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What Is Hair Loss And How to Diagnose It? The 9 Most Common Types.

Learn what hair loss is, its common causes and how to diagnose it.

The only constant in life is change, which affects everyone. So, it’s common to see certain changes in hair texture and color. Some changes that may occur include the appearance of gray strands, slight thinning, or a reduced growth speed. It is common to see the normal falling of hair daily, which is expected during the hair growth cycle. In most cases, you will continue to have a full head of hair even after experiencing this kind of hair fall. But here are certain cases where one can have an extreme loss and new hair doesn’t sprout.

In this article, we will focus on hair health prevention and methods to control loss of hair as we age. Let’s begin by understanding the science and causes and as we explore the process of hair loss, we shall also uncover methods of maintaining healthy hair at each stage of its existence.

Hair Loss

As suggested by the  American Academy of Dermatology Association, it is normal to lose about 100 hairs of an average adult’s head per day, out of 100,000 to 150,000. These hair follow a staged pattern, such as,

  • The growing period of hair, known as anagen, lasts two to six years.
  • The transitory period of two to three weeks is known as the catagen phase.
  • A two- or three-month rest period is known as the telogen phase.
  • The last is the shedding phase, which lasts about two to five months.

All the hair on our heads follows these stages to grow and regenerate via hair follicles. But in certain cases, hair loss becomes so evident that more hair falls from the head than usual. A receding hairline, patchy hair fall, or general thinning can result from a disruption in this cycle or injury to a hair follicle, which causes hair to fall out faster than it regenerates. This is known as hair loss or alopecia, in medical terminology. Although the scalp is the most typical site of losing hair, it can happen anywhere on the body where hair is present.

Types of Hair Loss

With complete explanations, here is a breakdown of the most common forms of hair loss.

1. Involutional Alopecia

It is also known as aging alopecia. It causes hair thinning, which is a common occurrence in the aging process and begins around the 40s and 50s in both sexes. The natural process of aging causes a decline in the density of hair follicles, which causes hair to thin down gradually.

In most cases, involutional alopecia affects the full scalp instead of only a few spots, making it different from other types of alopecia. It also doesn’t cause any inflammation, redness or scaring. In most cases, it causes a slow loss of hair density rather than total baldness.

2. Androgenetic Alopecia

It is the most common type and impacts over 50 million men and 30 million women annually in the United States. As the name indicates, androgenetic alopecia is genetic. It affects all sexes and is termed as male or female pattern hair loss. The term androgenetic mentions its role in the disruption of androgen hormones, which are involved in proper male sexual development and have other vital roles in both sexes, such as regulating hair growth and sex drive. The genetically programmed delay in the onset of the growth phase (anagen) and an increase in the duration between the beginning of the telogen phase characterize this alopecia.

This means that the typical growth cycle takes a little longer to regrow hair after it is shed. In males, a hair-thinning pattern that resembles the letter “M” typically develops from the hairline to the back of the head. In females, it predominantly impacts the tip of the crown of the head.

Another change that occurs is the hair follicle itself, which undergoes a process known as “follicular miniaturization.” This results in a thicker, shorter hair shaft. Consequently, “vellus” hairs” are grown from heads that are shorter, thinner, and non-pigmented, replacing the thicker ones.

Male Pattern Hair Loss

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It typically begins above the temples and winds its way around the crown and sides of the head, leaving a ring of hair at the base of the skull. At some point, baldness sets in for many men with male-pattern hair loss.

Female Pattern Hair Loss (FPHL)

A common misconception about patterned hair loss is that women don’t get it, but research has proven that female patterned hair loss is as common as it is for men. In FPHL, the hairline does not recede as that of men, but hair thinning and widening of the hairline on the top of the head occurs. It can begin anywhere after puberty but usually peaks around the 40s and 50s.

When describing female pattern baldness, clinicians use the Ludwig Classification.

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female androgenetic alopecia. The Ludwig Sign
  • Type I hair loss is very subtle and may be hidden using hairstyle tricks.
  • A narrowing of the midline and a reduction in volume defines type II.
  • Type III characterizes a diffuse thinning that appears see-through on top of the scalp.

FPHL can cause hair to thin out dramatically but never causes baldness.

3. Telogen Effluvium

In telogen effluvium, many hair follicles on the scalp enter the telogen phase, the dormant phase of the hair development cycle, but fail to initiate the next growth phase. It causes widespread hair thinning and the absence of fresh hair growth on the scalp. While total baldness is not usually the result of telogen effluvium, one can expect to lose 300–500 hairs daily and noticeably thinner hair on the crown and temples. The most significant amount of hair is lost, particularly when combing or bathing.

This form of hair loss is usually caused by a number of reasons, such as,

  • A medical event or condition, including a thyroid imbalance, giving birth, surgery, or a fever.
  • Iron deficiency, especially in women.
  • Certain medications, such as isotretinoin, are prescribed for acne, or warfarin, a blood thinner.
  • Using birth control pills.

Telogen effluvium usually begins almost 3 months after any of the above causes and begins to restore hair health within 6 months. Any time longer than 6 months is considered chronic and requires medical professional consultation to be treated. It accounts for only 5% of the cases of telogen effluvium.

4. Anagen Efflivum

The type of hair loss that occurs after harsh medical treatments such as chemotherapy/radiotherapy can result in a condition known as anagen effluvium. Although these powerful and rapidly acting drugs eliminate cancer cells, they have the potential side effect of reducing the body’s ability to produce new hair follicles, including on the scalp.

This rapid and extensive hair thinning may occur anywhere on the body, including the scalp. The good news is that hair often grows back naturally after chemotherapy within three to six months.

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5. Traction Alopecia

Traction alopecia happens when harsh combing, particular hairstyles, or hair accessories put undue stress on the hair follicles. The main culprit is hairstyles such as braids, tight ponytails, or extensions. It affects areas with the most tension, such as temples or hairlines. It may even cause redness in these areas. The hair follicles are susceptible to long-term damage. So, changing your hairdo, relaxing your muscles, and using hair protection products can all help stop more damage.

6. Alopecia Areata

It is an autoimmune type of alopecia affecting 2% of the global population. the average age affected by this type of alopecia is between 25 and 36 years.

In alopecia areata, the immune system mistakenly targets healthy tissues, such as hair follicles. Because of this, hair starts to fall out and doesn’t grow back. Scalp hair usually comes out in little clumps or patches and from other body parts, such as eyelashes and eyebrows. In more severe cases, it can progress to complete hair loss of the scalp (alopecia totalis) or the entire body (alopecia universalis).

7. Scarring Alopecia

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Scarring Alopecia

Also known as Cicatricial alopecia, is a permanent and rare type of hair loss that causes scaring of hair follicles. It can affect both sexes of any age.

Such type of scarring is a common consequence of inflammatory skin conditions (e.g., cellulitis, folliculitis, acne), as well as certain forms of lichen planus and lupus. The onset of hair loss might be so gradual that the signs go unnoticed. Affected areas may experience inflammation, swelling, or tenderness due to the condition. Hair loss is commonly irreversible as a result of follicle destruction. it means that hair does not regenerate.

8. Trichotillomania

Trichotillomania is more of a psychological condition. It causes a person to obsessively pluck off their own hair, resulting in bald spots.

Mental health problems like anxiety, stress, or OCD are often culprits when this behaviour manifests itself. Many trichotillomaniacs indicate a stressful incident occurred just before their hair-pulling habit began. As a result of the habit’s repetition, hair starts to fall out. Usually caused by oneself, hair loss manifests as bald spots. The scalp, eyelashes, eyebrows, and any other hair-bearing regions are all affected.

9. Loose Anagen Syndrome

When hair that isn’t securely anchored in the follicle may be pulled out easily, a condition known as loose anagen syndrome develops. This condition tends to occur in young children usually only in 10%. The typical time for hair to start falling out is when it reaches some artificial maximum length. No one knows what causes loose anagen syndrome. However, it might be associated with a problem with the hair development cycle that makes it impossible for hair to remain in the follicle.
Many children who suffer from loose anagen syndrome are unable to grow their hair over a certain length. Blonde and brown-haired girls are more likely to suffer from it. 

Cause of Hair Loss

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It is not so much known about the exact causes, but many factors can contribute.

  • Age: As expected, the most common cause is aging. The hair on our scalps gradually thins down as hair follicles stop producing new hair.
  • Genetics: Has either parent ever experienced hair thinning or loss? You will likely, as well. This is androgenetic alopecia, a hereditary hormonal condition.
  • Hormonal Changes: Testosterone, estrogen, and progesterone hormones influence optimal scalp health and hair development. Studies have shown that even a small change in these hormones can cause a dramatic increase or decrease in hair density. Especially in women during menopause, the hormones that promote hair growth, estrogen and progesterone, are reduced, while androgens, which cause hair follicles to shrink, are increased.
  • Diet Lacking Nutrients: Diets that are extremely low in protein or calories can also lead to temporary hair loss. A deficiency of Vitamins such as A.B, E, and K and minerals like iron can also contribute to hair loss.
  • Hair Cosmetic Procedures: Cosmetic procedures such as excessive cleansing, perming, bleaching, and dying can contribute to overall hair thinning and loss. Tight curling with hair picks, rollers, or heated curlers and tight braiding can also cause injury and breakage to the hair, but not baldness in any case. The hair regrows ordinarily once the underlying cause of the issue is eliminated.
  • STIs: Sexually transmitted infections can also cause hair loss. Syphilis, for example, if not treated, can lead to a pattern of thinning hair in several areas, including the scalp, eyebrows, beard, and more.
  • Stress: Chronic stress can exacerbate hair issues, such as thinning, brittleness, and loss.
  • Medical Conditions: A number of medical conditions, including anemia, thyroid illness, lupus, diabetes, and iron deficiency anemia, can lead to hair thinning and loss. Except for scarring conditions such as follicular diseases, lichen planus, or some types of lupus, hair usually grows back if the underlying cause is addressed.

Diagnosing Hair Loss

Sometimes, the causes of alopecia are obvious, such as after chemotherapy. But in many cases, alopecia can be diagnosed after a thorough medical history and a skin examination. Such as,

Medical History

Getting a comprehensive medical history is the first stage. A doctor will ask questions such as,

  • Questions about your family history, including the age at which someone in your family may have encountered hair loss.
  • Any recent stressors or life events such as surgery, childbirth, or stress.
  • Current lifestyle, diet, haircare practices, and sleeping habits.
  • Any underlying medical conditions or hormonal imbalances

The doctor may also ask you about the beginning, duration, pattern, and severity of hair loss and any related symptoms (such as redness, itching, or discomfort) will be inquired about by the healthcare professional.

Physical Examination

  • Scalp Examination: To identify the cause of hair loss, the doctor will then examine your scalp for bald patches, thinning hair, or other anomalies.
  • Pull Test: The doctor might also delicately pull dozens of hair from the scalp to gauge the amount of hair loss. The identification of five to six readily extractable hairs or more signifies a positive pull test result and active hair loss.
  • Tug Test: This is similar to the pull test, but the pull is carried out from the middle shaft of a bunch of strands. When the test results show hair breaking, it indicates weak hair or problems with the hair shaft.
  • Dermatoscopy: A dermatoscope is a medical instrument that magnifies the scalp and hair follicles. Its purpose is to examine the scalp’s health, hair density, and hair shaft structure up close.

Diagnostic Tests

Some additional diagnostic tests can also be carried out.

  • Blood Tests: Blood tests are performed to diagnose thyroid problems, iron deficiencies, hormonal imbalances, autoimmune diseases, and other underlying causes of hair loss.
  • Scalp Biopsy: When the source of hair loss cannot be determined, a biopsy of the scalp is performed to examine the tissue under a microscope. This can be useful in the diagnosis of inflammatory diseases and cicatricial alopecia.
  • Hair Analysis isn’t something you hear often, but it may come in handy sometimes. A hair sample can be analyzed to determine toxins, mineral content, and hair structure.

So, if you are losing hair, you must see a dermatologist or hair expert for a comprehensive assessment. Once you have a correct diagnosis, you may learn more about your illness and consider the best treatment options.

Read our upcoming article for an in-depth look at the numerous hair loss treatments, ranging from conventional methods to cutting-edge therapies.

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Dr Aimen

Being a Doctor by profession, Aimen is passionate about helping people get better health in their lives. Aimen enjoys her research on Prime With Time subjects and strives to create better awareness of the problems and changes related to women's health.
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