Hair Loss: Causes and Treatment

Hair Loss: What Causes It and How to Evaluate It?

Hair loss is not a single disease. It can occur for many different reasons, ranging from genetic predisposition and past illnesses to hormonal changes and immune system disorders. Therefore, the most important step in treating hair loss is not to start treatment immediately, but to determine which type of hair loss is present.

Some hair loss is temporary and the hair can regrow. Others are progressive. Early diagnosis is particularly important in some diseases that can cause permanent damage to hair follicles.

Briefly, what you need to know

Not all hair loss is caused by a vitamin deficiency.

Genetic hair loss is quite common in both men and women.

Stress, febrile illnesses, rapid weight loss, childbirth, and certain medications can cause temporary generalized hair loss.

Localized hair loss, redness, scaling, pain, or burning of the scalp can suggest various diseases.

Giving every patient the same blood tests or prescribing the same "hair vitamin" is not the right approach.

Dermatological examination and, if necessary, trichoscopy can provide important information in diagnosis.

What causes hair loss?

Hair has a natural growth cycle. Hair strands grow for a certain period, go through a transition phase, rest, and eventually fall out. Therefore, losing a certain amount of hair daily is physiological.

The problem arises when the normal cycle changes, the hair follicle gradually shrinks, the immune system targets the hair follicle, or the follicle is damaged by various diseases.

The pattern of hair loss is an important clue in understanding the cause of hair loss.

If hair is generally falling out and thinning

One common cause of generalized hair loss is telogen effluvium.

Hair loss can sometimes be caused by:;

febrile illness,

operation,

birth,

rapid weight loss or intense dieting,

significant physical stress,

some medications,

some nutritional deficiencies or systemic diseases

It may appear later.

Hair loss often doesn't start on the same day as the triggering event; it may be noticeable after some time has passed due to the hair cycle.

Telogen effluvium is temporary in most cases. However, in cases of prolonged, widespread hair loss, simply attributing it to "stress" is incorrect; differentiation from androgenetic alopecia and other causes may be necessary.

If hair is thinning, especially in the front and crown areas

One of the most common causes is androgenetic alopecia.

Although commonly known as male pattern baldness or genetic hair loss, it can occur in both men and women.

While men often experience receding hairline at the temples and thinning at the crown, women may be more prone to a wider middle parting and decreased density at the crown.

Hair follicles don't disappear all at once during this process. Under genetic and hormonal influences, some follicles miniaturize over time and begin to produce finer, shorter hair strands.

Therefore, early assessment is important.

If hair is falling out completely or significantly in certain areas

Sudden hair loss that appears in round or oval patches can be significantly caused by alopecia areata (hair loss).

Alopecia areata is an immune system-related disease. It can affect not only the scalp but also the beard, eyebrows, eyelashes, or other body hair.

In some patients, it may occur in small and limited areas, while in others it may be more widespread.

Ringworm is not contagious.

If there is redness, scaling, pain, or burning on the scalp

These findings may suggest the presence of a scalp disease in addition to hair loss.

In some types of cicatricial (scarring) alopecia, hair follicles can be permanently damaged.

Because;

redness,

noticeable crusting,

pustules,

pain,

combustion,

sensibility

Dermatological evaluation of hair loss occurring in conjunction with this condition should not be delayed.

Are male pattern and female pattern hair loss the same?

Although both are classified within the androgenetic alopecia group, their appearance and treatment approach are not entirely the same.

In men, receding hairline and thinning at the crown may be more characteristic.

In women, while the front hairline is largely preserved, a widening of the middle parting and a decrease in hair density may be observed.

In women, hormonal or systemic causes may also need to be investigated in some clinical situations.

How is hair loss diagnosed?

The diagnosis is based on the patient's history and dermatological examination.

Hair loss;

when it started,

whether it developed suddenly or gradually,

whether it is widespread or regional,

whether there is a history of similar hair loss in the family,

whether there has been any recent illness, childbirth, surgery, or weight loss,

medications used,

accompanying scalp symptoms

It is evaluated.

Trichoscopy

Trichoscopy is a non-invasive procedure that allows for the examination of hair and scalp under magnification.

Examining hair thickness, follicular structures, and certain characteristic findings on the scalp can help differentiate between different types of hair loss.

It can be particularly useful in the evaluation of androgenetic alopecia, alopecia areata, and some types of cicatricial alopecia.

Is a blood test necessary for every case of hair loss?

No.

Not everyone needs to undergo the same broad laboratory testing for hair loss.

Depending on the patient's history and physical examination findings, the following may be considered:;

blood count,

iron metabolism,

thyroid functions

Or tests may be ordered for other clinically suspected conditions.

The goal is not to conduct a large number of random tests, but to investigate by targeting the possible cause.

Is a scalp biopsy necessary?

It is not necessary for most hair loss cases.

However, in selected cases where the diagnosis is uncertain or a hair disease that leaves scars is suspected, a biopsy of the scalp may be necessary.

How is hair loss treated?

The most important point here is this:

There is no single treatment for hair loss.

Treatment varies depending on the underlying condition.

In androgenetic alopecia, the goal is to preserve existing hair, slow down miniaturization, and increase hair density in suitable patients.

In telogen effluvium, the priority is to identify the potential trigger and correct it if possible.

Treatment for alopecia areata is planned according to the extent and duration of the disease, the patient's age, and other clinical characteristics.

In cicatricial alopecia, the primary goal is often to control active inflammation to prevent further permanent hair loss.

Therefore, a single product found online should not be expected to work for all types of hair loss.

Can vitamins and supplements stop hair loss?

If there is a deficiency, it is important to correct it.

However, it is not accurate to say that vitamin and mineral supplements used without identifying deficiencies will cure all cases of hair loss.

“Products marketed as "hair vitamins" should not replace investigations into the true cause of hair loss.

Can platelet-rich plasma (PRP) and mesotherapy be used for hair loss?

For some types of hair loss, PRP, microneedling, or other supportive treatments may be considered.

However, these are not common treatments for all conditions called "hair loss.".

For example, the treatment goals for androgenetic alopecia and active cicatricial alopecia are completely different.

Therefore, diagnosis should be determined first, followed by a treatment approach.

Is hair transplantation a solution for all hair loss?

No.

Hair transplantation is a surgical option that can be considered, especially in suitable patients with androgenetic alopecia.

However, hair transplantation should not be planned without evaluating the cause of hair loss, whether the disease is active, the condition of the existing hair, and the quality of the donor area.

In some diffuse hair loss patterns, the donor area itself may also be affected. Therefore, it is important to carefully examine not only the bald area but also the donor area before a hair transplant.

What is DUPA?

DUPA (Diffuse Unpatterned Alopecia) is a condition in which hair loss, unlike classic patterned androgenetic alopecia, can show a more diffuse distribution, including the donor area.

This concept is particularly important when evaluating suitability for hair transplantation.

However, not all diffuse hair loss is DUPA. It needs to be differentiated from telogen effluvium, female pattern hair loss, and other types of diffuse alopecia.

When should you consult a dermatologist?

Especially;

If hair loss started suddenly,

if it is increasing significantly,

if regional gaps are forming,

If eyebrows or eyelashes are also falling out,

If there is redness, scaling, pain, or burning on the scalp,

If shiny and permanent-looking bald patches appear on the scalp,

If hair density is gradually decreasing,

If hair loss has been going on for a long time,

if hair transplant is being considered

A dermatological evaluation would be appropriate.

Frequently Asked Questions

How many strands of hair to lose per day is normal?

Daily hair loss can vary from person to person and depending on how often hair is washed. Therefore, diagnosing a condition is not accurate simply by counting the hairs seen in the shower or on a comb. More important is whether there is a significant increase in hair loss or a decrease in hair density compared to the individual's normal level.

Does stress cause hair loss?

Yes. Significant physical or psychological stress can affect the hair cycle in some individuals, contributing to telogen effluvium. However, it's not accurate to automatically attribute prolonged hair loss solely to stress.

Does washing hair frequently increase hair loss?

Washing your hair does not cause new hair loss from the root. A significant portion of the hair seen during washing is already in the shedding phase.

Does shaving the head make hair grow back stronger?

No. Cutting the portion of the hair strand above the skin does not alter the structure or genetic characteristics of the hair follicle.

Will hair loss reverse?

It depends on the cause. In some conditions, such as telogen effluvium, hair density may recover. However, in progressive conditions like androgenetic alopecia, early diagnosis and appropriate treatment are important for preserving existing hair. In cicatricial alopecia, if the follicle is permanently damaged, it may not be possible for the lost hair to regrow.