People's reaction to hair loss is a very personal issue - different people react differently. Some people become very distressed as they believe it makes them look older and less attractive, affecting their body image and self-esteem. Others are not as concerned. However, treatments are available for many of the different types of hair loss.

Normal Hair Growth
Hair grows, then rests, then falls out. Each hair follicle on your scalp produces a number of hairs throughout your life. Hair grows from the follicle at the rate of about 1cm a month for about three years. After that time that hair will die and no longer grow and simply sit dormant in the follicle for a further three months. After that three month interval the next hair starts to grow out of the follicle and, as it grows, it pushes the original one out. This is a cycle that continues throughout life.

Diffuse Hair Thinning
Hair growth is random so that rather than losing all our hairs at once every 3 years we tend to lose a few every day. It is normal to lose between 50 and 100 hairs a day. As long as the hairs that are lost are replaced by hairs of the same size and same characteristics, then the hair density on your scalp is maintained.

Types of Hair Loss and Their Causes
Hair loss can 'just happen' or it can be linked to some medical conditions and medicines. It can be patchy or widespread, and can range from mild to severe cases.

Androgenetic Alopecia
Androgenetic AlopeciaAndrogenetic alopecia, or male pattern hair loss, refers to scalp hair loss that occurs in a distinct pattern. It is called androgenetic alopecia because this type of hair loss is actually determined by male sex hormones called androgens, and by genetics (or having inherited the condition from your family).

Male pattern hair loss is a common condition in men, but can also occur in women to a lesser degree. Approximately 60% of men will have significant hair loss by the age of 50, and 50% of women will also have some hair loss by the age of 60. In men, the hair loss usually begins with a receding front hairline, then a bald patch develops on the crown or vertex of the head.

Eventually, complete loss of hair on top of the head can occur. In women the frontal hairline usually remains, with hair loss or thinning occurring over the crown extending to frontal hairline.

If you have androgenetic alopecia the normal hair growth cycle is disrupted. The new emerging hair is not as thick and does not grow for as long as the one before it. This results in old hair being replaced by finer and shorter hair and you losing more hairs each day. Alopecia areata is a condition where hair loss usually occurs suddenly in round patches. In contrast to male pattern baldness, the areas of hair loss are random and can occur on other parts of the body as well as
the scalp. In a small number of people, all the scalp and body hair may be lost. Alopecia areata can affect men, women and children. Why it develops is not known, but many cases resolve spontaneously and most of the remainder can be effectively treated. It is caused by an overactive immune system.

Tinea Capitis
Tinea Capitus, Scalp Ringworm
Tinea capitis, or scalp ringworm, is a fungal infection that may cause irregular areas of hair loss where the fungus occupies the hair shaft and the hair breaks off. It occurs more commonly in children than adults and is treated with antifungal medicines.

Tinea Capitus, Scalp Ringworm

Scarring Alopecia
Scarring alopecia with pus
Scarring alopecia is a rare condition that results in permanent destruction of the hair follicles. Unlike alopecia areata, there is no chance of renewed hair growth, but early diagnosis may prevent progression.

Traction Alopecia
Traction alopecia is a condition that may occur if hair curlers and hair grips are applied too tightly or if chemical treatments are used excessively or incorrectly. The hair becomes brittle causing it to break.

Trichotillomania
Trichotillomania is a form of hair loss caused by deliberate plucking and twisting of the hair. Hair shafts are broken off at irregular lengths, but the underlying scalp in normal and hair will grow back if pulling is not prolonged. Children may twist and pull their hair as a matter of habit similar to nail biting. When this condition occurs in older children or adults, it is usually part of a compulsive disorder. Psychiatric help is sometimes needed to treat this condition.

Other Causes of Hair Loss
Medical ConditionsMedical conditions, such as anaemia and thyroid diseases, can cause rapid hair loss. These can be reversed with treatment from your doctor.Certain medicinesCertain medicines, such as those used in the treatment of high blood pressure, high cholesterol, other heart problems, cancer, acne and birth control pills can cause hair loss.

Women on the pill who suffer hair thinning often have an hereditary tendency to hair loss. Hair may also start to fall out 2 to 3 months after stopping the pill, and this can last for up to 6 months.

Chemotherapy used to treat cancer can cause a rapid loss of nearly all scalp hair. When the treatment is completed the hair often regrows.Pregnancy and Child Birth Pregnancy and child birth can affect hair growth. During pregnancy women do not lose as much hair as usual. However, within 2 to 3 months after delivery, some women may see large amounts of hair coming out in their brushes and combs. This can last 1 to 6 months. In most cases the condition reverses completely. Longterm illness, major surgery and high fever Anyone who has had a high fever, major illness or operation, or a tremendous shock to the system (for example, death in the family) may notice increased hair loss within 1 to 3 months afterwards. The condition, called telogen effluvium, reverses itself within a few months but people who have a severe longterm illness may notice increased hair loss for the duration of the illness.

Crash diets, with rapid weight loss can also cause this type of hair loss.

Help from your Doctor
If you are concerned about your hair thinning or hair loss, talk to your doctor. Your doctor will review your history of hair loss and any events which may have played a role in it, as well as examine your scalp. Blood tests to check for anaemia, thyroid disease or hormonal changes may be needed.

Your doctor may refer you to a skin and hair specialist, called a dermatologist, who may conduct further tests to determine the cause of your hair loss. Further tests may include:

• Hair pluck - a group of hair roots are removed for examination and assessment.
Testing of the hair shafts for the presence of fungal infection. Scalp biopsy - examination of the scalp to determine the number of remaining hairs, their state of health, whether there is ongoing inflammation and whether the follicles are being destroyed.

After determining the cause of your hair loss, your doctor or dermatologist may be able to recommend an appropriate treatment.

Hair loss can be distressing. You can talk to your doctor about how you are feeling, or a support group such as the Alopecia Areata Foundation to learn about strategies that other people have used to cope with hair loss.

Treatment of Hair Loss
The treatment of hair loss depends on what is causing the problem. In some cases the hair loss may be temporary and full regrowth will occur without treatment. The identification and treatment of reversible conditions such as anaemia or thyroid disease can often result in complete recovery. In other cases hormone replacement therapy or measures to block hormone effects on the follicles may be used.

If your have alopecia area, cortisone injections into the scalp or a mixture of topical creams and lotions may be used.
Antifungals or antibiotics may be required for certain infections causing hair loss, for example for tinea capitis.

Male pattern hair loss (androgenetic alopecia) may be treated with topical lotions, such as minoxidil, or tablets, such as finasteride.

Apart from medical measures there are surgical options such as hair transplantation, scalp reductions and artificial hair fibre techniques which may be used in certain types of hair loss. Where appropriate, a wig or hairpiece can cover the area of hair loss.

Many people recommend various non-scientific treatments for hair loss, including vitamins, zinc, tyrosine, amino acids, hair lotions, tonics, etc. None of these has been shown to promote hair growth or prevent hair loss. Each year new treatments are recommended by non-medical practitioners. A recent example is the use of lasers and again there is not scientific evidence to support its use. If in doubt, check with your doctor before committing to any of these treatments.

Despite advances in the understanding of hair loss and the increased ability to diagnose individual conditions, there are limits to current treatment. In particular, age-related hair loss and inherited forms of hair loss are difficult to reverse, although there are treatments that may prevent further loss. there are also limits to controlling alopecia areata. In many conditions hair loss or thinning will stabilise and may not progress to baldness.

Talk to your doctor or dermatologist about the best form of treatment for you.

This information is based on a publication of the Australasian College of Dermatologists.