Hair loss

  • Many conditions and diseases can result in hair loss, as can improper hair care.
  • The most common cause of hair loss is hereditary thinning or baldness.
  • While daily shedding is normal, people who notice their hair shedding in large amounts after combing or brushing and those whose hair becomes thinner or falls out should consult a dermatologist for proper diagnosis and treatment.

Causes of hair loss

  • Causes of hair loss, some of which are temporary, include:
    • Excessive or improper use of styling products such as perms, dyes, gels, relaxers or sprays, which can cause weathering or hair breakage.
    • Hairstyles that pull on the hair, like ponytails and braids.
    • Shampooing, combing or brushing hair too much or too hard, or pulling it out.
    • A variety of diseases, including thyroid disease.
    • Childbirth, major surgery, a high fever or severe infection, stress, or even the flu.
    • Inadequate protein or iron in the diet, or eating disorders such as anorexia and bulimia.
    • Certain prescription drugs, including blood thinners, high-dose vitamin A, and medicines for arthritis, depression, gout, heart problems and high blood pressure.
    • Use of birth control pills (usually in women with an inherited tendency for hair thinning).
    • Hormonal imbalances, especially in women.
    • Ringworm of the scalp, a contagious fungal infection most common in children.
    • Some cancer treatments, such as radiation therapy and chemotherapy.
    • Alopecia areata, a type of hair loss that affects all ages, which causes hair to fall out in round patches.

 Psychosocial impact of hair loss

  • While the physical symptoms of hair loss can be traumatic for patients, the psychosocial impact of hair loss can be just as severe.
  • Hair loss can cause dramatic and devastating emotions in patients that can negatively impact their quality of life. Studies on the psychosocial impact of hair loss have found patients’ self-esteem, body image and self-confidence to be negatively affected.1-2
  • Known psychosocial complications include depression, low self-esteem, altered self-image, and less frequent and enjoyable social engagement.
  • The negative quality of life may be worse in women due to societal pressure to be attractive. Treatment from a dermatologist may be sought in order to improve quality of life.1-2

Treatment of hair loss

  • Topical minoxidil (for men and women; available over-the-counter) and oral finasteride (for men only; prescription only) have been shown to help the regrowth of hair or to slow hair loss. Hair loss caused by diseases such as thyroid disease may be reversed with treatment of the underlying disease.
  • Topical or injectable cortisone medications have been shown to accelerate the regrowth of hair in some types of hair loss.
  • Topical or oral estrogen or other female-specific hormones are sometimes prescribed for women experiencing hair loss.
  • Hair transplantation is a permanent form of hair replacement utilizing dermatologic surgery that involves moving some existing scalp hair to bald or thinning parts. It may benefit men with male pattern baldness, some women with thinning hair, and people who have lost some but not all hair from burns or other scarring injuries to the scalp, eyebrows or eyelashes.
  • Restoration surgery is another treatment option. In scalp reduction surgery, bald scalp is removed and hair-bearing scalp is brought closer together to reduce balding. In scalp expansion surgery, a physician temporarily inserts devices under the scalp to stretch hair-bearing areas, which also reduces balding. In scalp flap surgery, a hair-bearing piece of scalp is surgically moved and placed where hair is needed.


1. Tucker P. Bald is beautiful?: the psychosocial impact of alopecia areata. J Health Psychol 2009;14:142-51.

2. Cartwright T, Endean N, Porter A. Illness perceptions, coping and quality of life in patients with alopecia. Br J Dermatol 2009;160:1034-39.