Hair loss (Alopecia)

Hair loss, also called alopecia, is when hair falls out from your scalp or elsewhere on your body faster than it grows back. It ranges from mild thinning to complete baldness, It is not usually anything to be worried about, but occasionally it can be a sign of a medical condition. Due to the limited success of medical treatment in alopecia, it can be associated with considerable psychological distress (anxiety and depression).

Symptoms of hair loss

Losing some hair every day is normal. Signs that you may be losing more than usual include:

• finding noticeably more hair on your pillow, in the shower or on your hairbrush
• a wider parting or hair that looks thinner overall
• a receding hairline, often starting at the temples
• one or more round or patchy bald spots

Itching and soreness, however only when caused by an accompanying inflammatory skin disease. However, a burning, prickly discomfort known as trichodynia may accompany hair shedding.

Causes of hair loss and who is at risk

It's normal to lose 50–100 hairs a day, often without noticin. Some types of hair loss are permanent, such as male and female pattern baldness, which usually run in families and are linked to genetics and hormones.

Other types are temporary and can be caused by an illness, stress, cancer treatment, weight loss, or a lack of iron or other nutrients. Hair loss can also be a side effect of certain medications, a fungal infection of the scalp, or an autoimmune condition where your immune system attacks your hair follicles.

You may be more likely to experience hair loss if you:

• have a family history of baldness
• are getting older
• have recently been ill, had surgery, or given birth
• are under a lot of stress
• have a medical condition such as a thyroid disorder, lupus.
• have a poor diet or a deficiency in iron, zinc, protein or biotin
• wear tight hairstyles, or use harsh chemical treatments or heat styling regularly.

Are there different types of hair loss?

Hair loss is generally grouped into scarring and non-scarring types. Scarring hair loss is less common and permanently destroys the hair follicle, while non-scarring types are more common and often temporary. The most common types include:

• androgenic alopecia (male or female pattern baldness), caused by genetics and hormones and the most common type overall
• telogen effluvium, temporary shedding triggered by stress, illness, surgery or a change in hormones, such as after childbirth
• alopecia areata, an autoimmune condition that causes patchy hair loss when your immune system attacks your hair follicles
• traumatic alopecia, caused by tight hairstyles, heat, chemical treatments, or compulsive hair pulling
• tinea capitis, a fungal infection of the scalp that causes patchy hair loss with scaling.

How hair loss is diagnosed

Your doctor will usually start by asking about your medical history, any medications you take, your diet and your hairdressing habits, then examine your hair and scalp. Tell them if your hair loss is affecting your wellbeing and ask what treatments might help.

If they suspect a fungal infection, they may take a small hair or skin sample to test in a laboratory. Blood tests may also be used if an underlying illness, such as a thyroid problem, iron deficiency or hormone imbalance, is suspected.

How hair loss is treated

Most hair loss doesn't need treatment. It's often temporary, a normal part of getting older, or it stops and grows back once an underlying illness, deficiency or medication has been dealt with.

If your hair loss is causing you distress, there are things you can try, although not all treatments are available on the NHS and no treatment works for everyone.

Minoxidil and finasteride are the main medicines for male / Female pattern hair loss. Minoxidil is applied to the scalp and can be used by both men and women, but finasteride, taken as a tablet, is not recommended for women. Both treatments only work for as long as you keep using them, and it can take several months to see any improvement.

Other treatments include steroid injections or creams for alopecia areata, immunotherapy, and light treatment applied to bald patches. Wigs are another option, and some are available on the NHS, although you may need to pay unless you qualify for financial help.

Surgical options include hair transplant surgery, where hair is moved from the back of your head to thinning areas, and scalp reduction surgery, where sections of bald scalp are removed and the surrounding hair-covered skin is stitched together. These procedures are not routinely available on the NHS.

When to see a doctor

See a GP if you're worried about your hair loss, particularly if it's sudden, patchy or affecting your wellbeing. It's best to get a diagnosis from a GP before considering a commercial hair clinic.

You should also seek advice if:

• your hair loss happens suddenly or in clumps
• you have bald patches, especially with itching or scaling
• you have other symptoms alongside your hair loss
• your hair loss is causing you distress or affecting your quality of life.