What is alopecia?

Alopecia, or hair loss, is characterised by a noticeable shedding, thinning or breaking of the hair. It can affect both men and women. Causes include pattern baldness, chemotherapy, stress or an underlying medical condition.

Some people experience hair loss as a mild thinning, while in others, the hair may fall out in clumps, or bald patches may develop over time. Although hair loss is often thought of as a condition of the scalp, in rare cases hair can also be lost from other areas of the body.

Treatment results vary depending on the option chosen and the type of hair loss. Options include camouflage techniques, medications or hair transplant surgery. In general, these treatments aim to slow or hide hair loss, stimulate regrowth or replace damaged hair.

Chemotherapy

A medication-based treatment, usually used in the treatment of cancers. There are numerous, different types of chemotherapy drugs that can be prescribed by a specialist. These can commonly be used alongside other cancer treatments such as surgery and radiotherapy.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

Scalp

The skin that covers the head, excluding the face and the ears.

Hair growth

Hair is a unique structure that comprises:

1) The hair follicle, which is the part beneath the skin that contains the stem cells that allow hair to regrow, and; 

2) The hair shaft, which is the visible part of the hair extending above the skin surface. This is mainly made up of keratin, the same family of fibrous proteins found in nails and the outer surface as the skin.   

On the average scalp, there are around 100,000 hairs that are constantly growing (anagen phase), resting (catagen phase) and shedding (telogen phase).

Most hair (85%) is in the growing or anagen phase, and grows about one centimetre each month. About 3% of the hair is in the resting or catagen phase, which lasts 3-5 years. During the shedding or telogen phase (12%), around 100 hairs are shed each day. 

Normally, there is a balance between hair loss and new hair growth, so that overall there is no difference in thickness of the hair. However, in alopecia, due to many different causes, there is an imbalance that leads to visible hair loss. 

Hair follicles and hair loss, process of hair loss, cause of hair loss.Healthy hair cycle. 

Hair follicle

A tubular opening in the epidermal layer of the skin from which a hair grows.

Stem cells

Cells that have not yet developed into a specific type of cell. Some stem cells can be directed by the body or in the lab to become virtually any type of cell.

Scalp

The skin that covers the head, excluding the face and the ears.

Types and causes of hair loss

There are a number of different types of hair loss and numerous different causes, some of which are not known. In general, the main hair loss features are as follows:

Pattern hair loss

Pattern hair loss is the most common type of hair loss in both men and women. As the name suggests, the hair loss follows a particular pattern. It is also called androgenetic alopecia because it tends to happen in response to male sex hormones (androgens) and genetic factors. Women also produce androgens, but in different ways, so the pattern of hair loss is different.

Male pattern baldness

Male pattern baldness usually starts with the hair receding around the temples, followed by general thinning and balding on top of the scalp. Quite often, hair remains at the sides and back of the head. Male pattern baldness runs in families and by the age of 60, most men have some degree of baldness. [1]

Male pattern baldness is linked to the male sex hormone dihydrotestosterone (DHT). High levels of DHT affect the follicles, causing hairs to become thinner and grow for a shorter period. As individual follicles are affected at different times, balding occurs gradually.

Certain genes for male pattern baldness are also known to be passed on from parents to their children.

Female pattern hair loss

Female pattern hair loss usually only causes thinning of hair on the top of the head. It is generally milder than male pattern baldness and more likely to occur after menopause.

Female pattern hair loss is not as well understood as male pattern hair loss, but it is also thought to be influenced by genes and androgens. This helps to explain why female pattern hair loss occurs more often after menopause, when there are less female hormones (oestrogens) present.

Hair shedding

Hair shedding occurs due to imbalances in the hair cycle.

Telogen effluvium

In telogen effluvium, the anagen to telogen ratio is reversed by a particular event, which causes up to 70% of hairs to move into the telogen phase.

About 2-3 months after the event, widespread thinning usually occurs, rather than specific bald patches. However, new hair continues to grow, so hair loss is only temporary.

This process can be triggered by a number of factors, including:

  • Emotional stress;
  • Physical stress, such as childbirth;
  • Hormonal changes, such as pregnancy;
  • Certain medications, such as anticoagulants, antidepressants, anticonvulsants and hormones;
  • Certain medical conditions, such as infection, scalp diseases, trauma, cancer or liver disease;
  • Poisoning from heavy metals, such as selenium, arsenic and thallium, and;
  • Changes in diet, particularly those involving rapid weight loss, poor nutrition, or low levels of iron or zinc.

Anagen effluvium

In contrast, anagen effluvium occurs when hair is lost during the anagen phase of active growth. This type of hair loss is generally widespread and may affect the scalp, body and face. In most cases though, hair grows back after treatment finishes.

This condition is usually triggered by chemotherapy medications, such as doxorubicin and cyclophosphamide. It can also be a side effect of other cancer treatments, such as radiotherapy.

Alopecia areata

Alopecia areata occurs when the hair stops growing and falls out from the roots. Smooth, bald patches appear suddenly, usually as circular or oval patches on the scalp. It can occur at any age, but is most common in people aged 15-30 years. Alopecia areata occurs equally in young men and women, but later in life it mainly affects women. 

Quite often, hair grows back over months or even years, although it may look grey or white for several months until normal colour returns. Sometimes a new bald patch may appear while another is growing back.

Alopecia areata is caused by an autoimmune response, meaning that the body's immune system mistakenly attacks hair roots, leading to hair loss. It is not known what triggers this response, but genetic factors are thought to play a role.

Alopecia areata, characterised by several oval-shaped bald patches located across the top and back of the scalp.Alopecia areata. 

Scarring alopecia

Scarring alopecia describes permanent hair loss that occurs when hair follicles are destroyed, usually by skin damage or an underlying medical condition.

Quite often it is unclear what triggers this destruction. However, some known causes include:

Androgens

The male sex hormones.

Anticonvulsants

Medication used to prevent or reduce the severity of epileptic seizures and other convulsions.

Antidepressants

Medication used to treat depression and other mood disorders.

Autoimmune response

A medical condition in which the body's immune system abnormally targets substances that are normally found within the body.

Carbuncles

A cluster of red and painful boils that are connected to one another under the skin. A boil is an infection of hair follicles that is associated with the accumulation of pus.

Chemotherapy

A medication-based treatment, usually used in the treatment of cancers. There are numerous, different types of chemotherapy drugs that can be prescribed by a specialist. These can commonly be used alongside other cancer treatments such as surgery and radiotherapy.

Genes

A unit of inheritance (heredity) of a living organism. A segment of genetic material, typically DNA, that specifies the structure of a protein or related molecules. Genes are passed on to offspring so that traits are inherited, making you who you are and what you look like.

Genetic

Related to genes, the body's units of inheritance or origin.

follicles

A tubular opening in the epidermal layer of the skin from which a hair grows.

Hormones

A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.

Immune system

The organs and cells involved in protecting the body against infection.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Iron

An essential mineral required by the body. Iron is part of a protein in the blood called haemoglobin, which carries oxygen around the body.

Oestrogens

One of a group of steroid hormones involved in the development and maintenance of female sex characteristics. These are the primary female sex hormones.

Radiotherapy

A treatment that uses ionising radiation to kill or control growth of malignant cancer cells.

Scleroderma

A rare condition in which excess collagen fibres are produced by the body, affecting the skin and internal organs.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

Trauma

1. Physical injury to the body caused by force or a toxic substance. 2. Psychological damage caused by a severely disturbing experience.

Hormonal

Relating to hormones, which are chemicals secreted in one part of an organism and transported to another part of that organism, where they have a specific effect.

Lichen planus

A non-contagious, inflammatory condition in which itchy bumps and sores develop in moist areas such as the mouth, vagina and vulva.

temples

The slight indentations on each side of the head in front of the ears, at equal level with the eyes.

Scalp

The skin that covers the head, excluding the face and the ears.

Anticoagulants

Any substance that prevents the clotting of blood.

1. Male-pattern baldness. Health Direct Australia. Accessed 30 March 2014 from

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Risk factors

Risk factors that may increase the likelihood of developing hair loss include:

Autoimmune conditions

A medical condition in which the body's immune system abnormally targets substances that are normally found within the body.

Iron

An essential mineral required by the body. Iron is part of a protein in the blood called haemoglobin, which carries oxygen around the body.

Pernicious anaemia

A condition in which the body cannot produce enough red blood cells due to a lack of vitamin B12.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

Vitamin B12

A water-soluble vitamin needed for protein and DNA synthesis, metabolism of folate and red blood cell production.

1. Male-pattern baldness. Health Direct Australia. Accessed 30 March 2014 from

External link

Signs and symptoms

As outlined above, different types of hair loss have different signs and symptoms. In general though, hair loss can be identified by one or more of the following features:

  • Receding hair around the temples, followed by balding on top of the head (men);
  • Thinning of hair on top of the head (men and women);
  • Appearance of smooth, round bald patches, usually on the scalp;
  • Widespread thinning of hair in response to factors such as stress, childbirth, rapid weight loss, certain medications or chemotherapy treatment for cancer;
  • Permanent hair loss from damage to the follicle, and;
  • Loss of hair from the entire scalp or body (rare cases only).

Chemotherapy

A medication-based treatment, usually used in the treatment of cancers. There are numerous, different types of chemotherapy drugs that can be prescribed by a specialist. These can commonly be used alongside other cancer treatments such as surgery and radiotherapy.

follicle

A tubular opening in the epidermal layer of the skin from which a hair grows.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

temples

The slight indentations on each side of the head in front of the ears, at equal level with the eyes.

Scalp

The skin that covers the head, excluding the face and the ears.

1. Male-pattern baldness. Health Direct Australia. Accessed 30 March 2014 from

External link

Methods for diagnosis

Your doctor will most likely diagnose hair loss by looking closely at your skin and gently pulling on your hair to see how many hairs fall out. You may be asked questions about the rate of hair loss and your personal or family medical history. Blood tests may done to rule out an underlying medical condition, or you may be referred to see a specialist skin doctor (dermatologist).

A dermatologist may take a hair or skin sample to help confirm the cause of hair loss. Skin may be collected by taking a scraping of the outer layer, or through minor surgery (biopsy) to remove a small section of the deeper layers.

Dermatologist

A doctor who specialises in the diagnosis and treatment of skin disorders and related conditions.

1. Male-pattern baldness. Health Direct Australia. Accessed 30 March 2014 from

External link

Types of treatment

If you wish to seek treatment, a number of options aim to slow or hide hair loss, stimulate regrowth or replace damaged hair. Treating any underlying medical conditions that may be contributing to your hair loss may also help.

Although there is no cure for hair loss, your doctor may suggest one or more of the following treatment options:

Self care

To improve the general health and thickness of your hair, avoiding tight hairstyles, harsh styling products or vigorous brushing may help. A balanced diet, with plenty of protein, fruit and vegetables, may be recommended as low levels of iron, vitamin B12, folate and other nutrients can slow hair growth.

Alternatively, a hair substitute such as a toupee, wig, hairpiece or eyelash extensions may help to hide the appearance of hair loss. Other cosmetic options include lightly brushing mascara into the roots, or colouring the scalp to match existing hair. A professional trained in cosmetic procedures may also be able to bleach existing hair or tattoo the eyebrows or other areas to give the appearance of hair.

Pattern hair loss medications

The two most common medications prescribed for pattern hair loss are minoxidil and finasteride. Results vary from person to person, but these medications are not commonly known to stimulate hair regrowth. Instead, they tend to slow or decrease the progress of hair loss. Once treatment is stopped, hair loss usually continues. Minoxidil can be taken by men and women, whereas finasteride can only be taken by men.

In women only, oral hormonal medications such as spironolactone or cyproterone acetate may be prescribed. These medications have anti-androgen effects. 

Corticosteroids

Although there is no single effective treatment for alopecia areata, a course of corticosteroid injections may help speed up natural regrowth in bald patches. Options may include triamcinolone or betamethasone. Corticosteroids most likely block the autoimmune response thought to cause alopecia areata.

Injections are usually given by a dermatologist every 4-6 weeks. Several are usually given per session and then regrowth takes 1-2 months. As injections can be quite painful, this type of treatment is generally only suitable for small patches of baldness.

For the treatment of alopecia areata, your doctor may also prescribe a steroid cream for application directly onto the skin. However, corticosteroids can cause side effects, such as thinning of the skin, acne or a red rash. For this reason, they are usually only prescribed for short-term use.

Immunotherapy

In cases of alopecia areata where hair loss is widespread, your doctor may prescribe immunotherapy medication, such as diphencyprone (DPCP) or dinitrochlorobenzene (DNCB). These medications trigger a mild immune response in the skin, known as contact allergic dermatitis. This allergic reaction may result in hair regrowth over a period of about three months.

Immunotherapy is usually given weekly at specialised centres over several months. Side effects from immunotherapy may include a skin reaction, irritation or swollen lymph nodes. It is also quite common for hair to fall out again after treatment is stopped.

Another option may be an irritating skin ointment, such as dithranol. Similar to immunotherapy, irritation can stimulate hair regrowth in some people. Dithranol is applied to the scalp regularly and then washed off. Side effects may include itching, scaling or staining of the skin.

Hair transplant surgery

Transplant surgery is mainly used to treat pattern baldness in men. During this procedure, a surgeon removes 'donor grafts' of hair from the back and sides of the scalp and then transplants them into bald areas. Each graft contains one or more hairs still attached to a small patch of skin.

This procedure can take up to several hours and may need to be repeated a few times to achieve improved coverage of a balding scalp. Treatment results can vary from person to person.

As in most surgical procedures, additional side effects of hair transplantation may include pain, swelling, bleeding, numbness and infection. Sedative and local anaesthetic medications are administered to help prevent pain and discomfort.

Removal of a donor graft from the back of a man's head, separation of the graft into single units containing two to three hairs each and transplantation into the balding scalp. 

Androgen

The male sex hormones.

Autoimmune response

A medical condition in which the body's immune system abnormally targets substances that are normally found within the body.

Corticosteroid

A medication that resembles the cortisol hormone produced in the brain. It is used as an anti-inflammatory medication.

Folate

A type of vitamin B involved in the creation of DNA and RNA. It plays a key role in cell growth and reproduction.

Immunotherapy

The clinical exploitation of the immune system as a method to treat and prevent disease.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Iron

An essential mineral required by the body. Iron is part of a protein in the blood called haemoglobin, which carries oxygen around the body.

Local anaesthetic

A type of medication that, when administered to an area, creates a localised loss of sensation by blocking nerve activity.

Lymph nodes

A small organ of the lymphatic system containing many immune cells. Lymph nodes, also known as lymph glands, are the sites where many interactions between immune cells and foreign materials occur.

Hormonal

Relating to hormones, which are chemicals secreted in one part of an organism and transported to another part of that organism, where they have a specific effect.

Vitamin B12

A water-soluble vitamin needed for protein and DNA synthesis, metabolism of folate and red blood cell production.

Dermatologist

A doctor who specialises in the diagnosis and treatment of skin disorders and related conditions.

Scalp

The skin that covers the head, excluding the face and the ears.

1. Male-pattern baldness. Health Direct Australia. Accessed 30 March 2014 from

External link

Potential complications

Hair loss can increase the risk of sunburn on the scalp. However, this can be avoided by wearing a hat or applying sunscreen with a high sun protection factor (SPF) when outdoors.

In rare cases, alopecia areata can progress to alopecia totalis, which describes loss of all hair from the scalp. Rarer still is alopecia universalis, which is loss of all body hair, including the beard, eyebrows and eyelashes. The earlier these conditions start, the more likely they are to be widespread. Similarly, if the condition is widespread, hair is less likely to grow back.

As hair loss affects the appearance, widespread or early shedding may lead to psychological issues such as embarrassment, social withdrawal, low self-esteem or depression.

Psychological

Relating to, arising in, or affecting the mind.

Sun protection factor

An indication of the level of protection a sunscreen provides against ultraviolet A and B light when applied correctly.

Scalp

The skin that covers the head, excluding the face and the ears.

1. Male-pattern baldness. Health Direct Australia. Accessed 30 March 2014 from

External link

Prognosis

Full recovery of hair is common when the hair loss is not long-term or widespread. Normal thickness is often achieved within months to a year in cases of telogen effluvium, anagen effluvium and alopecia areata.

However, when hair loss affects half of the scalp or more, it is much less likely that hair will regrow. Hair regrowth is also more unlikely when hair loss starts at a young age, or occurs together with nail abnormalities, allergies or an autoimmune condition.

Treatment results from taking medications vary depending on the option chosen and type of hair loss. Medications used for pattern hair loss tend to slow the progress of hair loss, rather than stimulate new growth.

Allergies

A harmful, hypersensitive immune reaction to usually innocuous environmental substances.

Autoimmune condition

A medical condition in which the body's immune system abnormally targets substances that are normally found within the body.

Scalp

The skin that covers the head, excluding the face and the ears.

1. Male-pattern baldness. Health Direct Australia. Accessed 30 March 2014 from

External link

Prevention

In many cases, hair loss cannot be prevented, particularly if it is caused by genes, hormones, an underlying medical condition or chemotherapy. However, a diet containing healthy levels of iron, vitamin B12 and folate can help to promote steady hair growth. Similarly, avoiding tight hairstyles, harsh styling products or vigorous brushing is also recommended.

Chemotherapy

A medication-based treatment, usually used in the treatment of cancers. There are numerous, different types of chemotherapy drugs that can be prescribed by a specialist. These can commonly be used alongside other cancer treatments such as surgery and radiotherapy.

Folate

A type of vitamin B involved in the creation of DNA and RNA. It plays a key role in cell growth and reproduction.

Genes

A unit of inheritance (heredity) of a living organism. A segment of genetic material, typically DNA, that specifies the structure of a protein or related molecules. Genes are passed on to offspring so that traits are inherited, making you who you are and what you look like.

Hormones

A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.

Iron

An essential mineral required by the body. Iron is part of a protein in the blood called haemoglobin, which carries oxygen around the body.

Vitamin B12

A water-soluble vitamin needed for protein and DNA synthesis, metabolism of folate and red blood cell production.

1. Male-pattern baldness. Health Direct Australia. Accessed 30 March 2014 from

External link