Hair loss can have many causes and lead to hairlessness (alopecia). What stops hair loss? Where are the boundaries between normal and morbid? An overview

What is hair loss?

  • One single hair on the pillow, three more in the sink, and five in the hairbrush – this is not a hair loss, but completely normal. Each hair has only a limited lifespan, stops growing, falls out and a new one grows. And: As people get older, hair becomes a little lighter in most people.
  • If more than 100 hairs are lost every day – in children: more than 50 to 80 – over a few weeks, or if individual hairless spots arise, then one can speak of hair loss. It is all too understandable that it places a heavy burden on those affected, especially at a young age.
  • Hair loss can lead to hairlessness. The technical term for this is alopecia or alopecia. The hair loss itself (technical term: Effluvium) can be temporary, then the hair grows back on its own. However, if the hair roots have been irrevocably damaged, for example by burns or diseases with scarring hair loss, then no new hairs form at the affected site.

The animation below shows you the main shapes in case of hair loss, the subsequent text goes into it in more detail. The other chapters of the article supplement this information, including in terms of diagnosis and therapy.

Hair loss: The main shapes and causes

Plant-related hair loss (androgenetic alopecia): The common hair loss in men and women

Investment-related hair loss affects about two-thirds of men and almost one in two women, each with a typical appearance. With a 95 percent presence in both sexes, it is the most common form of hair loss ever.

Even if the suffering pressure – in both sexes – is often very high: Illness is not due to plant-related hair loss. The health insurance companies, therefore, do not cover any costs for the treatment.

Investment-related hair loss: Men

  • Symptoms: Secret rat corners at the temples and / or thin hair in the area of the head. This can expand over time to baldness on the forehead and back of the head until only one hair wreath is left(male hair loss pattern). The first signs usually appear in adolescents. As you get older, hair clearings increase. The earlier the beginning – this is genetically determined – the more pronounced the course.
  • Causes: Progressive shrinkage of head hair roots that are hypersensitive to the male sex hormone dihydrotestosterone (DHT, an androgen) and no longer form strong hair. Blood hormone levels are normal.
  • Diagnosis: See the section “Hair Loss: Diagnosis” below.
  • Note: If therapy is desired, ask your doctor or pharmacist in advance exactly what effects and side effects are to be expected.
  • Minoxidil solution 2% or 5% or minoxidil foam 5%, each 2x per day, or finasteride 1 mg (oral tablets, important notes in the chapter”Plant-related hair loss ” in this article), optionally also a hair transplant. More about hair transplantation also in the chapter “Plant-related hair loss”.

Investment-related hair loss: women

  • Symptoms: Shaker hair, especially in the apex area. It can gradually lighten more backward and sideways. However, baldness does not normally arise. Although some sufferers notice a tendency towards finer hair on the head as early as in their teenage years, the androgenetic hair loss usually only becomes more noticeable after the menopause.
  • Cause: The extent to which androgen sensitivity of the hair roots, which is also increased due to the investment, also plays a role in women is still unclear in detail.
  • Diagnosis: See the section “Hair Loss: Diagnosis” below.
  • Therapy (see also note on therapy in men above): Minoxidil solution 2% or 5% or minoxidil foam 5%, depending on the preparation 1 or 2 times daily for application; Hair transplantation only after careful examination to consider individually.

Circular hair loss (Alopecia areata): Bald spots as punched out

If on the head, less often also on the face – eyebrows, eyelashes, beard – in a short time like punched-out bald spots develop, it is usually an alopecia areata (circular hair loss).

In Germany, it is estimated that well over a million people suffer from it. Children and young people are the main sufferers, and this alopecia is less common beyond the age of 30.

Alopecia areata is an autoimmune disease. In the process, the body’s own tissue is attacked, here hair roots on the scalp, sometimes also on other hairy parts of the body.

  • Development of symptoms: On the one hand, there may be long-lasting, complete hair loss. On the other hand, more than 80 percent of those affected will eventually close the bald spots. In between there are all sorts of variants. The clinical picture is therefore unpredictable. Nails can also be affected. Rarely can lymph nodes swell behind the ears in an acute “push”.
  • Diagnosis: See the section “Hair Loss: Diagnosis” below.
  • Therapy: In addition and further about the clinical picture, the chapter “Circular Hair Loss (Alopecia areata): Symptoms, Therapy” in this article.

Caution: Women are more likely than men to deal with circular hair loss at any age. If a child suddenly develops a hair loss, which is by no means “normal”, it must be thoroughly investigated to find out and treat the underlying cause, such as alopecia areata (but there are also many other options, see chapter “DiffuseR Hair Loss” and ” HairLoss: Special Forms and Causes“).

Diffuse hair loss: hair consistently thinner

If more hair than usual spreads out all over the pod, this speaks to a diffuse hair loss. After pregnancy, for example, this happens more often.

Even with hormone treatments, for example with certain anti-baby pills or with hormone therapy during menopause, the overall hair density can decrease noticeably – depending on the preparation rather at the beginning of ingestion or after discontinuation.

  • The main causes of diffuse hair loss also include thyroid dysfunction and iron deficiency. Some medications can also make the hair thinner. The influence of stress on hair growth is discussed.
  • Development of symptoms: Between triggering events and hair loss maybe weeks. Hair is not always lost immediately. They often stop growing first and go into hibernation prematurely. At the end of this resting phase, hair increasingly fails at the same time (telogen Effluvium, more on this in the chapter “Diffuse hair loss: causes, therapy”). Very rarely do scarring spread out diffusely occur, see chapter “Hair Loss: Special Forms”).
  • The therapy depends on the trigger. If possible, a known cause will of course be fixed. For example, if the doctor has fixed and discontinued a suspected responsible drug (without consultation with him one should not do so!), it must be observed for at least three months whether the hair improves. In other cases, too, therapy often consists in waiting for a few months and observing development. A hair transplant is not indicated in case of diffuse hair loss.

Info: Diffuse hair loss (called telogen Effluvium) affects women to a greater extent than men. Depending on the cause, children may also become ill.

Hair Loss – Special shapes, without and with scarring

  • Herd-shaped hair loss leads to individual bald spots, so-called paladin. An example has already been described above: the alopecia areata, the circular hair loss. It is basically reversible, there are no scars.
  • But there are other examples, such as hair loss due to inflammatory diseases of the skin or scalp. For example, fungal infections such as cat fungus sometimes cause the hair to fail in individual places. Early therapy is crucial here to avoid deeper damage with scarring and permanent hair loss.
  • Due to constant pressure or pull – for the sake of hairstyle or as a result of morbid tearing out (trichotillomania) – the main hair can lighten in tufts. In extreme cases, diffuse scarring is possible. The hair no longer grows there.
  • The pseudopelade Broq, a rare, scarring hair loss of unknown cause, mainly affects women, mostly between the ages of 30 and 55. The scalp looks reddened and shines at the initially small, gradually expanding hairless spots.

Hair loss: diagnosis

In order to determine the cause of a hair loss, it is necessary to know that between triggering event and hair loss can lie weeks. Hair is not always lost immediately.

Often they first adjust their growth and switch to rest (see picture gallery “So grows the head hair” in the chapter “Diffuser Hair Loss“). At the end of this resting phase, a lot of hair suddenly falls out at the same time. In rare cases, hairlessness is already innate or occurs in the first years of life, for example as a result of metabolic defects.

The main contact person is the dermatologist (dermatologist)

The consultation is useful in consultation with the family doctor, gynecologist, or pediatrician. In conversation with the patient, the dermatologist first asks about the duration and strength of the hair loss, about further symptoms, such as itching or nail changes, about diseases, medications – even an application several weeks ago can be significant here – and living conditions that could affect hair growth.

Whether a close relative suffers from hair loss is also of interest. Women with suspected androgenetic or actually hormonal (androgenic)alopecia will be questioned by the doctor about changes in the cycle, use of hormonal contraceptives, after pregnancies, and births, depending on age also for the onset of menopause.

Why do the hairs fall out more?

Various studies can help to answer this question.

Eye diagnosis of the dermatologist: Often, the pattern of hair loss and the appearance of bald skin already refer to the diagnosis. The doctor may also use a magnifying glass light (dermatoscopy). The device allows multiple enlarged views of the skin.

Sometimes additional examinations are necessary, for example, a blood or hair analysis, less often a scalp biopsy (see below).

Then the physician will carefully look at the hair and its distribution pattern, nails, and scalp and assess whether there is a skin disease, whether the nails are affected and whether the hair is only exposed in certain places or diffusely spread over the whole head.

The doctor will also check the rest of the body hair pattern. With an orienting physical examination, further signs of the disease can possibly be found, such as swollen lymph nodes on the neck, as they can occur, for example, in head fungus.

Pluck test: The dermatologist may test how many hairs are already loosened by light, painless plucking (plucking, pulling, epilation, or extraction test). If the doctor keeps more than ten loose hairs in his hand when testing a patient with freshly washed hair out of about 60, this indicates active hair loss.

He also investigates whether pores of the hair bellows (hair follicles) are still recognizable on the hairless scalp. The hair loss then do not scar realize. This suggests that the hair could in principle regrow.

For details and documentation: Microscope, Photos & Computers

Microscope: If necessary, the dermatologist looks at individual hairs under the microscope and assesses their structure, for example, whether he has anagen- or telogen hair (see picture gallery in the chapter “Diffuser Hair Loss”) or broken hair in front of him.

Microscopic hair root analysis is also called Trichogramma. On the one hand, it shows how much of the hair is currently growing, whether, for example, an unusual number of hairs have stopped their growth. Normally, 80-90 percent of hair grows active and less than 10 to 20 percent rest. On the other hand, the doctor can assess hair roots and hair shafts more accurately.

Trichogramma can be used to predict the proportion of hair loss and hair growth capacity. For the examination, about 50 to 100 hairs are plucked in different areas of the scalp (for comparison). This is a bit unpleasant, but these hairs grow back.

In order for the examination to be a good statement, the patient should have washed his hair four to five days beforehand.

Phototricogram: No hair sample is required for this, but the hair is cut off in one or two, as unobtrusive as possible places. These areas are then tattooed and photographed with a camera. Three days later, the same places are photographed again and the pictures are compared. The study allows an accurate determination of growing and resting or failing hair and is more frequently used in studies. The hair roots cannot be judged with this.

Trichoscan: Further development of the phototricogram. The area with the severed hair is stained three days later and photographed with a digital camera in microscopic magnification (light microscopy). A computer analyzes the images and provides information about the number and percentage of hair in the different growth and cycle phases (see picture gallery in the chapter “Diffuser Hair Loss”). The statutory health insurance funds do not pay for the examination in general.

Special examinations for hair loss

Pathogen culture: In unclear cases, a culture of pathogens can be further aided by smears of hair or hair stumps from a diseased area. It is used, for example, to detect fungal disease on the scalp. However, it will take a few weeks for the result to be available.

A tissue sample from the scalp: In order to arrive at a diagnosis, it is sometimes necessary to examine a tissue sample of the scalp, a scalp biopsy, possibly also in a specialized center. The removal is carried out with local anesthesia under sterile conditions. It is mainly targeted in nearby alopecia or in unclear non-narcotic alopecia.

Searching for traces in the blood: If the physician suspects illnesses or deficiency symptoms as a cause, further examinations may be useful. For example, a blood test can detect iron, thyroid or inflammatory levels and morbid immune phenomena, and the results may reveal a disease.

A study of sex hormone levels in women is only useful if androgenic alopecia is suspected, for example, because of visibly enhanced masculinity signs such as male hair distribution patterns.

Treatment of hair loss: Each alopecia is treated separately

Hair loss can have many causes. Sometimes there is a disease, for example, a hormonal disorder or anemia in case of iron deficiency – causes that need to be targeted. Also, one form of hair loss can overlay another. Therefore, a visit to the doctor is always advisable. Often it also applies: time is hair. So the sooner the correct diagnosis is made and therapy is started, the greater the chance of “saving” and maintaining as many hairs as possible. Several clinics and established doctors now offer special hair consultation hours.

In principle, the motto should be: first the diagnosis, then (if necessary) the treatment. Also, there is no one therapy for every hair loss, and not every hair loss needs to be treated. In some cases, the hair also grows back by itself.

Sometimes cosmetic measures such as hair styling, hair spare parts, and permanent make-up can facilitate the acceptance of the hair problem.

Even in case of plant-related hair loss: Do not treat without the doctor

Androgenetic alopecia in men is extremely widespread (see above) and not automatically the cause of extensive medical examinations. Nevertheless, expert advice can also be helpful if therapy is desired.

Numerous products are available on the market to stimulate hair growth or to stop hair loss. However, only a few have been tested for efficacy in good clinical trials. If you want (optional) therapy, you should first check with your doctor or pharmacist exactly what effects and possible side effects you can expect.

For more information on treatment options for androgenetic alopecia, including hair transplantation, see the chapter “Plant-related hair loss”.

Tips for proper hair care

With the right care, the hair looks equally better. Here are eight basic tips:

  • The shampoo is there to cleanse hair and scalp, don’t use too much, shampoo only once per wash, and then rinse the hair well afterward
  • Haircare products should be tailored to hair and scalp
  • From time to time, the hair is happy about rinses and cures, so that the hair becomes more combable
  • Do not rub hair dry after washing, but gently “press dry” and leave it in the towel for a few minutes
  • Just moaning lukewarm, do not hold the hairdryer too close to the hair, alternatively, let the hair dry in the air
  • Protect hair and scalp from UV radiation
  • Do not use styling procedures such as bleaching, smoothing, or permanent waves too often – this can strain the hair and make hair more brittle. Hair loss usually does not arise.
  • Use brushes with rounded bristles and combs with tines far apart

Important Note:

This article contains only general notes and should not be used for self-diagnosis or treatment. He cannot replace a visit to the doctor.

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