Types And Characteristics Of Hair Loss
The medical term for hair loss is alopecia, and it can be scarring and non-scarring. Understanding the different types of hair loss is important for determining the appropriate treatment. Each type has its own characteristics and underlying causes, which can range from genetic factors to environmental influences.
Non-Scarring Alopecia
Non-scarring alopecia, also known as non-cicatricial alopecia, refers to various forms of hair loss caused by changes in the hair cycle, follicle size, and breakage. Non-scarring alopecia is of several types:
Patchy Alopecia Areata: In this type, hair loss occurs in circular and overlapping patches. Alopecia Totalis: This causes complete baldness. Alopecia Universalis: This involves total hair loss on the body. Alopecia Incognita: This rare form of alopecia causes diffuse hair loss that can be abrupt and intense. Ophiasis: Hair loss occurs in a band or wave-like shape along the head’s circumference, specifically near the ears and back of the head. Sisaipho: This chronic alopecia (Ophiasis spelled backward) causes hair loss on the scalp, except the borders. Marie Antoinette Syndrome: This variant of acute diffuse alopecia causes a sudden “overnight” hair graying and fall. Reticular Alopecia Areata: In this condition, hair loss occurs in patches separated by narrow bands of hair, giving a net-like appearance (3). Diffuse Alopecia Areata: This causes complete hair loss on the scalp and is often mistaken for androgenic alopecia or chronic telogen effluvium (3).
In men, hair starts to fall off when testosterone (the male sex hormone) is converted into dihydrotestosterone (DHT) that attacks the hair follicles. The role of androgens in female pattern hair loss is not completely understood. However, it may affect genetically susceptible women and cause diffuse thinning in the middle of the scalp that gradually increases outwards. A study on early onset female pattern hair loss comprising 63 patients and 341 individuals in a control group found that the condition is associated with androgen-related features, such as folliculitis, hirsutism, scalp greasiness, and polycystic ovary syndrome. Notably, patients with this condition report a higher frequency of scalp pain and itching. Drug-induced Anagen Effluvium (hair loss during the growth phase) occurs within a few days or weeks of taking the drug. In contrast, Telogen Effluvium occurs two to four months after taking the drug. In this condition, more than 20% of your follicles suddenly go into the telogen phase (resting phase), reducing the number of follicles that are actively growing hair (6). This causes loss of volume, and, eventually, balding. Some common triggers that induce telogen effluvium are:
Health Conditions: Malaria, typhoid, covid-19, tuberculosis, thyroid issues, organ dysfunctions, HIV, malnutrition, syphilis, autoimmune diseases, and nutrient deficiencies. Stress: Emotional trauma, heavy labor, starvation, crash diets, severe injuries, and surgeries. Chemicals: Chemicals in hair dyes and other hair products may cause allergies, resulting in hair loss.
Scarring Alopecia
Scarring alopecia or cicatricial alopecia refers to various hair loss disorders that cause irreversible damage to the hair follicles. Conditions that may cause permanent hair loss includes: Even children may experience scarring and non-scarring hair loss. Let’s take a look.
Hair Loss In Children
Non-Scarring Hair Loss
Short Anagen Syndrome: In this condition, the hair does not grow long. However, the hair strength and density are not affected. This is a non-scarring type of hair loss. Loose Anagen Syndrome: You may notice little to no hair growth on the child’s scalp in this condition. The strands are loose and cannot anchor into the scalp. Gradually, the hair becomes thin and unmanageable. This condition might be occasionally noticed in adults and is non-scarring.
Scarring Hair Loss
Temporal Alopecia Triangularis: This is a hair loss disorder noticed in newborns or young children. In this condition, you may notice a triangular or lancet-shaped bald spot on the child’s scalp with little terminal hair growth. It is a non-scarring type of hair loss. Tinea Capitis: It is caused by a fungal infection that affects the hair shaft. You may notice patchy hair loss spots with scalp inflammation, like erythema with scalp scales. However, this is curable. It has scarring and non-scarring varieties. Severe infection with nodules and information can turn into a scarring one.
A change or interference in the hair growth cycle is the primary reason for hair loss. Hair grows in a cycle that has four phases:
Anagen (growth phase) Catagen (regression phase) Telogen (resting phase) Exogen/Neogen (hair fall/birth of new hair)
Multiple factors can disrupt this cycle, hampering follicular growth and causing hair loss. Scroll down to understand the reasons for hair loss.
Causes Of Hair Loss
1. Genetic Factors
If you have a history of hair loss, you may experience hair loss. Often, conditions like alopecia and pattern baldness run in the family (13).
2. Hormonal And Thyroid Issues
A change in hormone levels like androgens can trigger androgenic alopecia in men and women (4). Imbalance in estrogen and other hormone levels during pregnancy, menopause, and conditions like ovarian cysts and thyroid issues may cause hair thinning and loss.
3. Pregnancy
The estrogen levels increase during pregnancy and decrease post-childbirth. These hormonal shifts may cause hair loss. However, in a few weeks or months of delivery, the normal hair growth cycle resumes. Sometimes, the drugs prescribed during pregnancy may also cause hair loss.
4. Physical And Mental Stress
Physical, emotional, and mental stress increases free radical production, leading to oxidative damage to the hair. This may prevent hair growth and causes hair loss. Animal studies showed that stress could induce inflammatory effects that inhibited hair growth, induced catagen (regression), and caused hair damage (14).
5. Scalp Infection
An unhealthy and unhygienic scalp can cause bacterial and fungal infections like dandruff. Moreover, the dirt, dust, and sebum accumulation further clog the hair follicles. These may weaken the hair roots and cause hair fall, breakage, and thinning.
6. Medical Conditions
Autoimmune conditions like lupus erythematosus and alopecia cause hair loss. Both conditions can coexist and may mimic discoid lupus erythematosus (a condition causing inflamed, scaly, and crusty patches) (2). Alopecia areata is often associated with other conditions like depression, anxiety, and autoimmune diseases like thyroid disease, vitiligo, rheumatoid arthritis, and inflammatory bowel syndrome (15), (16). Research suggests that people with alopecia areata are more vulnerable to other autoimmune diseases. In such cases, alopecia areata can also show symptoms of other inflammatory skin diseases like atopic dermatitis, psoriasis, and lichen planus (17).
7. Medication And Treatments
Hair loss can be a side effect of medications like voriconazole (an antifungal medicine), and antihypertensive, systemic, and other topical drugs (18), (6), (19), (20). These medications may damage the hair follicles, causing hair loss. Other medical treatments like chemotherapy, steroids, and medicine for typhoid, heart diseases, and depression may cause hair fall.
8. Excessive Grooming
Excessive grooming like over washing and aggressively brushing the hair causes dryness, and the traction may cause breakage and falling. Hair products like shampoos, mousses, hair gels, and sprays contain chemicals that may damage the scalp. The high pH levels in the products can disrupt the scalp environment. Similarly, using heating tools, chemicals, colors, and tight hairstyles can damage and weaken the roots, leading to hair loss.
10. Food Habits
Vitamins and minerals are vital to hair health. The deficiency of protein and essential and trace nutrients like iron, zinc, selenium, calcium, and vitamins A, B, C, and E can lead to hair loss (11).
11. Supplement Abuse
Vitamin supplements are beneficial only in cases of deficiencies. Excess intake of supplements like vitamins A and E and selenium may cause hair loss, among other health risks (9). The intake of nutrients through foods does not affect the hair and overall health. Always consult a doctor before taking any supplements. While you may experience some amount of hair loss every day (50-150 strands, depending on the hair length). However, if you notice excessive hair fall, consult a doctor.
When To Consult A Doctor: Symptoms To Look For
Symptom 1: Excessive Hair Breakage And Hair Loss
May indicate
Tinea capitis (hair follicle infection) Structural damage to the hair shaft caused by excessive use of styling products Disruption to the anagen phase
Symptom 2: Hair Loss From The Roots
May indicate
Telogen effluvium Underlying conditions leading to androgenic alopecia or drug-induced hair loss
Symptom 3: Scaly, Patchy, Crusty Scalp And Blisters
May indicate
Scalp issues like discoid lupus erythematosus and alopecia areata Lichen planus and other severe fungal, viral, or bacterial infections Traumatic hair loss caused by an injury or burns
If you experience any of these conditions, consult a doctor immediately. Here is what to expect during your visit.
Consulting A Doctor: What To Expect
The doctor will conduct a thorough check-up to determine the exact reason for hair loss. They may ask for:
A complete medical history (to check for a genetic or medical condition) A list of past and present medications (to identify drug-induced hair loss) The duration and pattern of hair loss (to track the progression)
The doctor may recommend:
A thyroid test Tests to check fungal and bacterial infections Scalp inspection to check for inflammation and scarring Analyzing your fallen hair strands under the microscope
They may also ask numerous questions to determine the type of hair loss. The doctor may further conduct a few tests to diagnose hair loss.
Diagnostic Tests To Determine The Reasons For Hair Loss
1. Pull Test
A basic pull test can help determine if you have hair loss. You can also try this at home. To do this:
Do not wash your hair for three to four days. Hold a bunch of hair strands and pull them gently. If more than 10 hair strands fall out, you have hair loss issues.
2. Daily Hair Count
You can perform the test at home on unwashed and washed hair. Here’s what you need to do:
After combing unwashed hair, collect the fallen hair Keep a count. Comb your washed hair and collect the loose hair strands and count them. Do this for three days and notice how many hair strands you lose per day. If you lose more than 100-150 hair strands per day, you have hair loss issues.
3. Pluck Test
In this test, the doctor will extract a hair strand by the root sheath and examine it under an electron microscope to determine the hair growth phase and defects (if any).
In the telogen phase, the strand will have tiny bulbs without root In the anagen phase, bulbs have a root sheath.
This process is used to determine telogen or anagen effluvium.
4. Wash Test
The expert may collect the loose hair strands you shed while shampooing. The strands are washed, counted, and divided into groups based on their length to determine the hair growth phase percentage. Hair strands that are shorter than 3 cm are considered telogen vellus hair. Hair strands between 3-5 cm are deemed to have an intermediate length. Strands measuring 5 cm or more indicate that the hair is in the anagen phase. People with 10% telogen hair are diagnosed with androgenic alopecia.
5. Hair Count Test
This test record the amount of hair loss. It is used to monitor the efficacy of hair loss treatments (medication and natural remedies). This test can be done at home, before shampooing. To do this,
Bend your head forward over a pillow or sheet. Comb the unwashed hair from the crown (middle part of the scalp) to the front hairline. Count the number of loose hair strands in the comb and the pillow or sheet. Repeat this procedure for three consecutive shampoo sessions. If you shampoo your hair every alternate day, perform this test every alternate day. Do the test every month to determine the efficacy of the treatment. Discuss the results with a dermatologist.
6. Trichogram
Dermatologists or trichologists perform this test. They collect a sample of about 50-100 hair strands from the scalp and analyze them under a light microscope to determine the number of hair strands in each hair growth phase. This helps to diagnose telogen or anagen effluvium, short anagen syndrome, and loose anagen syndrome.
7. Trichoscopy
There are two types:
Dermoscopy: This test helps diagnose early pattern hair loss. The doctor uses a handheld dermascope to examine the hair strand thickness to determine scalp disorders and pattern baldness. Videodermoscopy: Videodermoscopy is similar to dermascopy. It uses a videodermascope to get rapid, high-resolution images at different magnifications. The device can also capture images and is often used before a biopsy to determine the right area for sample collection.
Trichoscopic evaluation is broadly grouped into hair signs and pigment, vascular, and interfollicular patterns. Trichoscopy evaluation helps detect different types of alopecia, tinea capitis, and hair shaft disorders.
8. Trichoscan
The Trichoscan is a device that uses both epiluminescence microscopy and automated digital analysis to shows the number of hair strands and their density. It also indicates the percentage of hair strands in anagen or telogen phases. It is often used to monitor patients during hair or scalp disorder treatments. Procedure: The doctor shaves about 1 sq. cm of the area on the scalp and evaluates the shaved patch after 48-72 hours. The software automatically analyzes the image and evaluates aspects like the number of hair strands in the area, their density, and terminal and vellus hair strands. Anagen hair grows immediately and can be seen after 48-72 hours. In contrast, telogen hair doesn’t grow within that time.
9. Scalp Biopsy
The doctor conducts a scalp biopsy under local anesthesia. They use a 4 mm punch to dissect a patch of skin containing hair from the scalp. The hair strands are then counted and evaluated under a microscope.
In non-scarring alopecia, the sample is collected from the center of the lesion. In scarring alopecia, the sample is collected from the inflamed area for the biopsy.
A scalp biopsy can diagnose scarring and non-scarring hair loss. The punch may be used vertically or horizontally to achieve a definitive diagnosis. Usually, vertical punches are used to determines alopecia associated with lichenoid infiltrates.
10. Hair Weight Test
Hair strands are taken from an affected area to determine each strand’s weight. In this process,
Hair is clipped close to the scalp, right at the baseline, and weighed. New hair growth is monitored. Once the new hair grows a little, it is again clipped off at the baseline. The hair is weighed again to notice any improvement.
These are some tests used to diagnose the type of hair loss. Depending on the diagnosis, the doctor prescribes treatment. The next section explores both medical treatments and natural remedies to manage hair loss and improve hair health. Scroll down for more information.
Treatment For Hair Loss
1. Medical Remedies
Depending on the scalp issue and causes of hair loss, the doctor may suggest different medical treatments (individual and combined therapies) like (11):
Topical minoxidil is prescribed to manage and reduce hair loss. Minoxidil is often paired with intralesional corticosteroids and creams or anthralin to treat alopecia affecting less than 50% of the scalp. For alopecia affecting over 50% of the scalp, minoxidil is paired with topical immunotherapy psoralens and UV treatment. Oral finasteride can manage pattern baldness and androgenic alopecia. However, it is generally avoided for pregnant and postmenopausal women. Systemic anti-androgens like spironolactone, cyproterone acetate, or flutamide are used to reduce hair thinning. A hair transplant surgery is a solution to manage permanent hair loss caused by scarring and inflammation. Drug-induced hair loss resolves once you stop taking medicine. The doctor may suggest alternatives. Clomipramine is used to treat severe cases of trichotillomania. For tinea capitis, the doctor may prescribe antifungal treatments like griseofulvin, itraconazole, and terbinafine. Severe scarring alopecia is treated with antimalarials, intralesional corticosteroids, systemic steroids, or retinoids.
You may use natural remedies to manage hair loss and improve hair health. Oiling treatments, hair masks and packs, and deep nourishing treatments keep the scalp nourished and healthy. Here are some natural ingredients you can use as hair masks or add to your hair care products to maintain hair health.
2. Natural Remedies
Oils For Hair Loss
Coconut Oil: Coconut oil contains saturated fatty acids that promote hair growth. The lauric acid in the oil eliminates bacteria and fungi to maintain hair health. The fatty acids penetrate the hair shafts to protect, strengthen, and nourish them from within. Coconut oil also prevents protein loss, moisturizes the hair, and increases water retention to keep it healthy (21). Argan Oil: Argan oil is a hair moisturizer and is especially effective in soothing psoriasis and dryness to prevent hair loss. It also helps balance sebum production and has antibacterial properties to fight aureus that causes folliculitis decalvans. Saponin extracts from argan oil can inhibit 5-alpha reductase activity and prevent hair loss (22). Olive Oil: Olive oil contains oleuropein, a polyphenol that may help manage telogen hair loss. In animal studies, oleuropein induced anagenic hair growth during the telogen phase (23). Another study showed that olive oil could reduce hair loss and other hair issues like dryness and breakage (24). Jojoba Oil: Jojoba oil is used in herbal hair loss formulations to help stimulate hair growth (25). A study showed that massaging essential oils like cedarwood, lavender, and thyme with jojoba oil may improve hair growth in patients with alopecia (26). Sweet Almond Oil: Sweet almond oil is widely used in herbal formulations for hair loss. It contains vitamin E, an antioxidant, and may prevent hair loss (27). Sweet almond oil strengthens hair shafts and is used in Chinese and Ayurvedic medicine to soothe psoriasis and eczema. Essential Oils: Massaging the scalp with a combination of rosemary, thyme, lavender essential oils, and carrier oils like jojoba or grape seed can minimize hair loss. Peppermint essential oil is as effective as topical minoxidil in stimulating hair growth (26), (28), (29).
Fruits For Hair Loss
Oranges: They are rich in vitamin C, an antioxidant that reduces harmful free radicals and may help keep the scalp healthy and reduce hair fall. Orange peel has antifungal and antibacterial properties and is often used to manage acne (30). Apples: Apples contain procyanidin B2, a dimeric derivative extracted from apples. Human studies showed that the topical application of procyanidin B2 could promote hair growth. It may also increase hair density and hair protein content (31). Plantain: The topical application of plantain extract may help promote hair growth. Ingesting plantain extract can also improve scalp health by preventing dandruff and unclogging pores (32), (33). Avocado: Avocados contain protein and vitamins A, B, B1, B2, E, and C, beta-carotene, linoleic acid, lecithin, calcium, iron, pantoneat acid, potassium, phosphorus, and niacin. These nutrients help condition the hair and also promote hair growth. A study found that applying a mixture of 3% waru leaves extract and 8% of avocado fruit extract could promote hair growth (34). Grapes: Procyanidins, found in grapes, have antioxidant, anti-inflammatory, and antifungal properties (26). A study showed that grape seed extracts induced hair growth, reduced dandruff, strengthened hair follicles, moisturized the hair, and helped build hair tissue (35). Apricots: Apricot kernel oil contains two essential fatty acids – oleic and linolenic acids – along with vitamin E. They may help keep the scalp healthy and promote hair growth (36). Bitter kernel oil helps reduce hair fall and dandruff (37). Peaches: The ethanol extract of peaches can promote hair growth in human dermal papilla cells by prolonging the anagen phase (38). Peaches also have antioxidant, anti-inflammatory, antimicrobial properties and may promote scalp health (39). Plum: Plums have a high phenolic content. These antioxidants may fight free radicals to reduce oxidative damage (40). This may help prevent hair fall and damage. Guava: Guava leaves strengthen the hair follicles and shaft, increase hair thickness, and promote healthy hair growth (41). The fruit is rich in vitamin C and nutrients and may help maintain overall scalp health. Gooseberries: The Indian gooseberry or amla can stimulate hair growth and is used in herbal hair growth preparations. It prevents premature graying and strengthens the hair follicles. Amla also has the highest natural concentration of vitamin C that may reduce hair fall (42). Lemon: A study showed that lemon could reduce hair loss and balding. It also helps reduce dandruff, lice, and scalp acne. Lemon also contains vitamin C that may help prevent hair loss (43). Cherry: Cherries have antioxidant and antifungal properties. They are rich in phenolic compounds and help reduce oxidative stress. These properties may promote better hair and scalp health (44).
You may consume the fruits or apply them to your scalp and hair for other benefits. Click here to learn more about fruits for hair growth. You may also use herbs to manage hair loss. Let’s take a look. Herbs For Hair Loss
Henna: Henna has antifungal properties and is used traditionally to prevent and manage dandruff. It can balance the scalp’s pH level and prevent premature graying and hair fall (45). Wild Basil: Basil has anti-inflammatory properties and can help manage scalp issues, infections, and inflammation (46). It may keep the scalp healthy and promote healthy hair growth. Shikakai: The use of shikakai as a hair cleanser, especially in Asia, dates back to thousands of years. Massaging a paste made of dried shikakai powder and warm water on the scalp may promote hair growth, strengthen the strands, and improve scalp health (46). Ginkgo biloba: 70% ethanol extract of ginkgo biloba may promote hair growth. It is said to improve circulation, nourish the follicles, and keep the hair healthy (47), (48). Hibiscus: Hibiscus flowers contain vitamins and antioxidants that promote scalp and hair health. Research showed that hydroalcoholic extract of hibiscus (leaf and flowers) could promote significant hair growth (49). Ginseng: Chinese red ginseng may inhibit 5-alpha reductase, improve blood circulation, and promote hair growth. It can also help strengthen the strands (50), (47).
Before using any alternative and natural remedies, always do a patch test to prevent allergic reactions. If you are using oral herbs and medications, consult a doctor to avoid drug interaction. Besides medicines and treatment, following a basic hair care routine is also crucial to strengthening hair and reducing hair loss.
Tips To Reduce Or Manage Hair Loss
If the home remedies listed above do not help you in 1-2 months, consult a doctor without delay, as your hair is the barometer of your health. Hair loss could be just a symptom of a developing disease. It is the body’s call for attention and needs proper investigation and treatment if OTC products or home remedies don’t seem to work. Does lack of sleep cause hair loss? Lack of sleep may indirectly influence your hair health. It is linked to high stress levels, which may contribute to hair loss. How much vitamin D should I take for hair loss? Taking 20-50 micrograms of vitamin D may help if you have a deficiency. However, the recommended daily intake (RDI) of vitamin D may differ from person to person depending on the severity of the deficiency. Therefore, consult a doctor to know the correct dosage and avoid self-medication.
Find out the major causes of the hair loss from the video below. Learn about the different types and symptoms of hair loss, as well as treatment options to address this concern and promote a healthier and stronger mane.
