Androgenetic Alopecia is the most common cause of hair loss seen in both men and women. It is due to genetic or hormonal causes. It is also called as common bald ness, male pattern hair loss, female pattern hair loss, premature baldness.
Male pattern hair loss (MPHL) is the most common type of hair loss in men.
Baldness appears gradually on the crown of the scalp or as receding hairline at the frontal and thinning of hair over temple areas.
It affects about 30% of men by the age of 30 and 50% of men over the age of 50.
Both genetic and hormonal factors are responsible.
Testosterone is naturally converted in the body to dihydrotestosterone (DHT) which causes a change in the hair follicles on the scalp. Increased levels of DHT have been found in the balding scalp.
The hairs become progressively smaller in diameter, shorter in length and lighter in colour until eventually the follicles shrink completely and stop producing hair
Yes. It can be inherited from either or both parents.
A receding frontal hairline is the usual pattern and there may be loss of hair from the top of the head.
Hairs in the affected areas are thin and short before they become absent.
Men become aware of scalp hair loss or a receding hairline at any time after puberty but most of them become aware of it as they approach their thirties.A receding frontal hairline is the usual pattern and there may be loss of hair from the top of the head.
Hair loss may cause significant psychological difficulties.
A dermatologist diagnoses MPHL chiefly on history and clinical examination; a simple test such as dermatoscopy aids in the clinical diagnosis.
The diagnosis is usually based on the clinical examination and history of hair loss on the front/ top of the head or receding hairline, the pattern of hair loss and a family history of similar hair loss.
The skin on the scalp looks normal on examination.
The skin on the scalp looks normal on examination.
There is no cure but medical and surgical treatments which are available may improve the condition. However, it tends to progress very slowly, from several years to decades.
An earlier age of onset may lead to quicker progression
Male pattern baldness is progressive and it does not improve or reverse without treament. Minoxidil and Finasteride are commonly prescribed medications which may restore the hair to some extent.
Minoxidil
5% minoxidil liquid or foam applied to the scalp may slow down the progression of hair loss and partially restore hair.
It is applied to the affected scalp (not the hair) using a dropper or pump spray device and should be spread over the affected area lightly.
Minoxidil can cause reactions such as dryness, redness, scaling and/or itchiness at the site of application and should not be applied if there are cuts or open wounds.
At least 6 months of application is required to notice any benefit.
Minoxidil solution may cause an initial hair fall in the first 2-8 weeks of treatment, and this usually subsides when the new hairs start to grow.
Finasteride
Finasteride tablets reduce levels of DHT (hormone), which may slow hair loss and possibly help regrowth of hair.
Continuous use for 3 to 6 months is required before a benefit is usually seen. Side-effects are decreased libido and erectile problems.
Surgical treatments
Hair restoration surgery or transplantation is a procedure where hair follicles are taken from the back and sides of the scalp and transplanted onto the bald areas.
Scalp reduction, where a section of the bald area is removed and the hair-bearing scalp stretched to cover the gap. Tissue expanders may be used to stretch the skin.
Wigs and Hair pieces
Wigs, toupees and hair extensions are helpful in disguising hair loss.
Scalp Camouflage
Spray preparations containing small pigmented fibres are available and may help to disguise the condition in some individuals.
These preparations may wash away if the hair gets wet i.e. rain, swimming, perspiration, and they only tend to last between brushing/shampooing.
Light therapy
A variety of laser and light sources have been tried with varied success.
Future directions
Various growth factors and platelet rich plasma (PRP) have shown promising results in male pattern baldness.
Treatment of MPHL is effective only as long as treatment is continued.
Female pattern hair loss (FPHL) is the most common type of hair loss seen in women usually occurring in the 40-60s years of age.
It is due to genetic and hormonal factors.
There is gradual thinning of scalp hair at the centre and increased shedding. Bald patches are uncommon in women.
May be associated with conditions in which androgen (a group of hormones) levels are elevated such as polycystic ovarian syndrome (PCOS). Acne, increased facial hair, irregular periods and infertility are all signs of PCOS.
Yes. It can be inherited from either or both parents.
There is wide spread thinning of the hair, mainly on the crown of the scalp. It may initially start aS widening Of the hair parting areas.
In females, the hairline at the front of the scalp often remains normal unlike in men where receding Of frontal hair line is observed.
Hairs in the affected areas are initially thinner and shorter compared to hairs in unaffected areas, before they become absent.
FPHL usually manifests after 40 years Of age. Earlier onset may be seen in PCOS patients.
A dermatologist diagnoses FPHL chiefly on history and clinical examination; a Simple test Such aS dermoscopy aids in the clinical diagnosis.
The diagnosis is usually based on the history of gradual thinning of hair or increased hair shedding On the top of the head, the pattern of hair loss and any family history of similar hair loss.
Most FPHL patients do not have any underlying hormonal abnormalities except few cases where excess androgen levels are found.
Sometimes tests are done to rule out PCOS and congenital adrenal hyperplasia.
FPHL can be controlled with appropriate treatment. However, it tends to progress very slowly, from several years to decades.
Topical minoxidil and various hormonal treatments can be used to treat FPHL.
2% or 5% minoxidil solution is applied to the scalp to slow down the progression and partially restore hair in some women.
Minoxidil solution should only be applied to the scalp. Any spillage to the forehead or cheeks should be cleansed to avoid increased hair growth in these areas.
Minoxidil should be used for at least 6 months before any benefit may be noted.
Oral treatments such as spironolactone, cyproterone acetate, flutamide and cimetidine can block the action of DHT (hormone) on the scalp, which may lead to some improvement in hair loss.
Spironolactone and cyproterone acetate should be avoided in pregnancy since they can cause feminisation of a male foetus; both should be avoided during breast feeding. Flutamide carries a risk of damaging the liver.
Hair transplantation is a procedure where hair follicles are taken from the back and sides Of the scalp and transplanted onto the bald areas.
Wigs, toupees and hair extensions can be helpful in disguising hair loss.
FPHL is not Only a cosmetic issue, but causes Significant psychological distress.
Women with FPHL have low Self-esteem, depression, and feelings Of unattractiveness.
Appropriate treatment based on patient needs Should be hence instituted.
Disclaimer: This article is only for general patient information and is not intended for self medication. There is no legal liability of IADVL arising out of any adverse consequence to the patient. Subsequent to its use for self treatment of the disease images adjust for the depiction of the condition and is not to be used for any other purpose.
Hair loss or Alopecia is a common condition affecting millions of people worldwide. Often perceived as a purely cosmetic issue, hair loss can significantly impact the individual’s psychological well-being and quality of life. Understanding the underlying causes is crucial for effective management and treatment.
Hereditary hair loss: Both men and women develop this type of hair loss, which is the most common cause of hair loss worldwide. In men, it’s called male pattern hair loss. Women get female pattern hair loss. It means that you’ve inherited genes that cause your hair follicles to shrink and eventually stop growing hair. Shrinking can begin as early as your teens, but it usually starts later in life.
In women, the first noticeable sign of hereditary hair loss is usually overall thinning or a widening part. When a man has hereditary hair loss, the first sign is often a receding hairline or bald spot at the top of his head.
Treatment can help to stop or slow hair loss. It may also help regrow hair. The earlier the treatment, the better it works. Without treatment, you will continue to lose hair and eventually become bald over some time.
Age: With age, most people notice some hair loss because hair growth slows. At some point, hair follicles stop producing hair, which causes the hair on our scalp to look thin. Hair also starts to lose its color. If diagnosed early, treatment helps some people regrow their hair.
Alopecia areata: It is a disease that develops when the body’s immune system attacks hair follicles, causing hair loss. You can lose hair anywhere on your body, usually starting on the scalp. But some people lose their eyelashes or eyebrows as well. Treatment varies according to the pattern and extension of the patches.
Cancer treatment: If you receive chemotherapy or have radiation treatment to your head or neck, you may lose all or most of your hair within a few weeks of starting treatment. Hair usually starts to regrow within months of finishing chemotherapy or radiation treatments to the head or neck. Dermatologists can offer medication to help hair grow back more quickly. Wearing a cooling cap before, during, and after each chemotherapy session may help prevent hair loss.
Childbirth, illness, or other stressors: A few months after giving birth, recovering from an illness, or having an operation, you may notice a lot more hairs in your brush or on your pillow. This can also happen after a stressful time in your life, such as a divorce or the death of a loved one. When the shedding stops, most people see their hair regain its normal fullness within 6 to 9 months.
Hair care: If you color, perm, or relax your hair, you could be damaging your hair. Over time, this damage can lead to hair loss. Once you damage a hair follicle, hair cannot grow from that follicle. Having many damaged hair follicles creates permanent bald spots.
Hairstyle pulls on your scalp: If you often wear your hair tightly pulled back, the continual pulling can lead to permanent hair loss. The medical name for this condition is traction alopecia. You can prevent hair loss by making hairstyle changes.
Hormonal imbalance: A common cause of this imbalance is polycystic ovary syndrome (PCOS). The use of some types of birth control pills can cause a temporary hormonal imbalance. Women who develop a hormonal imbalance can develop thinning hair (or hair loss) on their scalp. Treatment may help with this condition.
Scalp infection: A scalp infection can lead to scaly and sometimes inflamed areas on your scalp. You may see what looks like small black dots on your scalp. These are stubs of hair. Some people develop a bald spot. Treatment can get rid of the infection. Once the infection clears, hair tends to grow.
Medication: A possible side effect of some medications is hair loss. It’s essential that you do not stop taking the medication before talking with your doctor. Abruptly stopping some medications can cause serious health problems.
Pulling your hair: Some people pull on their hair, often to relieve stress. They may be unaware that they’re pulling their hair. The medical term for this is trichotillomania. If you haven’t destroyed the hair follicles, regrowth is possible. A multidisciplinary approach is needed in this condition.
Scarring alopecia: This condition develops when inflammation destroys hair follicles. Once destroyed, a hair follicle cannot grow hair. Diverse conditions can cause this. The medical name for this group of conditions is cicatricial alopecia. Catching this condition early can prevent further hair loss.
Sexually transmitted infection: Left untreated, a sexually transmitted infection (STI) can lead to hair loss. Syphilis is such an STI. Left untreated, syphilis can cause patchy hair loss on the scalp, eyebrows, beard, and elsewhere. After treating the STI, hair often starts to regrow.
Thyroid disease: If you have a problem with your thyroid, you may see thinning hair. Some people notice that their hair comes out in clumps when they brush it. Treating the thyroid disease can reverse the hair loss.
Nutrition: A deficiency of protein, vitamins, and minerals like biotin, iron or zinc can cause hair loss. When your body gets enough of the missing nutrients, hair can regrow.
Friction: People can develop hair loss where boots, socks, or tight clothing frequently rub against their skin. The medical term for this is frictional alopecia. Hair tends to regrow on its own when the rubbing stops.
Harmful elements: Harmful elements that can cause hair loss include arsenic, thallium, mercury, and lithium. Taking large amounts of vitamin A or selenium is also toxic and can cause hair loss. Hair tends to regrow when you are no longer exposed to the poison.
It is of paramount importance to visit a board-certified dermatologist as without an accurate diagnosis an effective treatment is often ineffective.
Effective treatment for hair loss begins with finding the cause. To get an accurate diagnosis, one has to see a board-certified dermatologist. Dermatologists are true hair care physicians/trichologists having in-depth knowledge about the many causes of hair loss and experience treating the diverse causes.
To pinpoint the cause of your hair loss, a dermatologist begins by gathering information. Your dermatologist will:
Ask questions. It is important to know how long you’ve had hair loss and whether it came on quickly.
Look closely at your scalp, nails, and any other area with hair loss. This clinical examination provides vital clues about what’s happening.
Test the health of your hair. Gently pulling on your hair tells your dermatologist a lot about how your hair is doing at present and whether it’s prone to breaking.
If your dermatologist suspects that the cause of your hair loss could be a disease, vitamin deficiency, hormone imbalance, or infection, you may need a blood test or scalp biopsy. These tests can be done in your dermatologist’s clinic. Once your dermatologist has this information, it’s often possible to tell you what’s causing your hair loss.
This can happen if you have recently:
Had a baby
Recovered from a major illness or had surgery
Underwent cancer treatment
Lost 20 pounds or more
Developed a mild case of a disease called alopecia areata, which causes your immune system to attack your hair follicles
Your dermatologist can tell you whether your hair may start to grow again on its own.
Some hairstyles and hair care habits can damage hair, leading to hair loss. If your dermatologist finds that this may be causing your hair loss, your dermatologist can recommend changes that will help you stop damaging your hair.
While your hair may regrow on its own, your dermatologist may recommend treatment to help it grow more quickly. Sometimes, treatment is essential to prevent further hair loss in cases of androgenetic alopecia, alopecia areata, telogen effluvium, etc.
A treatment plan for hair loss may include one or more of the following.
Hormone stabilizing medications for women:
For men/ women who have patterned hair loss, this medication may be an option. It can:
Stop further hair loss
Increase hair thickness
It’s essential that you do not become pregnant while taking spironolactone. This medication can cause birth defects.
If your blood test reveals that you’re not getting enough biotin, iron, or zinc, your dermatologist may recommend taking a supplement. If you’re not getting enough protein, your dermatologist can tell you how to boost your intake.
You should only take biotin, iron, or zinc when your blood test shows that you have a deficiency. If your levels are normal, taking a supplement can be harmful. For example, if you take too much iron, you can develop iron poisoning. Early signs of this include stomach pain and vomiting.
Other supplements meant to help with hair loss tend to contain a lot of one nutrient. Because this can cause you to get too much of the nutrient, many dermatologists recommend taking a multivitamin instead.
The US FDA has approved LLLT for hereditary hair loss in men and women. It stimulates cellular activity in tissues and is a non-invasive, safe, and potentially effective treatment option. It may help in:
Hereditary hair loss
Alopecia areata
Hair loss due to chemotherapy
Stimulate healing and hair growth after a hair transplant
Studies indicate that laser therapy is safe and painless but requires many treatment sessions. To see a bit of hair growth, you may need several treatments a week for many months.
A microneedling device contains hundreds of tiny needles. A few studies have shown that it can help stimulate hair growth especially if used with biostimulatory agents. While you can buy a microneedling device without a prescription, it’s best to check with your dermatologist first. Microneedling can worsen some conditions. It’s also important to get the right microneedling device.
To help your hair regrow, your dermatologist injects this medication into the bald or thinning areas. These injections are usually given every 3 to 6 weeks as needed, so you will need to return to your dermatologist’s office for treatment.
This is considered the most effective treatment for people who have a few patches of alopecia areata, a condition that causes hair loss.
Studies show that this can be a safe and effective hair loss treatment. PRP involves drawing a small amount of your blood, placing your blood into a machine that separates it into parts, and then injecting one part of your blood (the plasma) into the area with hair loss.
The entire procedure takes about 30 minutes and usually doesn’t require any downtime. You will need to return for repeat injections. Most patients return once a month for 6 months and then once every 3 to 6 months. Within the first few months of treatment, you may notice that you are losing less or minimal amounts of hair.
If you have an area of thinning or balding due to male or female pattern hair loss, your dermatologist may mention a hair transplant as an option. This can be an effective and permanent solution.
If you feel uncomfortable taking medication and if your schedule limits the amount of time you have for treatment then your dermatologist may recommend a wig or concealer.
While these cannot slow hair loss or help you regrow hair, they can boost your self-esteem. Another advantage is that a wig or concealer offers immediate results.
Many types of wigs, including ones that can be custom-made for you, are available. If you’re looking for a concealer, such as a spray or powder that can hide hair loss, you’ll find many products available online. With endless choices, it can be helpful to have a dermatologist guide you in selecting one.
It is of utmost importance to visit a board-certified dermatologist for an accurate diagnosis and treatment. If you need regrowth treatment, the earlier you start, the more likely you are to see better and faster coverage.
It’s important to understand that:
Not every type of hair loss can be treated, but a dermatologist may be able to prevent further hair loss.
It can take months before you see results from treatment.
No one treatment works for everyone, even two people with the same type of hair loss.
Sometimes, hair loss is stubborn and requires trying different treatments before finding one that works.
Self-care also plays an essential role in preventing and treating hair loss. Kindly do visit a board-certified dermatologist for a customized hair care and treatment plan.
Explore articles in this section to gain a deeper understanding of various skin diseases and conditions. Each article provides detailed information on symptoms, causes, and treatment options, helping you to manage and address these dermatological issues effectively.
Psoriasis is a skin condition where new skin forms at a faster rate, showing up as red rashes with whitish scales, commonly over elbows, knees, and other body parts.
Dandruff is a common scalp condition in which small pieces of dry skin flake off from the scalp and is usually associated with itching. The exact cause of Dandruff and Seborrhoeic Dermatitis is unknown.
Dermatophyte infection is a superficial fungal infection of skin, hair and nails. It is also known as ringworm. In Hindi it is termed as Daad and in Marathi it is termed as Gachkaran.
