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Hair Loss: Common Types and Testing

Hair loss has been studied since the beginning of recorded history. Archeologists find written and physical evidence of hair loss research and treatments, proving it’s a top concern for people across cultures and civilizations.

Our understanding of hair loss causes and treatments has expanded significantly in just the past 100 years, although a comprehensive cure is still beyond our reach.

Researchers continue to push forward in efforts to develop stronger medicines and therapies to promote hair restoration.

Now, doctors have identified several reasons for hair loss and tests that help them determine the best treatment for the individual. In this article, we’ll examine the main types of hair loss in both men and women, look at some common testing techniques used by physicians, and offer some tips to patients aiming to combat hair loss with counteractive treatment.

Androgenetic Alopecia

The most common type of hair loss is simply called male pattern balding, also known by its scientific name Androgenetic Alopecia. Nearly 90% of all men will experience some degree of this genetically-induced balding at some point in their lives, and the likelihood increases about 10% with each decade after the age of 20.

Researchers have made major strides in their understanding of this condition in recent years, attributing the mechanism of hair loss to the interference of follicle life cycles in the scalp, primarily along the temples, vertex, and hairline.

Follicles experience cycles of growth and decline like other cells of the body, although these cycles can be disrupted by the presence of male hormones, namely DHT. This byproduct of testosterone interacts with receptors in the scalp to shorten follicle life cycles and “miniaturize” hairs to the point of stagnation or apoptosis (cell death).

This is why we tend to see similar patterns of male pattern balding, as indicated by the Norwood Scale that showcases common instances of hair loss. This is one of the main visual tests used by doctors for decades to determine whether a patient is experiencing androgenetic alopecia.

In addition to a visual assessment (typically sufficient to identify this type of balding), doctors may also perform a blood test on patients to uncover medical conditions that could be contributing to hair loss. There may be hormone imbalances, nutrient deficiencies, or adverse interactions with other medications that lead to accelerated hair loss.

Pull tests are considered by some to be archaic but can help doctors identify hair loss in its very early stages. A patient may bring up concerns about shedding in the shower or on pillows, and doctors can use this test to determine if it is indeed occurring in excess.

A more involved test is known as a scalp biopsy, in which doctors scrape samples from the skin and hair to examine the follicles closely under a high-powered microscope. This can inform doctors about the quality of the roots of the hair, identify infections, and determine what types of treatments can be effective moving forward.

Light microscopy is a similar technique in which doctors use a different type of microscope to look for disorders and inconsistencies in the follicle units and gather more information.

Common forms of treatment for Androgenetic Alopecia include over-the-counter topical medication like Minoxidil or prescribed oral medication such as Finasteride or Dutasteride.

Alopecia Areata

Genetics are the reason behind the majority of balding cases, but sometimes hair loss can be caused by more severe disorders that require different types of testing and treatment.

Alopecia Areata is a condition effecting millions of people worldwide, characterized by the sudden, irregular, and unpredictable loss of hair in patches across the scalp and throughout the body.

Scientists have identified alopecia areata as a type of autoimmune disorder that comes in waves and cannot be cured. While treatments can help ease the discomfort of the condition for some patients, hair loss is a symptom of the disease that continues to come and go.

The severity of this condition will also vary between patients and hair loss may not even be noticeable in some instances. The problem is when missing patches of hair connect on the scalp and form larger patterns of lost hair.

Within this category are several terms that doctors use to describe the unique nature of hair loss. Ophiasis is a form of alopecia areata in which hair is lost in a wave pattern at the back of the head.

Alopecia totalis refers to the complete loss of scalp hair from alopecia areata, and alopecia universalis describes the most advanced form of the condition in which the scalp and body lose 100% of their hair.

Testing for this condition will be different from standard genetic alopecia tests and may involve more in-depth blood tests from an immunologist or another specialist in a field other than dermatology or hair loss.

Treatment will be less focused on stimulating hair growth with topical medication or DHT-blocking mechanisms and more targeted toward the root immune condition.

Hair loss experts also recommend against procedures like hair transplantation for patients with alopecia areata, suggesting instead that they look at alternative therapies that address the condition itself.

Other Types of Alopecia

Aside from genetics and immune disorders, alopecia can occur for several other reasons.

Traction alopecia results from tension, friction, or constant pulling on the hair over many years. This form is common in men and women who wear hairstyles that place heavy stress on the roots of the hair, such as ponytails, buns, or braids.

Doctors recommend against wearing tight-fitting hats or headwear too frequently if patients are concerned about damaging roots and causing traction alopecia.

A rarer condition known as cicatricial alopecia describes several disorders in which hair follicles are destroyed and replaced with scar tissue. This condition is difficult to detect ahead of time with tests and results in permanent hair loss on the scalp.

Doctors do look for certain patterns to anticipate the trend of cicatricial alopecia, such as a circular pattern on the crown of the scalp that radiates outward and could be linked to high-stress hairstyles like braids and weaves.

Alternatively, infection could be the cause of cicatricial alopecia, more specifically known as lichen planopilaris. This type of scarring hair loss is the result of a certain bacteria and is signified by intense itching and burning sensations on the scalp.

While hair loss specialists may be able to draw on past experience to diagnose these rarer conditions properly, patients should seek help in other disciplines if more complex medical issues appear to be the cause.

Types of Effluvium

Effluvium is a cause of hair loss thought to be separate from the category of alopecia.

Rather than resulting from genetic influence, effluvium is typically caused by the interaction of exogenous chemicals or unexpected events that impact the scalp’s hair growth cycles.

For example, telogen effluvium occurs when follicles of the scalp enter the resting (telogen) phase but fail to initiate the next phase of growth. Eventually, these hairs stagnate, thin out, weaken at the root, and fall out at a rate of 300 to 500 per day.

While telogen effluvium does not typically lead to complete baldness, the effects can be very noticeable at the crown of the head and around the temples, especially if the individual has high coverage and density throughout the scalp to begin with.

When doctors assess the context of telogen effluvium, they typically analyze factors that manipulate the hormones of the patient. This could include anything from vitamin or mineral deficiency (iron or selenium are common culprits) or certain medications for acne or birth control.

Blood work is almost always the first step in determining the cause of this condition, and doctors will want to look at a complete list of medications for the patient to identify and negative interactions. It often comes down to a discussion of trade-offs or seeking alternative medications to reach a proper hormonal balance and combat the symptoms of telogen effluvium.

Luckily, the effects of this condition tend to reverse after several months of the medical event or change that triggered the hair loss. If patients continue to see a downward trend after this time, it may require further intervention or alternative treatments.

Anagen effluvium is the other common condition in this category, indicated by the loss of hair during the growth phase of the hair. This form of effluvium appears to be more closely linked to exposure to chemicals or toxins, such as a patient undergoing chemotherapy or radiation.

Doctors sometimes choose not to interfere with this condition as aggressively so as not to disrupt the mechanisms of treatment for cancer or other more serious diseases. If patients are fortunate enough to recover and build their systems back up, hair loss from this condition should again return in several months.

Other Types of Hair Loss

The most typical causes of hair loss have been covered above, but there are less common causes worth noting to get the full picture.

Some instances of hair loss are the result of bacterial or fungal infection, falling under the umbrella term of scalp folliculitis. What starts as minor inflammation (may look like acne or red rings) may develop into something more serious that damages the follicles permanently.

Dermatologists should be able to identify these types of infections on sight and provide medication that solves the problem in the form of antibiotics or otherwise. They will stress the importance of keeping the scalp clean and caring for cuts, scrapes, and post-surgery wounds.

Individuals who use harsh styling practices like heat and chemicals (colors or treatments) may find themselves weakening certain clusters of follicles along the hair shaft in a condition known as trichorrhexis nodosa. This is why many hair loss specialists warn against aggressive treatments like hot irons, presses, and dyes.

A rare yet devastating condition called trichotillomania involves individuals compulsively pulling out their own hair to the point where permanent damage occurs. Dermatologists or hair specialists may not be able to address this one – it’s a job for a psychologist.

Finally, there are rare cases in which an individual is incapable of growing much hair anywhere on the body, a condition known as hypotrichosis. Doctors typically identify this issue very early on since hair loss occurs before puberty and little hair remains by the time the individual reaches their early 20s. Treatments are few, but some medications may help.

Therapies and Procedures

The causes for hair loss are quite varied despite the major reasons being genetic or influenced by certain triggering events. It’s important that individuals seek assistance from medical professionals as soon as possible, ideally at the first moment of recognition of hair loss.

While normal folks may not want to run pull tests, bloodwork, or examine their hair under a microscope, they should be vigilant about tracking the trends of their hair if they suspect they’re reaching a certain age or certain situation in which hair loss may occur.

Some people may choose to take bi-weekly photos in the mirror and from all angles around the scalp to watch for patterns because looking straight-on at oneself each day will not offer much insight in terms of meaningful trends.

Others might want to check in with a hair loss specialist as a preemptive measure to combat hair loss before it starts to take hold. Even with minor shedding or thinning, it’s not too early for a doctor to prescribe a medication like Minoxidil or Finasteride to slow the process or possibly grow back some lost hair.

Eventually, the patient may want to consider undergoing surgery such as hair transplantation, hairline lowering, or another procedure that offers a more permanent solution to hair loss. Once again, guidance and expertise from a top professional in the hair loss field is recommended to get the best results and avoid unwanted risk.

How Dr. Jae Pak Can Help

Still, you have so many questions about hair loss: What are my options? What kind of results can I expect? Are my expectations realistic? Hair loss is not a common topic of discussion. So, who do you turn to? 

A successful hair restoration or transplant process starts with a consultation with an expert who truly wants to understand your personal goals. Dr. Jae Pak of Jae Pak, M.D. Medical is a board-certified physician and a hair transplant artist with 15 years experience. With a complementary background in engineering, Dr. Pak uses precision-like skill to bring his patients a natural and balanced hair line they can be proud of.

Schedule a consultation with Dr. Pak today and discover what hair transplants can do for you.

Sources:

Types of Hair Loss | NYU Langone Health

Telogen effluvium | DermNet NZ

Hair loss | Mayo Clinic

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