgical procedure for the treatment of hair loss that first became popular in the 1950s. Originally, large plugs of hair were used, which sometimes led to unsatisfactory and unnatural-looking results.
These days, very small mini- and micro-plugs of skin, each containing between one and five hairs, are used. Unlike the original large plugs, this modern technique does not produce very thick or dense hair growth. It appears more natural and, in many cases, is undetectable as a transplant.
Types of hair loss that respond best to hair transplantation include:
- Androgenetic hair loss in men – this is the most common type of baldness that can be helped by hair transplantation
- Hair loss due to accidents and operations.
The surgeon removes hair plugs from the back or sides of the scalp (where the hair is less likely to fall out) and transfers them to the bald areas. The surgeon places the plugs in such a way that they receive adequate blood flow during the healing process. The transplant session may take several hours.
One to three months later, the surgeon may add more grafts. A person needs several treatments to give a progressive increase in the amount of hair. Hair will regrow in the area from which the hair plug was taken for transplantation.
A sedative is usually given prior to the procedure. Local anaesthetic is used at the hair removal (donor) and recipient sites. As the anaesthetic wears off, you may notice some discomfort. This can be eased with simple pain-relieving medications.
Complications of hair transplantation surgery
Complications of hair transplant surgery can include:
- Infection – this can occur because the skin is broken to perform the procedure. It can be treated with antibiotics
- Bleeding – this is usually controlled through careful post-operative care
- Scarring – approximately 11 per cent of people have a tendency to scar
- Temporary, operation-induced hair loss – known as telogen effluvium, can occur with hair transplantation as well as some other operations. It occurs in approximately five per cent of people
- Unacceptable cosmetic results – scarring and poor cosmetic results are more common when hair transplants are carried out by inexperienced practitioners.
Many hair clinics offer hair transplantation. However, specialist dermatologists are best qualified to properly advise about this surgery, as they generally have the most knowledge about hair in health and disease.
Where to get help
- Your doctor
- Australasian College of Dermatologists Tel. 1300 361 821
- Plastic surgeon
Things to remember
- Most men and women will be affected by hair loss at some stage in their lives.
- There are many causes of hair loss, ranging from rough handling to hereditary factors.
- Different treatments are available to slow or reduce hair loss and stimulate partial regrowth.
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Australian College of Dermatologists
Last reviewed: January 2013
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