Alopecia (hair loss)

What causes hair loss?

Hair loss is not a diagnosis but a symptom of an underlying cause. There are many possible causes of hair loss. Sometimes more than one cause may be present.

The commonest cause of hair loss in both males and females is androgenetic alopecia (male and female pattern balding). Another common cause of generalised hair loss, especially in women, is telogen effluvium (increased hair shedding after pregnancy, stress or illness). Some people have a focal type of hair loss called alopecia areata; they develop “holes” in the scalp, which may be single or multiple. In this condition the body produces antibodies against the hair follicles, causing them to break and fall. Occasionally the condition may be severe and extensive (alopecia totalis or universalis). Medical conditions (e.g. iron deficiency, thyroid disease, syphilis) can also cause hair loss. Less common causes of hair loss include trichotillomania (self pulling of hair), scalp inflammation or infection, and scarring conditions.

What is the treatment for hair loss? 

The treatment depends on the cause of the hair loss. Your dermatologist will assess the pattern of hair loss, the condition of the scalp and general health before diagnosing the cause of hair loss. Sometimes, investigations such as blood tests or scalp biopsies are required.

Androgenetic alopecia, can be controlled with certain medication (e.g. topical minoxidil, finasteride, dutasteride, oral minoxidil, spironolactone in women). Low level laser therapy (LLLT) can be used as a supplementary home treatment to stimulate circulation to the scalp.
Telogen effluvium is often temporary and should resolve in several months, with support from hair supplements. Chronic telogen effluvium may need investigation and treatments like topical and oral minoxidil.
Alopecia areata may be treated with injection/ topical/ oral steroids and topical immunotherapy (diphencyprone). For refractory or extensive alopecia areata, immunosuppressants (e.g. methotrexate, cyclosporin) or Janus kinase (JAK) inhibitors like Olumiant® (baricitinib) can be prescribed for suitable patients.