Everyone sheds about 100 hairs each day as part of the normal hair growth cycle, but excess loss is usually a distressing development. (iStock)
Hair loss is typically considered the domain of aging men, but this equal-opportunity condition – which has many causes – can affect virtually anyone.
Alopecia is the medical term for hair loss, and it doesn’t only happen on the scalp. Some illnesses and medications can trigger balding over the entire body, though genetics account for most cases on the head, according to the Cleveland Clinic.
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Everyone sheds about 100 hairs each day as part of the normal hair growth cycle, but excess loss is usually a distressing development. Americans spend more than $3.5 billion each year trying to treat it, according to the American Hair Loss Association.
Symptoms & causes
Most people’s hair grows about a half-inch per month, and about 90 percent of your hair is actively growing at any given time, with the other 10 percent in dormant phase. After two or three months, this dormant hair falls out and its follicles begin growing new hair as other follicles begin a dormant phase.
Shedding hair is different from hair loss, when a hair falls out and doesn't grow back. People often shed hair during stressful events, such as childbirth, a breakup or divorce or during times of grief.
"It still doesn’t feel good, and it takes the hair [awhile] to reach a certain length where you perceive its presence," said Doris Day, a board-certified dermatologist New York City and an attending physician at Lenox Hill Hospital, also in New York. "So it feels like a hair loss, but it's not a hair loss."
Aside from heredity, noticeable hair loss can be caused by wide variety of factors, including:
Harsh hairstyles or treatments: Hairstyles that consistently use rubber bands, rollers or barrettes, or pull hair into tight styles such as cornrows, can inflame and scar hair follicles. So can incorrectly used chemical products such as dyes, bleaches, straighteners or permanent wave solutions. Depending on the degree of damage, resulting hair loss can be permanent.
Hormone imbalances: In women, hormonal shifts from birth control pills, pregnancy, childbirth, menopause or hysterectomy can induce more hair follicles than normal to enter the dormant phase.
Illness or surgery: The stress from sickness or surgery may prompt the body to temporarily cease nonessential tasks such as hair production. Specific conditions can also trigger it, including thyroid disorders, syphilis, iron deficiency, lupus or severe infection. An autoimmune condition called alopecia areata, which has no cure, causes rapid body-wide hair loss.
Medications and vitamins: Cancer chemotherapy, which attacks hair follicles in its attempt to kill all fast-growing cells around the body, is a well-known reason for hair loss. Other medications’ side effects include hair shedding as well, such as some that treat high blood pressure and gout (a painful joint condition caused by a buildup of uric acid). Excessive levels of vitamin A also contribute.
Nutritional deficits: Heavy dieting or eating disorders such as bulimia and anorexia can temporarily stun hair follicles to cease growth. This can also occur from insufficient protein, vitamin or mineral intake.
Aging: A natural effect of growing older is slowed hair growth.
Women usually don't go completely bald, but lose hair on the top of the head or the temples. Men tend to lose hair on their temples, and are more likely than women to go completely bald, Day said.
Diagnosis
Dermatologists will examine the person's scalp and take a history of medical or stressful events "to see what's been going on in their life and their world," Day said.
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The dermatologist may take a biopsy — a small patch of skin that includes the hair follicle — and send it to a pathologist to determine if an autoimmune disease, such as lupus, is the cause of the hair loss.
Examining the hair and follicle can also determine whether someone has a bacterial or fungal infection, Day said.
Treatment & medication
Hair loss remedies range from the mild to the extreme and the inexpensive to the costly. Much depends on how much hair is gone and how high a priority it is to mask its absence or replace it.
According to the Cleveland Clinic, treatments include:
Hair weaves or wigs: Typically expensive, wigs and hair weaves either completely cover the head or add to existing hair, restoring the appearance of a full head of hair. They are especially practical for cancer patients and those whose hair loss is temporary.
Topical creams and lotions: Over-the-counter minoxidil (also known as the brand name Rogaine) can restore some hair growth, especially in those with hereditary hair loss. It is applied directly to the scalp. Prescription-strength finasteride (Propecia) comes in pill form and is only for men. According to the American Academy of Family Physicians (AFP), it may take up to six months to tell if these medications are working.
Anti-inflammatory medications: Prescription steroid-based creams or injections can calm follicles damaged or inflamed by harsh chemicals or excessive pulling.
Surgery: Men tend to be better candidates for surgical hair-replacement techniques because their hair loss is often limited to one or two areas of the scalp. Procedures include grafting, which transplants from one to 15 hairs per disc-shaped graft to other locations. Scalp reduction removes bald skin from the scalp so hair-covered scalp can be stretched to fill in the bald areas. Side effects include swelling, bruising and headaches.
Hair-growth laser treatment can also help stimulate hair follicles and improve growth, Day said. People often see results when they combine laser treatment with another intervention, she said. Treatments range in price from $30 and up for Rogaine to about $3,000 for laser treatment, she added.
Natural and alternative therapies
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMSD), alternative therapies may not help hair regrow and many are not supported by medical research. However, other treatments that reportedly improve alopecia areata include Chinese herbs, acupuncture, zinc and vitamin supplements, evening primrose oil and aroma therapy.
Viviscal, a natural supplement, has also shown more hair growth in men compared to those who took fish extract in clinical trials, Day said.
The NIAMSD recommends discussing any alternative treatments with physicians before use.
Latest treatment developments
The drug Tofacitinib is approved to treat adults with arthritis, but a growing number of cases suggest that it can also treat alopecia universalis, a condition in which people lose all of the hair on their body because their immune system attacks hair follicles, Live Science previously reported.
The finding occurred after doctors prescribed a 25-year-old man with alopecia universalis the drug because they had heard it had treated a similar condition in mice, according to a statement from Yale University. After three months of treatment, the man had completely regrown the hair on his scalp, and he had visible eyebrows, eyelashes, facial hair, as well as hair elsewhere on his body.
"It's exciting," said Day, who did not treat this particular patient. "There seems to be a real effect here."
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It's unclear how Tofacitinib (brand name Xeljanz) works, but researchers hope to determine its mechanism soon. This data may help them learn which biological pathways lead to hair loss.
There are now clinical trials taking place around the country to test the safety and efficacy of the drug for hair loss conditions. One such study lasting 3 months gave Tofacitinib to 66 people with alopecia areata (an immune system condition that causes hair to fall out in patches). Half of the people regrew some hair, and one-third had more than 50 percent of the hair on their scalp grow back, according to the 2016 study, published in the journal JCI Insight.
However, researchers are still working to determine the best dose needed, whether the results are lasting, and whether they can develop a topical form of the drug, Day said. She added that patients should be aware that Tofacitinib has side effects. It's already associated with an increased risk of serious infections, as well as stomach and intestinal tears, according to Pfizer, the manufacturer.
Besides investigating Tofacitinib, researchers are also looking at ways to clone hair or use stem cell therapy to treat alopecia, Day said.
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