Loosing 50 to 100 hairs per day is normal. However, if this number lost is increased, or the regrowing hairs come in thinner or fewer, then we have alopecia. There are many causes to alopecia and there are many types of alopecia. Therefore, once a medical diagnosis of alopecia is determined, the right treatment plan can be developed. Over 80 million Americans have the most common type of alopecia, which includes male pattern alopecia and female pattern alopecia, both having strong genetic causes. Fortunately, medical and surgical intervention can greatly improve both these forms of alopecia.

Forms of alopecia:

  • Male and female pattern alopecia:
    With men the first sign can be a receding hairline. Many men will then see a bald spot forming on the top of their head. Women, however, tend to keep their hairlines but loose hair diffusely. In rare cases men can have a female pattern of loss and women can have a male pattern of loss. In such scenarios a hormonal workup is appropriate.
  • Alopecia areata: In areata, the body’s own immune system attacks its own hairs, leaving  round patches of hair loss, although diffuse loss and even total loss is possible. A blood workup for thyroid, autoimmune panels, ferritin should be done. Hair transplantation is not a viable treatment, since the grafts will be attacked also. Treatment includes both diet counseling and topical immuno-suppresants.
  • Cicatricial (scarring) alopecia: Here, inflammation or trauma cause scar formation, which kills hair follicles and the accompanying stem cells.  Causes of scarring alopecia abound from lupus like reactions, to folliculitis, to trauma, and many more. A biopsy of the scalp is important in the diagnosis, accompanied by a battery of blood tests. In the ethnic populations, hair relaxers and hot oil treatments can cause insidious scarring alopecia, most commonly on the crown of the scalp, known as Central centrifugal cicatricial (scarring) alopecia. Treatment includes stopping the offending agent, topical anti-inflammatory agents, topical minoxidil, platelet rich plasma, followed by follicular unit grafts.
  • Telogen effluvium secondary to a medical conditions: Conditions like lupus, sarcoid, anemia, thyroid imbalance, protein deficiency, severe anxiety, severe stress, after surgery or pregnancy, menopause, after severe fever or infection, sudden weight loss, excessive vitamin A or its derivatives, blood thinners, hormones, blood pressure meds, chemotherapy are just a few causes. The first treatment is remedying the cause.
  • Some cancer treatments: Radiation therapy and chemotherapy can cause hair loss. This hair loss is often temporary, but it can cause great distress.
  • Ringworm of the scalp: This is a fungal infection of the hair and if untreated can cause permanent scarring.
  • Trichotillomania (trick-uh-til-uh-mey-knee-uh): In this disorder, people pull out their own hair by habit. This can be a form of obsessive compulsive disorder, needing psychological care.
  • Contact dermatitis Irritation or even allergy to products or excessive washing, blow drying, flat ironing, etc.
  • Physical causes Hair cannot withstand prolonged pulling, therefore hair styles of items that pull on hair, like hairpins or rubber bands.