Hair loss

Hair loss can ‘just happen’ or it may be linked to some medical conditions and medicines. It can be patchy or widespread, and may range in effect from mild to severe.

Permanent hair loss is the result of genetic and hormonal factors. Hereditary baldness is the most common form. In fact, it is so common that many people think it is a normal part of the ageing process.

The majority of men and women will be affected by hair loss at some stage in their life. For most people, hair loss is mild and occurs later in life. However, when hair loss is premature or severe, it can be a source of distress. A range of treatments is available to slow or reduce hair loss, replace damaged hair and stimulate partial regrowth.

About hair

The human body is completely covered with hair follicles, except on the palms of the hands, soles of the feet, genitals 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 protrude from the pore.
Hair is made mainly of a protein called keratin. The only living part of the hair is the root (sometimes known as the bulb), which is anchored 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 to lose some hair each day. Hair grows in phases, with around one in ten head hairs ‘resting’ at any given time. The colour, curl, length, thickness and amount of hair depend on genetic factors.

Causes of hair loss

There are many different causes of hair loss. Some cause temporary loss (known as telogen effluvium), while others may have long-term effects. Only those that damage the follicles or the root (the living part of the hair) cause permanent loss. Breaking or damaging the hair shaft has no affect at all on the health of the hair root.

Some causes of hair loss include:

• Heredity – the effects of testosterone, the male sex hormone
• Hormonal changes – such as thyroid disease, childbirth or use of the birth control pill
• Alopecia areata – an autoimmune disorder
• Medications – such as cancer chemotherapy or corticosteroids
• Nervous habits – such as continual hair pulling or scalp rubbing
• Rough handling – brushing too vigorously, tight rolling of hair curlers, overbleaching or the use of harsh dyes and chemicals
• Burns or injuries
• Tinea capitis (ringworm of the scalp)
• Long-term illness, major surgery and high fever – may cause temporary hair loss.

Genetic factors more important than other factors

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 in causing hair loss than environmental factors.

Stress, vitamin and mineral deficiencies, and low protein diets are exaggerated as causes of hair loss. Other suggested causes that seem to have little direct effect on permanent hair loss include scalp disorders, drug use (for example, cigarettes and alcohol), wearing hats, frequent washing or shampoos, and perming, colouring or use of hair products.

Alopecia areata

Alopecia areata is a disorder characterised by inflammation of the hair root, which shrivels and ultimately stops producing hair. Alopecia areata is an autoimmune disease, which means the immune system mistakenly attacks cells of the body – in this case, the hair root.

Typically, a small patch of hair – ranging from around one to five centimetres in diameter – drops out, leaving only a few stubbly hairs. In some cases, the hair starts to grow back within a few weeks or months, but other people are left with persistent bald spots. The scalp is most commonly affected, although facial and body hair can also be lost.

Mild cases generally respond well to cortisone creams or injections, while oral tablets may be required for more severe forms. However, for a small proportion of people with alopecia areata, it is difficult to get the hair to regrow and cosmetic options such as wigs may need to be considered.

Male pattern baldness (androgenic alopecia)

The most common cause of hair loss in men is androgenic alopecia, or male pattern baldness. In men who have inherited the condition, testosterone (the male sex hormone) actively targets the hair follicles. Over time, the hair follicles are damaged and the hair shaft is reduced until it is short, fine and downy. Women generally don’t suffer from androgenic alopecia because their levels of testosterone are too low to exert a damaging influence.

While there are a number of treatments available for male pattern baldness, there is no cure. Treatments include minoxidil lotion and finasteride medication, which are available on prescription. Cosmetic options include wigs and hair transplant surgery.

Patterned hair loss in women (androgenetic alopecia)

Hair loss in women tends to produce thinning over the top of the scalp rather than a patch of baldness. Minor degrees of patterned hair loss occur in over 55 per cent of women as they age, but only about 20 per cent of women develop moderate or severe hair loss.

Female pattern baldness is caused by genetic predisposition, ageing and increased levels of endocrine hormones (particularly androgens, the male sex hormones). Thyroid disease is a rare cause of patterned hair loss in women.

A number of treatments are available for female pattern hair loss including topical minoxidil lotion (not recommended for pregnant and breastfeeding women) and antiandrogen medication. These are available on prescription and require medical supervision.

Hair loss can occur in women for reasons other than female pattern baldness. These may include temporary shedding of hair (telogen effluvium), breaking of hair (from such things as styling treatments and twisting or pulling of hair), the autoimmune disorder alopecia areata, hormonal imbalances, the contraceptive pill or the effects of corticosteroids.

Scalp or hair trauma

Hair loss may be caused by injury to the scalp or to the hair itself. Options include:

• Traction alopecia – tight ponytails, plaits or buns can all result in patches of hair loss, usually around the scalp margins.
• Trichotillomania – sometimes, people chew or pull on hair when they are nervous. This is a stress response similar to nail biting.
• Hair weathering – hair shafts can be broken by rough handling. Brushing too vigorously, tight rolling of hair curlers, overbleaching and the use of harsh dyes and chemicals can dry out the hair and make it brittle enough to split or break. The hair root is generally unharmed and normal hair growth will resume with gentle handling and care.

Ringworm

Ringworm is a fungal infection of the skin, caused by the fungus Microsporum or Trichophyton. Usually, ringworm of the scalp starts as a small circle of red, itchy and scaly skin. As this ring grows, the hairs within its circumference snap off close to the scalp. Treatment options include antifungal antibiotics.

Chemotherapy

Chemotherapy refers to a course of cancer-killing drugs that are taken by cancer patients. One of the most common side effects of chemotherapy is hair loss. Once the chemotherapy is completed, the hair usually grows back.

Where to get help

• Your doctor
• Australasian College of Dermatologists Tel. 1300 361 821

Things to remember

• The majority of men and women will be affected by hair loss at some stage in their life.
• There are many causes of hair loss, ranging from rough handling to hereditary factors.
• Permanent hair loss is the result of genetic and hormonal factors. Hair loss is only permanent if the living part of the hair, the root, is damaged.
• A range of treatments is available to slow or reduce hair loss, replace damaged hair and stimulate partial regrowth.

You might also be interested in:

• Hair.
  
• Hair loss treatments.
  
• Hair transplant surgery.
  

Want to know more?

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This page has been produced in consultation with and approved by:

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Australian College of Dermatologists

Fact sheet currently being reviewed.
Last reviewed: April 2010

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.

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<a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Hair_loss?open">Hair loss - Better Health Channel</a><br/>
Hair loss, including partial or full baldness, affects most men and women at some stage in their life. There are many causes of hair loss, ranging from rough handling to hereditary factors. Permanent hair loss is the result of genetic and hormonal factors, and occurs when the living part of the hair – the root – or the follicle are damaged. Alopecia areata is an autoimmune disorder. Chemotherapy may cause temporary hair loss.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

For the latest updates and more information, visit www.betterhealth.vic.gov.au

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