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Hair loss, also known as alopecia or baldness, refers to a loss of
hair Hair is a protein filament In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecular interactions, Ph ...

hair
from part of the head or body. Typically at least the head is involved. The severity of hair loss can vary from a small area to the entire body.
Inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology is the natural science that studies life and living organisms, including their anato ...
or
scarring A scar is an area of fibrous tissue that replaces normal skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other cuticl ...
is not usually present. Hair loss in some people causes
psychological distress Mental distress (or psychological distress) is a term used, by some mental health practitioners and users of mental health services, to describe a range of symptoms and experiences of a person's internal life that are commonly held to be troubling, ...
. Common types include male- or female-pattern hair loss,
alopecia areata Alopecia areata, also known as spot baldness, is a condition in which hair is lost from some or all areas of the body. Often it results in a few bald spots on the scalp, each about the size of a coin. The disease may cause psychological stress ...

alopecia areata
, and a thinning of hair known as
telogen effluvium Telogen effluvium is a scalp The scalp is the anatomical area bordered by the human face The face is the front of an animal's head that features the eyes Eyes are organs An organ is a group of tissues with similar functions. Plant ...
. The cause of male-pattern hair loss is a combination of
genetics Genetics is a branch of biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular biology, molecular interactions, Physiology, ...

genetics
and male hormones; the cause of female pattern hair loss is unclear; the cause of alopecia areata is
autoimmune Autoimmunity is the system of immune responses of an organism against its own healthy cells, tissues and other body normal constituents. Any disease that results from such an aberrant immune response is termed an "autoimmune disease An autoimmun ...
; and the cause of telogen effluvium is typically a physically or psychologically stressful event. Telogen effluvium is very common following
pregnancy Pregnancy, also known as gestation, is the time during which one or more offspring In biology, offspring are the young creation of living organisms, produced either by a Asexual reproduction, single organism or, in the case of sexual repr ...

pregnancy
. Less common causes of hair loss without inflammation or scarring include the , certain medications including
chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment Cancer Cancer is a group of diseases A disease is a particular abnormal condition that negatively affects the structure or f ...

chemotherapy
,
HIV/AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection An infection is the invasion of an organism's body by , their multiplication, and the reaction of ...
,
hypothyroidism Hypothyroidism (also called ''underactive thyroid'', ''low thyroid'' or ''hypothyreosis'') is a disorder of the endocrine system in which the thyroid gland The thyroid, or thyroid gland, is an endocrine gland in the neck consisting of two ...

hypothyroidism
, and
malnutrition Malnutrition is 'a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein and other nutrients causes measurable adverse effect on tissue and body form (body shape, size and composition) and function and clinical ou ...
including
iron deficiency Iron deficiency, or sideropenia, is the state in which a body lacks enough iron Iron () is a with Fe (from la, ) and 26. It is a that belongs to the and of the . It is, on , right in front of (32.1% and 30.1%, respectively), formi ...
. Causes of hair loss that occurs with scarring or inflammation include
fungal infection Fungal infection, also known as mycosis, is disease A disease is a particular abnormal condition that negatively affects the structure A structure is an arrangement and organization of interrelated elements in a material object or s ...

fungal infection
,
lupus erythematosus Lupus erythematosus is a collection of autoimmune diseases in which the human immune system becomes hyperactive and attacks healthy tissue (biology), tissues. Symptoms of these diseases can affect many different body systems, including joints, sk ...

lupus erythematosus
,
radiation therapy Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation Ionizing radiation (or ionising radiation), including nuclear radiation, consists of s or s that have sufficient to s or s by detachi ...

radiation therapy
, and
sarcoidosis Sarcoidosis is a disease involving abnormal collections of inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph nodes. Less commonly affected are the eyes, liver, heart, and brain. Any ...

sarcoidosis
. Diagnosis of hair loss is partly based on the areas affected. Treatment of pattern hair loss may simply involve accepting the condition, which can also include shaving one's head. Interventions that can be tried include the medications
minoxidil Minoxidil (2,4-diamino-6-piperidinopyrimidine 3-oxide), sold under the brand name Rogaine among others, is a medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to ...

minoxidil
(or
finasteride Finasteride, sold under the brand names Proscar and Propecia among others, is a medication used to treat hair loss Hair loss, also known as alopecia or baldness, refers to a loss of hair Hair is a protein filament In biology ...

finasteride
) and
hair transplant surgery Hair transplantation is a surgical Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical or dental specialty that uses operative manual and instrumental tec ...
. Alopecia areata may be treated by
steroid A steroid is a biologically active organic compound In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up matter to the composed of s, s and s: their composition, structure, ...
injections in the affected area, but these need to be frequently repeated to be effective. Hair loss is a common problem. Pattern hair loss by age 50 affects about half of men and a quarter of women. About 2% of people develop alopecia areata at some point in time.


Terminology

Baldness is the partial or complete lack of hair growth, and part of the wider topic of "hair thinning". The degree and pattern of baldness varies, but its most common cause is
androgenic hair loss Pattern hair loss is hair loss Hair loss, also known as alopecia or baldness, refers to a loss of hair Hair is a protein filament In biology Biology is the natural science that studies life and living organisms, including t ...
, ''alopecia androgenetica'', or ''alopecia seborrheica'', with the last term primarily used in Europe.


Hypotrichosis

Hypotrichosis is a condition of abnormal hair patterns, predominantly loss or reduction. It occurs, most frequently, by the growth of
vellus hair Vellus hair is short, thin, light-colored, and barely noticeable hair Hair is a protein filament that grows from follicles found in the dermis. Hair is one of the defining characteristics of mammals. The human body, apart from areas of g ...
in areas of the body that normally produce
terminal hair In humans, terminal hair is thick and long, such as what grows on the scalp, as compared with vellus hair Vellus hair is short, thin, light-colored, and barely noticeable hair Hair is a protein filament that grows from follicles foun ...
. Typically, the individual's
hair growth The growth of human hair occurs everywhere on the body except for the soles of the feet, the inside of the mouth, the lips, the backs of the ears, the palms of the hands, some external genital A sex organ (or reproductive organ) is any part of a ...
is normal after birth, but shortly thereafter the hair is shed and replaced with sparse, abnormal hair growth. The new hair is typically fine, short and brittle, and may lack pigmentation. Baldness may be present by the time the subject is 25 years old.


Signs and symptoms

Symptoms of hair loss include hair loss in patches usually in circular patterns, dandruff, skin lesions, and scarring. Alopecia areata (mild – medium level) usually shows in unusual hair loss areas, e.g., eyebrows, backside of the head or above the ears, areas the male pattern baldness usually does not affect. In male-pattern hair loss, loss and thinning begin at the temples and the crown and hair either thins out or falls out. Female-pattern hair loss occurs at the
frontal Front may refer to: Arts, entertainment, and media Films * The Front (1943 film), ''The Front'' (1943 film), a 1943 Soviet drama film * ''The Front'', 1976 film Music *The Front (band), an American rock band signed to Columbia Records and acti ...

frontal
and . People have between 100,000 and 150,000 hairs on their head. The number of strands normally lost in a day varies but on average is 100. In order to maintain a normal volume, hair must be replaced at the same rate at which it is lost. The first signs of hair thinning that people will often notice are more hairs than usual left in the hairbrush after brushing or in the basin after shampooing. Styling can also reveal areas of thinning, such as a wider parting or a thinning crown.


Skin conditions

A substantially blemished face, back and limbs could point to cystic acne. The most severe form of the condition,
cystic acne Acne, also known as acne vulgaris, is a long-term Cutaneous condition, skin condition that occurs when Keratinocyte, dead skin cells and Sebum, oil from the skin clog hair follicles. Typical features of the condition include comedo, blackhead ...

cystic acne
, arises from the same hormonal imbalances that cause hair loss and is associated with
dihydrotestosterone Dihydrotestosterone (DHT, 5α-dihydrotestosterone, 5α-DHT, androstanolone or stanolone) is an endogenous Endogenous substances and processes are those that originate from within a system such as an organism, Tissue (biology), tissue, or Cell ...
production.
Seborrheic dermatitis Seborrhoeic dermatitis, sometimes inaccurately referred to as seborrhoea, is a long-term skin disorder. Symptoms include red, scaly, greasy, itchy, and inflamed skin. Areas of the skin rich in sebum, oil-producing glands are often affected includi ...
, a condition in which an excessive amount of
sebum A sebaceous gland is a microscopic exocrine Exocrine glands are gland In animals, a gland is a group of cells in an animal's body that synthesizes substances (such as hormone A hormone (from the Greek participle , "setting in motion") is a ...
is produced and builds up on the scalp (looking like an adult
cradle cap Cradle cap causes crusty or oily scaly patches on a baby's scalp. The condition is not painful or itchy, but it can cause thick white or yellow scales that are not easy to remove. Cradle cap most commonly begins sometime in the first three months ...
), is also a symptom of hormonal imbalances, as is an excessively oily or dry scalp. Both can cause hair thinning.


Psychological

Hair thinning and baldness cause psychological stress due to their effect on appearance. Although societal interest in appearance has a long history, this particular branch of psychology came into its own during the 1960s and has gained momentum as messages associating physical attractiveness with success and happiness grow more prevalent. The
psychology Psychology is the scientific Science () is a systematic enterprise that builds and organizes knowledge Knowledge is a familiarity or awareness, of someone or something, such as facts A fact is an occurrence in the real world. ...

psychology
of hair thinning is a complex issue. Hair is considered an essential part of overall identity: especially for women, for whom it often represents femininity and attractiveness. Men typically associate a full head of hair with youth and vigor. Although they may be aware of pattern baldness in their family, many are uncomfortable talking about the issue. Hair thinning is therefore a sensitive issue for both sexes. For sufferers, it can represent a loss of control and feelings of isolation. People experiencing hair thinning often find themselves in a situation where their physical appearance is at odds with their own
self-image Self-image is the mental picture, generally of a kind that is quite resistant to change, that depicts not only details that are potentially available to an objective investigation by others (height, weight, hair color, etc.), but also items that ...
and commonly worry that they appear older than they are or less attractive to others. Psychological problems due to baldness, if present, are typically most severe at the onset of symptoms. Hair loss induced by cancer
chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment Cancer Cancer is a group of diseases A disease is a particular abnormal condition that negatively affects the structure or f ...

chemotherapy
has been reported to cause changes in
self-concept One's self-concept (also called self-construction, self-identity, self-perspective or self-structure) is a collection of beliefs about oneself. Generally, self-concept embodies the answer to the question ''"Who am I?"'' Self-concept is disting ...

self-concept
and
body image Body image is a person's thoughts, feelings and perception of the aesthetics Aesthetics, or esthetics (), is a branch of philosophy Philosophy (from , ) is the study of general and fundamental questions, such as those about Metaphy ...

body image
. Body image does not return to the previous state after regrowth of hair for a majority of patients. In such cases, patients have difficulties expressing their feelings (alexithymia) and may be more prone to avoiding family conflicts. Family therapy can help families to cope with these psychological problems if they arise.


Causes

Although not completely understood, hair loss can have many causes:


Pattern hair loss

Male pattern hair loss is believed to be due to a combination of genetics and the androgen, male hormone
dihydrotestosterone Dihydrotestosterone (DHT, 5α-dihydrotestosterone, 5α-DHT, androstanolone or stanolone) is an endogenous Endogenous substances and processes are those that originate from within a system such as an organism, Tissue (biology), tissue, or Cell ...
. The cause in female pattern hair loss remains unclear.


Infection

* Dissecting cellulitis of the scalp * Fungal infections (such as tinea capitis) * Folliculitis from various causes ** Demodex folliculitis, caused by ''Demodex folliculorum'', a microscopic mite that feeds on the sebum produced by the sebaceous glands, denies hair essential nutrients and can cause thinning. ''Demodex folliculorum'' is not present on every scalp and is more likely to live in an excessively oily scalp environment. * Secondary syphilis


Drugs

* Temporary or permanent hair loss can be caused by several medications, including those for blood pressure problems, Diabetes mellitus, diabetes, heart disease and cholesterol. Any that affect the body's hormone balance can have a pronounced effect: these include the contraceptive pill, Hormone replacement therapy (menopause), hormone replacement therapy, steroids and Acne vulgaris, acne medications. * Some treatments used to cure fungus, mycotic infections can cause massive hair loss. * Medications (side effects from drugs, including
chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment Cancer Cancer is a group of diseases A disease is a particular abnormal condition that negatively affects the structure or f ...

chemotherapy
, anabolic steroids, and birth control pills)


Trauma

* Traction alopecia is most commonly found in people with ponytails or cornrows who pull on their hair with excessive force. In addition, rigorous brushing and heat styling, rough scalp massage can damage the Cuticle (hair), cuticle, the hard outer casing of the hair. This causes individual strands to become weak and break off, reducing overall hair volume. * Frictional alopecia is hair loss caused by rubbing of the hair or follicles, most infamously around the ankles of men from socks, where even if socks are no longer worn, the hair often will not grow back. * Trichotillomania is the loss of hair caused by compulsive pulling and bending of the hairs. Onset of this disorder tends to begin around the onset of puberty and usually continues through adulthood. Due to the constant extraction of the hair roots, permanent hair loss can occur. * Traumas such as childbirth, major surgery, poisoning, and severe stress may cause a hair loss condition known as
telogen effluvium Telogen effluvium is a scalp The scalp is the anatomical area bordered by the human face The face is the front of an animal's head that features the eyes Eyes are organs An organ is a group of tissues with similar functions. Plant ...
, in which a large number of hairs enter the resting phase at the same time, causing shedding and subsequent thinning. The condition also presents as a side effect of
chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment Cancer Cancer is a group of diseases A disease is a particular abnormal condition that negatively affects the structure or f ...

chemotherapy
– while targeting dividing cancer cells, this treatment also affects hair's growth phase with the result that almost 90% of hairs fall out soon after chemotherapy starts. * Radiation to the scalp, as when radiotherapy is applied to the head for the treatment of certain cancers there, can cause baldness of the irradiated areas.


Pregnancy

Hair loss often follows childbirth in the postpartum period without causing baldness. In this situation, the hair is actually thicker during pregnancy owing to increased circulating oestrogens. Approximately three months after giving birth (typically between 2 and 5 months), oestrogen levels drop and hair loss occurs, often particularly noticeably around the hairline and Temple (anatomy), temple area. Hair typically grows back normally and treatment is not indicated. A similar situation occurs in women taking the fertility-stimulating drug clomiphene.


Other causes

* Autoimmune disease. Alopecia areata is an autoimmune diseases, autoimmune disorder also known as "spot baldness" that can result in hair loss ranging from just one location (''Alopecia areata monolocularis'') to every hair on the entire body (''Alopecia areata universalis''). Although thought to be caused by hair follicles becoming dormant, what triggers alopecia areata is not known. In most cases the condition corrects itself, but it can also spread to the entire scalp (alopecia totalis) or to the entire body (alopecia universalis). * Skin diseases and cancer. Localized or diffuse hair loss may also occur in cicatricial alopecia (
lupus erythematosus Lupus erythematosus is a collection of autoimmune diseases in which the human immune system becomes hyperactive and attacks healthy tissue (biology), tissues. Symptoms of these diseases can affect many different body systems, including joints, sk ...

lupus erythematosus
, lichen plano pilaris, folliculitis decalvans, central centrifugal cicatricial alopecia, postmenopausal frontal fibrosing alopecia, etc.). Tumours and skin outgrowths also induce localized baldness (sebaceous nevus, basal cell carcinoma, squamous cell carcinoma). * Hypothyroidism (an under-active thyroid) and the side effects of its related medications can cause hair loss, typically frontal, which is particularly associated with thinning of the outer third of the eyebrows (also seen with syphilis). Hyperthyroidism (an over-active thyroid) can also cause hair loss, which is parietal rather than frontal. * Sebaceous cysts. Temporary loss of hair can occur in areas where sebaceous cysts are present for considerable duration (normally one to several weeks). * Triangular alopecia, Congenital triangular alopecia – It is a triangular, or oval in some cases, shaped patch of hair loss in the temple area of the scalp that occurs mostly in young children. The affected area mainly contains vellus hair follicles or no hair follicles at all, but it does not expand. Its causes are unknown, and although it is a permanent condition, it does not have any other effect on the affected individuals. * Hair growth conditions. Gradual thinning of hair with age is a natural condition known as ''involutional alopecia''. This is caused by an increasing number of hair follicles switching from the growth, or anagen, phase into a resting phase, or telogen phase, so that remaining hairs become shorter and fewer in number. An unhealthy scalp environment can play a significant role in hair thinning by contributing to miniaturization or causing damage. * Air and water pollutants, environmental toxins, conventional styling products and excessive amounts of sebum have the potential to build up on the scalp.. This debris can block hair follicles and cause their deterioration and consequent miniaturization of hair. It can also physically restrict hair growth or damage the Cuticle (hair), hair cuticle, leading to hair that is weakened and easily broken off before its natural lifecycle has ended. * Obesity. Obesity-induced stress, such as that induced by a high-fat diet (HFD), targets hair follicle stem cells (HFSCs) to accelerate hair thinning in mice. It is likely that similar molecular mechanism play a role in human hair loss. Other causes of hair loss include: * Alopecia mucinosa * Biotinidase deficiency * Chronic inflammation * Diabetes * Pseudopelade of Brocq * Telogen effluvium * Tufted folliculitis


Genetics

Genetic forms of localized autosomal recessive hypotrichosis include:


Pathophysiology

Hair follicle growth occurs in cycles. Each cycle consists of a long growing phase (anagen phase, anagen), a short transitional phase (anagen phase, catagen) and a short resting phase (anagen phase, telogen). At the end of the resting phase, the hair falls out (exogen) and a new hair starts growing in the follicle, beginning the cycle again. Normally, about 40 (0–78 in men) hairs reach the end of their resting phase each day and fall out. When more than 100 hairs fall out per day, clinical hair loss (
telogen effluvium Telogen effluvium is a scalp The scalp is the anatomical area bordered by the human face The face is the front of an animal's head that features the eyes Eyes are organs An organ is a group of tissues with similar functions. Plant ...
) may occur. A disruption of the growing phase causes abnormal loss of anagen hairs (anagen effluvium).


Diagnosis

Because they are not usually associated with an increased loss rate, male-pattern and female-pattern hair loss do not generally require testing. If hair loss occurs in a young man with no family history, drug use could be the cause. * The pull test helps to evaluate diffuse scalp hair loss. Gentle traction is exerted on a group of hairs (about 40–60) on three different areas of the scalp. The number of extracted hairs is counted and examined under a microscope. Normally, fewer than three hairs per area should come out with each pull. If more than ten hairs are obtained, the pull test is considered positive. * The pluck test is conducted by pulling hair out "by the roots". The root of the plucked hair is examined under a microscope to determine the phase of growth, and is used to diagnose a defect of telogen, anagen, or systemic disease. Telogen hairs have tiny bulbs without sheaths at their roots. Telogen effluvium shows an increased percentage of hairs upon examination. Anagen hairs have sheaths attached to their roots. Anagen effluvium shows a decrease in telogen-phase hairs and an increased number of broken hairs. * Scalp biopsy is used when the diagnosis is unsure; a biopsy allows for differing between scarring and nonscarring forms. Hair samples are taken from areas of inflammation, usually around the border of the bald patch. * Daily hair counts are normally done when the pull test is negative. It is done by counting the number of hairs lost. The hair from the first morning combing or during washing should be counted. The hair is collected in a clear plastic bag for 14 days. The strands are recorded. If the hair count is >100/day, it is considered abnormal except after shampooing, where hair counts will be up to 250 and be normal. * Trichoscopy is a noninvasive method of examining hair and scalp. The test may be performed with the use of a handheld dermoscope or a video dermoscope. It allows differential diagnosis of hair loss in most cases. There are two types of identification tests for female pattern baldness: the Ludwig Scale and the Savin Scale. Both track the progress of diffused thinning, which typically begins on the crown of the head behind the hairline, and becomes gradually more pronounced. For male pattern baldness, the Hamilton–Norwood scale tracks the progress of a receding hairline and/or a thinning crown, through to a horseshoe-shaped ring of hair around the head and on to total baldness. In almost all cases of thinning, and especially in cases of severe hair loss, it is recommended to seek advice from a doctor or dermatologist. Many types of thinning have an underlying genetic or health-related cause, which a qualified professional will be able to diagnose.


Management


Hiding hair loss


Head

One method of hiding hair loss is the comb over, which involves restyling the remaining hair to cover the balding area. It is usually a temporary solution, useful only while the area of hair loss is small. As the hair loss increases, a comb over becomes less effective. Another method is to wear a hat or a hairpiece such as a Wig (hair), wig or toupee. The wig is a layer of artificial or natural hair made to resemble a typical hair style. In most cases the hair is artificial. Wigs vary widely in quality and cost. In the United States, the best wigs—those that look like real hair—cost up to tens of thousands of dollars. Organizations also collect individuals' donations of their own natural hair to be made into wigs for young cancer patients who have lost their hair due to
chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment Cancer Cancer is a group of diseases A disease is a particular abnormal condition that negatively affects the structure or f ...

chemotherapy
or other cancer treatment in addition to any type of hair loss.


Eyebrows

Though not as common as the loss of hair on the head, chemotherapy, hormone imbalance, forms of hair loss, and other factors can also cause loss of hair in the eyebrows. Loss of growth in the outer one third of the eyebrow is often associated with
hypothyroidism Hypothyroidism (also called ''underactive thyroid'', ''low thyroid'' or ''hypothyreosis'') is a disorder of the endocrine system in which the thyroid gland The thyroid, or thyroid gland, is an endocrine gland in the neck consisting of two ...

hypothyroidism
. Artificial eyebrows are available to replace missing eyebrows or to cover patchy eyebrows. Eyebrow embroidery is another option which involves the use of a blade to add pigment to the eyebrows. This gives a natural 3D look for those who are worried about an artificial look and it lasts for two years. Micropigmentation (permanent makeup tattooing) is also available for those who want the look to be permanent.


Medications

Treatments for the various forms of hair loss have limited success. Three medications have evidence to support their use in male pattern hair loss:
minoxidil Minoxidil (2,4-diamino-6-piperidinopyrimidine 3-oxide), sold under the brand name Rogaine among others, is a medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to ...

minoxidil
,
finasteride Finasteride, sold under the brand names Proscar and Propecia among others, is a medication used to treat hair loss Hair loss, also known as alopecia or baldness, refers to a loss of hair Hair is a protein filament In biology ...

finasteride
, and dutasteride. They typically work better to prevent further hair loss, than to regrow lost hair. * Minoxidil (Rogaine) is a nonprescription medication approved for male pattern baldness and alopecia areata. In a liquid or foam, it is rubbed into the scalp twice a day. Some people have an allergic reaction to the propylene glycol in the minoxidil solution and a minoxidil foam was developed without propylene glycol. Not all users will regrow hair. The longer the hair has stopped growing, the less likely minoxidil will regrow hair. Minoxidil is not effective for other causes of hair loss. Hair regrowth can take 1 to 6 months to begin. Treatment must be continued indefinitely. If the treatment is stopped, hair loss resumes. Any regrown hair and any hair susceptible to being lost, while Minoxidil was used, will be lost. Most frequent side effects are mild scalp irritation, allergic contact dermatitis, and unwanted hair in other parts of the body. * Finasteride (Propecia) is used in male-pattern hair loss in a pill form, taken 1 milligram per day. It is not indicated for women and is not recommended in pregnant women (as it is known to cause birth defects in fetuses). Treatment is effective starting within 6 weeks of treatment. Finasteride causes an increase in hair retention, the weight of hair, and some increase in regrowth. Side effects in about 2% of males, include decreased libido, sex drive, erectile dysfunction, and ejaculatory dysfunction. Treatment should be continued as long as positive results occur. Once treatment is stopped, hair loss resumes. * Corticosteroids injections into the scalp can be used to treat alopecia areata. This type of treatment is repeated on a monthly basis. Oral pills for extensive hair loss may be used for alopecia areata. Results may take up to a month to be seen. * Immunosuppressants applied to the scalp have been shown to temporarily reverse alopecia areata, though the side effects of some of these drugs make such therapy questionable. * There is some tentative evidence that anthralin may be useful for treating alopecia areata. * Hormonal modulators (oral contraceptive pill, oral contraceptives or antiandrogens such as spironolactone and flutamide) can be used for female-pattern hair loss associated with hyperandrogenism, hyperandrogenemia.


Surgery

Hair transplantation is usually carried out under local anaesthetic. A surgeon will move healthy hair from the back and sides of the head to areas of thinning. The procedure can take between four and eight hours, and additional sessions can be carried out to make hair even thicker. Transplanted hair falls out within a few weeks, but regrows permanently within months. Hair transplants, takes tiny plugs of skin, each which contains a few hairs, and implants the plugs into bald sections. The plugs are generally taken from the back or sides of the scalp. Several transplant sessions may be necessary. * Surgical options, such as follicle transplants, scalp flaps, and hair loss reduction, are available. These procedures are generally chosen by those who are self-conscious about their hair loss, but they are expensive and painful, with a risk of infection and scarring. Once surgery has occurred, six to eight months are needed before the quality of new hair can be assessed. ** Scalp reduction is the process is the decreasing of the area of bald skin on the head. In time, the skin on the head becomes flexible and stretched enough that some of it can be surgically removed. After the hairless scalp is removed, the space is closed with hair-covered scalp. Scalp reduction is generally done in combination with hair transplantation to provide a natural-looking hairline, especially those with extensive hair loss. ** Hairline lowering can sometimes be used to lower a high hairline secondary to hair loss, although there may be a visible scar after further hair loss. * Wigs are an alternative to medical and surgical treatment; some patients wear a wig or hairpiece. They can be used permanently or temporarily to cover the hair loss. High-quality, natural-looking wigs and hairpieces are available.


Chemotherapy

Hypothermia caps may be used to prevent hair loss during some kinds of
chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment Cancer Cancer is a group of diseases A disease is a particular abnormal condition that negatively affects the structure or f ...

chemotherapy
, specifically, when taxanes or anthracyclines are administered. It is not recommended to be used when cancer is present in the skin of the scalp or for lymphoma or leukemia. There are generally only minor side effects from scalp cooling given during chemotherapy.


Embracing baldness

Instead of attempting to conceal their hair loss, some people embrace it by either doing nothing about it or sporting a Head shaving, shaved head. The general public became more accepting of men with shaved heads in the early 1950s, when Russian-American actor Yul Brynner began sporting the look; the resulting phenomenon inspired many of his male fans to shave their heads. Male celebrities then continued to bring mainstream popularity to shaved heads, including athletes such as Michael Jordan and Zinedine Zidane and actors such as Dwayne Johnson, Ben Kingsley, and Jason Statham. Baldness in females, however, is still viewed as less "normal" in various parts of the world.


Alternative medicine

Dietary supplements are not typically recommended. There is only one small trial of saw palmetto which shows tentative benefit in those with mild to moderate androgenetic alopecia. There is no evidence for biotin. Evidence for most other alternative medicine remedies is also insufficient. There was no good evidence for ginkgo, aloe vera, ginseng, bergamot essential oil, bergamot, hibiscus, or sophora as of 2011. Many people use unproven treatments to treat hair loss. Egg oil, in Indian, Japanese, Unani (Roghan Baiza Murgh) and Chinese traditional medicine, was traditionally used as a treatment for hair loss.


Research

Research is looking into connections between hair loss and other health issues. While there has been speculation about a connection between early-onset male pattern hair loss and heart disease, a review of articles from 1954 to 1999 found no conclusive connection between baldness and coronary artery disease. The dermatologists who conducted the review suggested further study was needed. Environmental factors are under review. A 2007 study indicated that smoking may be a factor associated with age-related hair loss among Asian men. The study controlled for age and family history, and found statistically significant positive associations between moderate or severe male pattern hair loss and smoking status. Vertex baldness is associated with an increased risk of coronary heart disease (CHD) and the relationship depends upon the severity of baldness, while frontal baldness is not. Thus, vertex baldness might be a marker of CHD and is more closely associated with atherosclerosis than frontal baldness.


Hair follicle aging

A key aspect of hair loss with age is the aging of the hair follicle. Ordinarily, hair follicle renewal is maintained by the stem cells associated with each follicle. Aging of the hair follicle appears to be primed by a sustained cellular response to the DNA damage that accumulates in renewing stem cells during aging. This damage response involves the proteolysis of Collagen, type XVII, alpha 1, type XVII collagen by neutrophil elastase in response to DNA damage in hair follicle stem cells. Proteolysis of collagen leads to elimination of the damaged cells and, consequently, to terminal hair follicle miniaturization.


Etymology

The term ''alopecia'' () is from the Classical Greek wikt:ἀλώπηξ, ἀλώπηξ, ''alōpēx'', meaning "fox". The origin of this usage is because this animal sheds its coat twice a year, or because in ancient Greece foxes often lost hair because of mange.


See also

* Alopecia in animals * Lichen planopilaris * List of conditions caused by problems with junctional proteins


References


External links

* {{Authority control Conditions of the skin appendages External signs of ageing Hair diseases Human hair Radiation health effects Wikipedia medicine articles ready to translate Wikipedia neurology articles ready to translate