Hair loss (alopecia): causes, types and treatment

Definition: When is it referred to as hair loss?

Alopecia is the medical term for visible hair loss or baldness. The process of increased hair loss is known as effluvium.

Every hair goes through a cycle comprising a growth phase, a transitional phase and a resting phase. Eventually, it falls out and new hair grows in its place. Losing up to more than 100 hairs a day is normal. Hair loss is only considered to be a problem if this loss is significantly higher over a prolonged period, the hair becomes thinner or bald patches appear. This excessive hair loss requires medical investigation.

What types of hair loss are there?

It is important to know what type of hair loss you are suffering from, as the causes and treatments vary:

Hereditary hair loss (androgenetic alopecia)

This is the most common form of hair loss, often referred to as hereditary hair loss or hormone-related hair loss. It is caused by a genetic hypersensitivity of the hair follicles to dihydrotestosterone (DHT).

Hair loss in men: It often starts with receding hairline and a patch of thinning hair on the crown (tonsure). If the hair loss continues, it can lead to baldness.

Hair loss in women: This usually manifests as diffuse thinning at the crown. Hormonal changes (the menopause) can exacerbate hair loss in women.

Alopecia areata

An autoimmune disorder in which the immune system attacks the hair follicles. Alopecia areata often occurs suddenly, taking the form of round, bald patches. People with alopecia areata often experience a relapsing-remitting course; spontaneous recovery is possible, but not guaranteed. In cases of alopecia areata, the beard or eyebrows may also be affected.

Diffuse hair loss (alopecia diffusa)

In cases of diffuse hair loss, hair falls out evenly across the scalp. The hair becomes thinner overall. This type of hair loss is usually the result of a disruption to the hair growth cycle caused by a variety of factors.

Other forms of hair loss

Scarring alopecia: Rarer forms in which inflammation permanently destroys the hair follicles.

Traction alopecia: Due to chronic tension (tight hairstyles).

Hair loss in children: This can happen (e.g. alopecia areata, fungal infections) and should always be investigated by a doctor.

Causes of hair loss

Hair loss can have many different causes:

• Genetics: The main cause of genetic hair loss
• Hormones: DHT, falling oestrogen levels, thyroid disorders
• Nutrient deficiency: Iron, zinc, biotin
• Diseases: Infections, autoimmune diseases
• Certain medicines: Can cause hair loss
• Stress: Physical or mental stress can lead to hair loss
• Scalp conditions: Fungal infections, eczema

It is crucial to identify the specific cause of hair loss.

Diagnosis of hair loss

In order to diagnose hair loss and initiate the correct treatment, a thorough examination by a dermatologist is necessary:

1. Medical history A detailed interview regarding the progression of hair loss and factors that might influence it
2. Scalp examination Assessment of pattern and condition
3. Tug test Assessment of hair loss activity
4. Trichoscopy Microscopic examination of the scalp and hair follicles
5. Blood test Screening for deficiencies, hormonal imbalances and inflammation
6. Hair root analysis Determining the phases of the hair cycle
7. Scalp biopsy In cases of unclear findings or suspected scarring alopecia

Treatment of hair loss

Treatment for hair loss aims to stop or slow down hair loss and, ideally, to stimulate hair growth:

Drug therapies

• Minoxidil: Topical solution/foam, effective against androgenetic hair loss in men and women
• Finasteride: Tablets for men (due to the formulation), blocks DHT
• Antiandrogens: For women experiencing hormone-related hair loss
• Cortisone/immunotherapy/JAK inhibitors: In cases of alopecia areata

Many treatments need to be used on a long-term basis to prevent hair loss from recurring.

PRP autologous blood therapy

Injection of processed autologous blood plasma into the scalp to stimulate the hair follicles using growth factors.

Mesotherapy and microneedling

Microinjections of active substances or the stimulation of regeneration through fine needle pricks.

Hair transplant

In cases of advanced hair loss (genetic in origin), the patient’s own hair follicles can be redistributed. A hair transplant can often effectively conceal hair loss.

Treatment of the underlying condition

If the hair loss is caused by another medical condition, that condition must be treated. The hair will often grow back then.

What to do about hair loss? Tips and prevention

Although it is often not possible to prevent hair loss entirely (particularly when it is hereditary), the following measures may help:

• A balanced diet
• Gentle hair care
• Stress management
• Patience with treatments

Warning: Be sceptical about miracle cures. Not everything that claims to combat hair loss actually works. Follow your doctor’s advice.

When should you see a doctor if you are experiencing hair loss?

Anyone who notices hair loss should seek medical advice, particularly if:

• If the increased hair loss persists for a longer period (>100 hairs per day)
• Hair loss occurs suddenly and severely
• Bald patches become visible
• The scalp is causing further problems
• There is a high level of psychological distress

An early diagnosis makes the treatment of hair loss more effective and successful.