Identifying Causes of Hair Loss

1. Look into genetic factors

Hair loss (known as alopecia) can be based on genetic factors (male-pattern baldness and female-pattern baldness). These are both known as androgenic alopecia because both are dependent on levels of the hormone androgen, which is responsible for hair on the scalp, face, chest, underarms, and genital regions.

• In men, the hair loss occurs at the front of hairline and on the top of the head (the “bald spot”).
• In women, hair is thinned all over the scalp, but more at the top of the head. Women usually don’t get bald spots.
• Androgenic alopecia is the most common form of hair loss.
• Though far less common, congenital hypotrichosis is a group of genetic conditions with little or no hair growth. These may be due to single or multiple gene defects.\

2. Examine recent events and stress levels

Environmental causes can lead to what’s known as telogen effluvium (TE), which is the second leading cause of hair loss. The telogen phase is the resting phase of hair growth. If, for any reason, the number of hair follicles in the active, growth phase drops, TE can result, and a person would notice more shedding, usually by noting more hair than usual in a comb or brush. You might also notice more hair loss during bathing or on a bath towel. TE can develop in three ways:

• An environmental “insult” stuns or shocks the hair follicles, and they stop growing. This type of TE is usually temporary as long as the triggering event is temporary, and normal hair growth returns within 6-12 months.
• If the environmental “insult” is more persistent, more and more hair follicles enter the resting state, and there will be a slow, but constant loss of hair.
• A third type of TE may or may not be due to an environmental stressor. In this type, the hair follicles go through shorter hair-growth cycles. The result is thin scalp hair and shedding short hairs, which are very thin.
• The environmental stressors can be many. Some short-term stressors include postpartum alopecia (after giving birth), physical trauma (an accident, a fall, or a broken leg, for instance), vaccinations, crash dieting, or medications, especially antidepressants. More persistent environmental stressors that may lead to more persistent TE include nutritional deficiencies (iron, zinc, B-vitamins, lysine) and chronic stress.

3. Consider chemical interactions that affect the growth phase of your hair

Anagen effluvium is a rapid form of hair loss due to an interruption in the anagen (or growth phase) of your hair. The most common causes are cancer chemotherapy and poisonings (such as heavy metal poisoning). Once chemotherapy ends, or when the poisoning has been treated, hair growth returns, though not always as before. Some people experience a change in hair color or type—changing to curly from straight or vice versa.

4. Consider autoimmune and/or inflammatory conditions

Alopecia areata (AA) is believed to be an autoimmune disease where the immune system attacks the hair follicles. Hair loss can be sudden and most often happens on the scalp in patches. If the entire scalp is affected, it is called alopecia totalis. If the entire body is affected, it is called alopecia universalis. If it is limited to the beard area in men, it is termed alopecia barbae. Different forms of AA are seen in men, women, and children. AA may go into a spontaneous remission, or it can be persistent.

• Conditions such as systemic lupus erythematosus (Lupus or SLE), discoid lupus erythematosus (DLE) and sarcoidosis are other autoimmune conditions that can lead to hair loss.
• Folliculitis and seborrheic dermatitis are two examples of inflammatory skin conditions that can cause hair loss. If you notice any overly dry skin or red, acne-like rashes around the site of the hair loss, then contact your doctor for a diagnosis.
• Many of these conditions can lead to scarring alopecia, which occurs when scar tissue results in irreversible destruction of hair follicles. This can be the result of a chronic disease (SLE) or various forms of folliculitis.

5. Try to diagnose any infections

Certain viral, bacterial, and fungal infections (such as HIV, late-stage syphilis, and ringworm, respectively) can also lead to hair loss. When ringworm (a group of common fungal infections with no actual worms involved) occurs on the scalp, it results in patchy hair loss called tinea capitis.

• There are a number of fungal organisms that can cause tinea capitis, including Microsporum audouini, Trichophyton tonsurans (especially in Latin American countries), Trichophyton schoenleinii, Trichophyton megnini (Southern Europe and Africa), and Trichophyton violaceum (Middle East).

6. Read medication labels closely for hair loss as a side effect

Drugs such as antidepressants, acne medications, anticoagulants (blood thinners), anticonvulsants, cholesterol-lowering drugs, beta-blockers used in glaucoma or heart disease, anti-fungals, anti-gout medications, anti-inflammatory drugs, and medications used to treat Parkinson’s disease, ulcers, and thyroid disease may all have hair loss as a side effect.

7. Consider other conditions and diseases that can result in hair loss

If you suffer from muscular disorders (muscular dystrophy) or glandular conditions such as hyperthyroid (overactive thyroid), hypothyroid (underactive thyroid), either low or high adrenal function, or diseases of the pituitary gland, then you may also experience hair loss as a result.

8. Note if your hair style can contribute to hair loss

Certain hairstyles (tight pigtails and corn rows, for instance) and chemical or physical treatments (curling irons, perms, hot oil treatments, hair color products) can encourage hair loss. Keratin-treated hair (also known as Brazilian Blowout or Brazilian Keratin Treatment) has been reported to cause hair loss because of the presence of formaldehyde-like chemicals in the products.

• In August 2011, the U.S. Food and Drug Administration (FDA) sent a warning letter to the producers of many such products citing both safety and labeling violations.