Hair Loss (cont.)

Medical Author:
Medical Author:
Medical Editor:

How do physicians classify hair loss?

There are numerous ways to categorize hair loss. One must first examine the scalp to determine if the hair loss is due to the physical destruction and loss of hair follicles. If the scalp appears perfectly normal with plenty of follicular structures (which seem to be simply unoccupied) this is called non-scarring hair loss. On the other hand, the follicles are permanently destroyed in scarring hair loss. Localized, small areas, large areas or the whole scalp may be affected in scarring and non-scarring hair loss. Occasionally, it may be necessary to do a biopsy of the scalp to distinguish these conditions. Sometimes, a physician may pull a hair to examine the percentage of hairs in the growth (anagen phase). This article will concentrate on the non-scarring types of hair loss.

Patchy hair loss

Some conditions produce small areas of hair loss, while others affect large areas of the scalp. Common causes of patchy hair loss are

  • alopecia areata (small circular or coin size patches of scalp baldness that usually grow back within months),
  • traction alopecia (thinning from tight braids or ponytails),
  • trichotillomania (the habit of twisting or pulling hair out),
  • tinea capitis (fungal infection).

What is alopecia areata?

A common condition, alopecia areata usually starts as a single quarter-sized circle of perfectly smooth baldness. Alopecia patches usually regrow in three to six months without treatment. Sometimes, hair temporarily regrows in white where it was previously dark. In another variant, alopecia can produce two or three bald patches. When these regrow, others may replace them. The most extensive form is called alopecia totalis, in which the entire scalp goes bald. It's important to emphasize that patients who have localized hair loss generally don't go on to lose hair all over the scalp. Alopecia can affect hair on other parts of the body, too - for example, the beard or eyebrows.

Alopecia areata is an autoimmune condition in which the body attacks its own hair follicles. Most alopecia patients, however, do not have systemic problems and need no medical tests. While alopecia areata is frequently blamed on "stress," in fact, it may be the other way around; that is, having alopecia may cause stress.

Treatments for alopecia areata include injecting small amounts of steroids like triamcinolone into affected patches to stimulate hair growth. Although localized injections may not be practical for large areas, often this is a very effective treatment in helping the hairs return sooner. Other treatments such as oral steroids or other immunosuppressives, or ultraviolet light therapy are available for more widespread or severe cases but may be impractical for most patients because of potential side effects or risks. In most mild cases, patients can easily cover up or comb over the affected areas. In more severe and chronic cases, some patients wear hairpieces; nowadays, some men shave their whole scalp now that this look has become fashionable.

Medically Reviewed by a Doctor on 3/24/2014

Patient Comments

Viewers share their comments

Hair Loss - Treatments Question: What hair loss treatments have worked well for you?
Hair Loss - Age and Pattern Question: How old were you when you first experienced hair loss? How would you describe or classify the pattern?
Hair Loss - Vitamins Question: What vitamins do you take for hair loss? Have you noticed an improvement since taking them?
Hair Loss - Options Question: What optional treatments have you tried for your hair loss? Are you happy with the results?
Hair Loss - Telogen Effuvium Question: Describe your experience with telogen effuvium, including the suspected cause for your "sudden" hair loss.
Hair Loss - Women Question: If you are a woman, describe your experience with hair loss, including any treatments.