Hair loss can range from mild hair thinning to total baldness. Hair can fall out for many different reasons. Medically, hair loss falls into several categories, including:

Telogen effluvium — This common form of hair loss happens two to three months after a major body stress, such as a prolonged illness, major surgery or serious infection. It also can happen after a sudden change in hormone levels, especially in women after childbirth. Moderate amounts of hair fall out from all parts of the scalp, and may be noticed on a pillow, in the tub or on a hairbrush. While hair on some parts of the scalp may appear thinner, it is rare to see large bald spots.

Drug side effects — Hair loss can be a side effect of certain medications, including lithium, beta-blockers, warfarin, heparin, amphetamines and levodopa (Atamet, Larodopa, Sinemet). In addition, many medications used in cancer chemotherapy — such as doxorubicin (Adriamycin) — commonly cause sudden hair loss affecting the entire head.

Symptom of a medical illness — Hair loss can be one of the symptoms of a medical illness, such as systemic lupus erythematosus, syphilis, a thyroid disorder (such as hypothyroidism or hyperthyroidism), a sex-hormone imbalance or a serious nutritional problem, especially a deficiency of protein, iron, zinc or biotin. These deficiencies are most common in people on restrictive diets or in women who have very heavy menstrual flow.

Tinea capitis (fungal infection of the scalp) — This form of patchy hair loss happens when certain types of fungi infect the scalp. This causes the hair to break off at the scalp surface and the scalp to flake or become scaly. Tinea capitis is a common form of patchy hair loss in children.

Alopecia areata — This is an autoimmune disease that causes hair to fall out in one or more small patches. The cause of this condition is unknown, although it is more common in people who have other autoimmune diseases. When the same process causes total loss of hair from the scalp it is known as alopecia totalis.

Traumatic alopecia — This form of hair loss is caused by hairdressing techniques that do one of the following: pull the hair (tight braiding or cornrowing), expose hair to extreme heat and twisting (curling iron or hot rollers) or damage the hair with strong chemicals (bleaching, hair coloring, permanent waves). In addition, some people have an uncommon psychiatric disorder (trichotillomania) in which compulsive hair pulling and twisting can cause bald spots.

Hereditary pattern baldness, or androgenetic alopecia — In men, hair loss may follow the typical male pattern (receding front hairline and/or thinning hair at the top of the head). This is the most common type of hair loss, and it can begin at any time in a man's life, even during his teen years. It usually is caused by the interaction of three factors: an inherited tendency toward baldness, male hormones and increasing age. Many women will develop some degree of female-pattern baldness. In women, thinning occurs over the entire top or crown of the scalp, sparing the front of the scalp.

                           

1. Improper hair cosmetic use or improper hair care - Many men and women use chemical treatments on their hair, including dyes, tints, bleaches, straighteners and permanent waves. These treatments rarely damage hair if they are done correctly. However, the hair can become weak and break if any of these chemicals are used too often. Hair can also break if the solution is left on too long, if two procedures are done on the same day, or if bleach is applied to previously bleached hair. If hair becomes brittle from chemical treatments, it is best to stop until the hair has grown out.
   
   
2. Diseases like diabetes, lupus and thyroid disorders can cause hair loss. Both an over-active thyroid and an under-active thyroid can cause hair loss. Your doctor can diagnosis thyroid disease with laboratory tests. Hair loss associated with thyroid disease can be reversed with proper treatment.
   
   
3. Poor nutrition. Having inadequate protein or iron in your diet or poor nourishment in other ways can cause you to experience hair loss. Fad diets, crash diets and certain illnesses, such as eating disorders, can cause poor nutrition. Inadequate protein in diet - Some people who go on crash diets that are low in protein, or have abnormal eating habits, may develop protein malnutrition. The body will save protein by shifting growing hair into the resting phase. Massive hair shedding can occur two to three months later. Hair can then be pulled out from the roots fairly easily. This condition can be reversed and prevented by eating the proper amount of protein and, when dieting, maintaining adequate protein intake.
   
   
4. Medications. Certain drugs used to treat gout, arthritis, depression, heart problems and high blood pressure may cause hair loss in some people. Taking birth control pills also may result in hair loss for some women.
   
   
5. Medical treatments. Undergoing chemotherapy or radiation therapy may cause you to develop alopecia. After your treatment ends, your hair typically begins to regrow.
   
   
6. Recent high fever, severe flu or surgery. You may notice you have less hair three to four months after events such as an illness or surgery. These conditions cause hair to shift rapidly into a resting phase (telogen effluvium), meaning you'll see less new hair growth. A normal amount of hair typically will appear after the growth phase resumes.
   
   
7. Infancy. Newborns often lose hair during the first several months of life. This baby hair (vellus) is eventually replaced by more permanent hair. It's also common for babies to lose a patch of hair on the back of their heads from rubbing against mattresses, playpens and car seats. Hair will grow back once a baby begins to spend more time sitting up.
   
   
8. Hairstyles that pull on the hair, like ponytails and braids, should not be pulled tightly and should be alternated with looser hairstyles. Constant pull causes some hair loss, especially along the sides of the scalp.
   
   
9. Shampooing, combing and brushing too often can also damage hair, causing it to break. Using a cream rinse or conditioner after shampooing will make it easier to comb and more manageable. When hair is wet, it is more fragile, so vigorous rubbing with a towel, and rough combing and brushing should be avoided. Do not follow the old rule of 100 brush strokes a day that damages hair. Instead, use wide toothed combs and brushes with smooth tips.
   
   
10. Hereditary thinning or balding - Hereditary balding or thinning is the most common cause of hair loss. The tendency can be inherited from either the mother's or father's side of the family. Women with this trait develop thin hair, but do not become completely bald. The condition is called androgenetic alopecia and it can start in the teens, twenties or thirties.
    
    
11. Alopecia areata - In this type of hair loss, hair usually falls out, resulting in totally smooth, round patches about the size of a coin or larger. It can, rarely, result in complete loss of scalp and body hair. This disease may affect children or adults of any age. The cause of alopecia areata is unknown. Apart from the hair loss, affected persons are generally in excellent health. In most cases, the hair regrows by itself. Dermatologists can treat many people with this condition. Treatments include topical medications, a special kind of light treatment, or in some cases pills.
    
    
12. Childbirth - When a woman is pregnant, more of her hair will be growing. However, after a woman delivers her baby, many hair enter the resting phase of the hair cycle. Within two to three months, some women will notice large amounts of hair coming out in their brushes and combs. This can last one to six months, but resolves completely in most cases.
    
    
13. Cancer treatments - Some cancer treatments will cause hair cells to stop dividing. Hair become thin and break off as they exit the scalp. This occurs one to three weeks after the treatment. Patients can lose up to 90 percent of their scalp hair. The hair will regrow after treatment ends. Patients may want to get wigs before treatment.
    
    
14. Birth control pills - Women who lose hair while taking birth control pills usually have an inherited tendency for hair thinning. If hair thinning occurs, a woman can consult her gynaecologist about switching to another birth control pill. When a women stops using oral contraceptives, she may notice that her hair begins shedding two or three months later. This may continue for six months when it usually stops. This is similar to hair loss after the birth of a child.
    
    
15. Low serum iron - Iron deficiency occasionally produces hair loss. Some people do not have enough iron in their diets or may not fully absorb iron. Women who have heavy menstrual periods may develop iron deficiency. Low iron can be detected by laboratory tests and can be corrected by taking iron pills.
    
    
16. Major surgery/chronic illness - Anyone who has a major operation may notice increased hair shedding within one to three months afterwards. The condition reverses itself within a few months but people who have a severe chronic illness may shed hair indefinitely.
    
    
17. Fungus infection (Ringworm) of the scalp – This is caused by a fungus infection. Ringworm (which has nothing to do with worms) begins as small patches of scaling that can spread and result in broken hair, redness, swelling, and even oozing. This contagious disease is most common in children and oral medication will cure it.
    
    
18. Hair pulling (Trichotillomania) - Children and sometimes adults will twist or pull their hair, brows or lashes until they come out. In children especially, this is often just a bad habit that gets better when the harmful effects of that habit are explained. Sometimes hair pulling can be a coping response to unpleasant stresses and occasionally is a sign of a serious problem needing the help of a mental health professional.

What is baldness?

Baldness, also known as alopecia, is hair loss, or absence of hair. Baldness is usually most noticeable on the scalp, but can occur anywhere on the body where hair grows. The condition is more common in men than in women.

What causes hair loss?

Hair loss is believed to be primarily caused by a combination of the following:

• aging
• change in hormones
• illness
• family history of baldness
• burns
• trauma

However, hair loss is not caused by the following:

• poor circulation to the scalp
• vitamin deficiencies
• dandruff
• excessive hat-wearing
• a gene passed on from an individual's maternal grandfather

Generally, the earlier hair loss begins, the more severe the baldness will become.

What are the different types of baldness?

Baldness can be classified into various types, depending on the cause. Several of the many different types of baldness include the following:

• female-pattern baldness
  Although less common, female-pattern baldness differs from that of male-pattern baldness in that the hair generally thins all over the head, but the frontal hairline is maintained. Female-pattern baldness rarely results in total hair loss.
• male-pattern baldness
  Male-pattern baldness usually is a hereditary condition. The condition may begin at any age. Hair loss often begins on the front, sides, and/or on the crown of the head. Some men may develop a bald spot or just a receding hair line, while others may lose all of their hair.
• alopecia areata
  This hair loss disorder is characterized by sudden loss of hair in one particular area, which grows back after several months. However, if all body hair is suddenly lost, regrowth may not occur. The cause of this type of hair loss is unknown.
• toxic alopecia
  Toxic alopecia may occur following a high fever or severe illness. Certain medications, especially thallium, high doses of vitamin A, and retinoids, may cause toxic alopecia. Medical conditions, such as thyroid disease, and after giving birth may also trigger toxic alopecia. The condition is characterized by temporary hair loss. Also, some cancer medications can cause hair loss.
• scarring alopecia
  Scarred areas may prevent the hair from growing back. Scarring may occur from burns, injury, or x-ray therapy. However, other types of scarring that may cause hair loss can be caused by diseases such as lupus, bacterial or fungal skin infections, lichen planus, sarcoidosis, tuberculosis, or skin cancer.
• trichotillomania (hair pulling)
  Hair pulling, a habit most common among children, may cause hair loss.

How is the type of baldness diagnosed?

In addition to a medical history and physical examination, a biopsy of the skin area may help to identify the type of baldness and/or its cause.

Treatment for baldness:

Specific treatment for baldness will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, and therapies
• expectation for the course of the disease
• your opinion or preference

Most forms of baldness have no cure. Some types of baldness will disappear on their own. Treatment may include:

• certain medications to promote hair growth (such as minoxidil and finasteride)
• corticosteroid injections (when treating alopecia areata)
• treating any underlying condition or disease
• hair transplants
• scalp reduction
• skin lifts and grafts

What is hair replacement surgery?

The interest in hair replacement has significantly increased over the past 10 years. Two out of every three men, and one in five women, suffer from hair loss. For men, the main cause of a diminishing hairline is heredity. Hormonal changes such as menopause can cause both thinning and hair loss in women.

There are a number of hair replacement techniques that are available, although hair replacement surgery cannot help those who suffer from total baldness. Candidates for hair replacement must have a healthy growth of hair at the back and sides of the head. The hair on the back and sides of the head will serve as hair donor areas where grafts and flaps will be taken.

There are four primary different types of hair replacement methods, including the following:

• hair transplantation
  During hair transplantation, the surgeon removes small pieces of hair-bearing scalp grafts from the back or sides of the head. These grafts are then relocated to a bald or thinning area.
• tissue expansion
  In this procedure, a device called a tissue expander is placed underneath a hair-bearing area that is located next to a bald area. After several weeks, the tissue expander causes the skin to grow new skin cells. Another operation is then required to place the newly expanded skin over the adjacent bald spot.
• flap surgery
  Flap surgery is ideal for covering large balding areas. During this procedure a portion of the bald area is removed and a flap of the hair-bearing skin is placed on to the bald area while still attached at one end to its original blood supply.
• scalp reduction
  Scalp reduction is done in order to cover the bald areas at the top and back of the head. This technique involves the removal of the bald scalp with sections of the hair-bearing scalp pulled together filling in the bald area.

Possible complications associated with hair transplantation procedures:

Possible complications associated with hair transplantation procedures may include, but are not limited to, the following:

• patchy hair growth
  Sometimes, the growth of newly placed hair has a patchy look, especially if it is placed next to a thinning area. This can often be corrected by additional surgery.
• bleeding and/or wide scars
  Tension on the scalp from some of the scalp reduction techniques can result in wide scars and/or bleeding.
• grafts not taking
  Occasionally, there is a chance that the graft may not "take." If this is the case, surgery must be repeated.
• infection
  As with any surgical procedure, there is the risk of infection.

Traction alopecia may look similar to trichotillomania, but it is often the result of hair styles which involve pulling and securing hair into shape such as braiding or corn rows. The over use of hair stylers such as sponge hair rollers or curling irons may also promote traction alopecia. Traction alopecia often shows as distinct patches of hair loss in those areas where the hair and hair follicles have been put under excessive strain. The hair loss may occur anywhere on the scalp depending on the nature of the hair style or process that is causing the traction alopecia.

Traction alopecia is a very common cause of temporary hair loss. Typically, traction alopecia in the early stages involves affected hair follicles being pushed into the telogen resting state along with localized trauma to the hair follicles as a result of hair fibres being forcibly pulled out.

As with trichotillomania, traction alopecia is generally a non-scarring, non-inflammatory form of hair loss although long term use of hair styles involving traction over 3 or more years may result in a mild immune cell infiltrate and irreversible scarring damage to some hair follicles. Any form of chronic traction alopecia will eventually lead to fibrosis around hair follicles and total destruction of some hair follicles. Once destroyed the hair follicles will not regrow under any circumstances hence chronic traction alopecia can be described as a scarring cicatricial alopecia.

Traction alopecia is reversible if diagnosed in the early stages. An effective treatment is to simply avoid hair styling that puts excessive strain on the hair. Even with removal of the cause of traction alopecia it may take up to three months for the hair to recover. Areas of scalp subjected to chronic traction alopecia may never fully recover. Chronic traction alopecia may be treated by hair transplants.

Los Angeles, California, June 21^st, 2008 –Richard Farrell, owner of Farrell Hair Replacement announced today that he is adding an extra stop on his personal design tour. Richard will be at his Hair Salon & Production Center Los Angeles, CA on June 27^th and 28^th.

The Farrell Los Angeles location (which is conveniently located at 5059 W. Pico Boulevard, Los Angeles, CA 90019) has an artistic factory/loft type atmosphere dedicated to hair system perfection. The trendy location is dedicated to making Farrell Hair clients feel comfortable and cared for, Richard went on to say that “along with our very private salon rooms and our plush consultation area, one just can’t help but feel relaxed when they come in for a no cost/no obligation consultation”.

Richard Farrell who is always striving for completely undetectable and natural looking hair systems says: “Hair systems need to be produced under watchful eyes.” And no one is more precise in Hair system making than Richard Farrell himself.

The Farrell Los Angeles personal design tour is scheduled for June 27^th and June 28^th, since this is only a 2 day tour Richard has added a free registration page on his website where anyone can set their own appointment to see Richard in person. All of this and the Los Angeles appointment page are all posted on Richard’s website at: http://www.farrellhair.com/meetrichardcut.asp.

The Hair...
What do people look at first? The Hair... Is your real hair fine & limp? Well, that is the type of hair that needs to be on your hair replacement system. 99% of the companies who want to sell you a system buy inexpensive systems for overseas factories that produce their systems with Indian or Asian hair. If you want beautiful, natural looking hair, Farrell Hair Replacement will make your hair system with hair that matches your own hair texture, behaviors and characteristics.

The Front Hairline...
Not all women want to wear their hair with bangs on their forehead. With most factory hair systems you will be condemned to wearing bangs because those bangs are necessary in order to cover a thick base which could never pass for a natural hairline. Farrell hair systems are renown for their undetectable hairlines. Our hairlines can be brushed straight back from your hairline - exposing your hairline - enabling you to create most of today's fashionable hairstyles.

The Side Hairline...
This area is very important. Women might want to brush their hair back into a ponytail. With a Farrell system you will be able to wear many hairstyles which are brushed, pinned or clipped back from the face.

Hair Density...
If hair is too dense it simply has no room to move into certain hairstyles. When other companies use their thinning shear in order to adjust the density of a factory system they lose the scalp-like appearance that the system should have. A system needs to be made with approximately the same amount of hair tied into the base as the hair you have in the area that the system will be placed against. This is necessary because an undetectable hair replacement system requires that a certain amount of scalp be seen through the hair system.

The Right Base Material...
We at Farrell Hair Replacement custom make all of our own systems which allow us to offer you many options in regard to base materials or combinations of materials. Each material has plusses and minuses which we can discuss during your consultation.

Breathability & Washability...
I believe in designing and producing systems for women that breathe. Today's women are very active. So, whether you are training for a triathlon or jogging on a treadmill, your system must be as breathable as you own hair. Farrell system can be shampooed in the shower, worn in a pool or a hot tub. When you are laying on a chaise lounge by a hotel pool it should look as good as growing hair would when damp or wet. Only at Farrell will you find hair with these characteristics.

Lightweight...
Base materials need to be thin and lightweight. If they are too thin they can wear out quickly. If they are too thick then they are too detectable to the touch. We will help you choose base materials that make sense for you and will give you the longevity you might expect from Farrell Hair Replacement systems. Our systems for women are ultra custom, comfortable and undetectable to both sight and touch in most situations.

Hidden beneath Elline Surianello's beautiful hair is a woman few ever see.

Since she was 14, Surianello has suffered from a condition called alopecia, commonly known as hair loss. She wears a wig to hide the bald spots.

"To be like this all the time and think that this is how you have to be all the time, every day a little part of you dies," she said.

Surianello is among 30 million American women, about 1 in 5, living with female hair loss.

"Very few men are shocked that they are losing their hair," said Dr. Mark Kaufmann, a dermatologist. "With women, there's a complete shock and disbelief."

Surianello agreed to walk outside without her hairpiece with "Good Morning America" cameras following her.

"How do I function in the world knowing that everyone's paying attention to this," Surianello said, pointing to her hair. "Now they're not going to say anything to me because this is not a conversation, but they're going to ignore me. I become a nonentity. I become not a person that makes a statement. And I don't want to live my life that way."

About 70 percent of female hair loss is genetic. Other causes include stress, illness, medication and diet. Crash diets, tight ponytails/braids/weaves/extension, thyroid disorders, pregnancy, going off birth control and general anesthesia can all result in hair loss.

Dermatologist Susan Taylor had the following advice for preventing female hair loss.

• Don't ignore the problem. Get help soon.

• Hair care should be gentle, not painful. If it hurts, it's going to harm your hair.

• Avoid tight pony tails.

• Use gentle shampoos, nothing that itches.

• Don't skip conditioner.

• Don't over brush.

For those who have already lost a significant amount of hair, Taylor said Rogaine and cortisone injections or creams may help stabilize growth and in some cases regrow it. Rogaine costs about $25 per month. Cortisone requires a doctor's prescription and may be covered by insurance. Without insurance, the treatments cost approximately $50 to $150, Taylor said.

Hair transplants are the most expensive and time consuming treatment for female hair loss, at about $5,000 to $10,000 for a series of transplants over several months.

"There's a lot of research being done on stem cells," Taylor said. "The cells that grow hair have been identified, and hopefully we'll be able to use them one day to regrow hair in people who have lost it."

Watch the videos and become a believer!
At Farrell Hair Replacement, you can expect to receive close to perfect duplication of the hair you used to grow naturally. Watch our client testimonial video and see for yourself! And when you visit us at one of our worldwide locations, we will prove to you in person that our hair systems are totally undetectable! But before you come in, study our website and view Richard Farrell's performances at Live Cut-Ins, TV Appearances and Makeover Shows. All of these projects offer further proof that Farrell Hair Replacement is the Best in the World.

Question 1: What does the term alopecia come from?
Answer 1: It's from the Greek alopekia which means "fox".

Question 2: If my child has lost all his hair except his upper eyelashes two different times, what is this called? And also I'd like you if you would expand and give us the real definitions for alopecia areata, totalis and universalis, and also possibly, I'm going to give you a little bit more here, if you could also tell us the difference between alopecia areata and its many forms and androgenetic alopecia.
Answer 2: Now, alopecia areata differs from androgenetic alopecia. Generally male pattern hair loss starts out in the front, usually bi-temporal. In women it looks different. It can be bi-temporal but more commonly they thin in the front and they thin in the back and fortunately women don't get the same degree of complete hair loss. Usually they just get thinning in the front and thinning in the back. This is actually very normal for women. When they're in their 50s they start to notice some. Alopecia areata can sometimes mimic androgenetic alopecia but as you know tends to cause very complete hair loss, very smooth hair loss. It starts off often but not always in round patches. And androgenetic alopecia can sometimes progress rapidly. It's not a linear disease as it previously was, but as you know it usually doesn't progress the way alopecia areata can. Regarding terminology, this classic terminology is that patches of hair loss in the scalp is called alopecia areata. If you lose all the hair on the scalp that's classically alopecia totalis; all the hair on the body would be alopecia universalis. Now if you lose all your hair on the scalp and one eyebrow, it's obviously a bit more than alopecia totalis. I think it's just nomenclature, it's not really critical what you call it, you know what you have. There are real biological differences however between those people who get patchy hair loss and the people with alopecia universalis. First of all the more extensive the hair loss the worse the prognosis. Second, there seems to be something different biologically between people who get patchy hair loss and people who lose all their hair. I'm not an expert on the genetics but those genetic studies that have been done showed different genetic associations between the patchy alopecia areata and the alopecia universalis. In fact it was reported at the World Congress of Dermatology in Paris just two weeks ago that there is a gene found in some patients with alopecia universalis which is associated with that condition. So at least a sub-population of patients with alopecia universalis have a gene that's now been identified. Very interestingly, this gene is on chromosome 21. The reason that is interesting is because with Down's syndrome have a very high incidence of alopecia areata; approximately 10%. Down's syndrome is trisomy chromosome 21; there are three copies of 21, and this gene that they found associated with universalis is on chromosome 21, near the area on 21 which seems to be most critical for Down's syndrome. And this particular gene is also associated with other auto-immune diseases. So there apparently are biological differences between alopecia universalis and patchy alopecia, and these biological differences are more than the obvious extent of the disease.

Question 3: Are the number of cases of alopecia areata increasing?
Answer 3: I have no reason to think that there are more patients with alopecia areata today than there ever were.

Question 4: What are the chances of alopecia areata developing into totalis or universalis?
Answer 4: I don't know the exact number. I think in general in alopecia areata the figure is about 2-3% develop totalis or universalis.

Question 5: If alopecia areata gets so severe that it can't be hidden anymore and a prosthesis is needed, will wearing the prosthesis prevent the hair re-growth?
Answer 5: A cranial prosthesis will not prevent anything, a cranial prosthesis really has no relevance. It's a great way to hide your problem, it will not prevent any hair regrowth at all because the problem, it's underneath the skin. It's at the level of the bulb so a hair prosthesis is irrelevant.

Question 6: On a cellular level, is the body reacting the same way with alopecia areata, totalis and universalis, and what are the cellular differences?
Answer 6: At the level of the t-lymphocytes that I was talking about we do not yet know if there is any difference. We haven't identified that there's any difference in the antigen but we haven't really broken it down and looked at it. The only difference that I could remark about are these genetic studies showing that there seems to be a genetic difference between alopecia universalis and alopecia areata in its milder forms.

Question 7: Is it possible for alopecia areata to just go away on its own?
Answer 7: Yes. Actually this ability of alopecia areata to turn itself on and off is so pronounced that it makes doing studies with new treatments very challenging because you have to be sure you either have a control group or treat only half the scalp so you have the other half of the scalp as a control, to try and get over the fact that alopecia areata can flip flop very frequently on its own and even patients who have had universalis can reverse. In fact one of the things I was going to do was just ask if any of you have ever had for any length of time in your life an episode of totalis and universalis, and has it ever regrown? I'm not saying permanently, but has it ever regrown. Would you put up your hands if you've ever had totalis or universalis and had it regrow, whether it fell out again or not? Yes. So I think it's important for all of you to know that. And I stress to my patients, I'm the eternal optimist and I say I can never say to someone that your very extensive alopecia areata or totalis or universalis won't revert, won't regrow. I think that's very important

Hair loss

Hair loss can ‘just happen’ or it may be linked to some medical conditions and medicines. It can be patchy or widespread, and may range in effect from mild to severe.

Permanent hair loss is the result of genetic and hormonal factors. Hereditary baldness is the most common form. In fact, it is so common that many people think it is a normal part of the ageing process.

The majority of men and women will be affected by hair loss at some stage in their life. For most people, hair loss is mild and occurs later in life. However, when hair loss is premature or severe, it can be a source of distress. A range of treatments is available to slow or reduce hair loss, replace damaged hair and stimulate partial regrowth.

About hair
The human body is completely covered with hair follicles, except on the palms of the hands, soles of the feet, genitals and lips. Hair follicles are pouch-like tubes of skin cells that contain the hair root. Most follicles are tiny and many of the hairs they produce do not grow long enough to protrude from the pore.
Hair is made mainly of a protein called keratin. The only living part of the hair is the root (sometimes known as the bulb), which is anchored to the base of the follicle. The follicle supplies oxygen and nutrients to the root, and lubricates the hair shaft with an oily substance called sebum.

Hair is in a constant cycle of growth, rest and renewal – it is natural to lose some hair each day. Hair grows in phases, with around one in ten head hairs ‘resting’ at any given time. The colour, curl, length, thickness and amount of hair depend on genetic factors.

Causes of hair loss
There are many different causes of hair loss. Some cause temporary loss (known as telogen effluvium), while others may have long-term effects. Only those that damage the follicles or the root (the living part of the hair) cause permanent loss. Breaking or damaging the hair shaft has no affect at all on the health of the hair root.

Some causes of hair loss include:

• Traction alopecia – tight ponytails, plaits or buns can all result in patches of hair loss, usually around the scalp margins.
• Trichotillomania – sometimes, people chew or pull on hair when they are nervous. This is a stress response similar to nail biting.
• Hair weathering – hair shafts can be broken by rough handling. Brushing too vigorously, tight rolling of hair curlers, overbleaching and the use of harsh dyes and chemicals can dry out the hair and make it brittle enough to split or break. The hair root is generally unharmed and normal hair growth will resume with gentle handling and care.

• 
  
• The majority of men and women will be affected by hair loss at some stage in their life.
• There are many causes of hair loss, ranging from rough handling to hereditary factors.
• Permanent hair loss is the result of genetic and hormonal factors. Hair loss is only permanent if the living part of the hair, the root, is damaged.
• A range of treatments is available to slow or reduce hair loss, replace damaged hair and stimulate partial regrowth.

The registry has been established by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the National Institutes of Health (NIH). The new registry will be located at the University of Texas M.D. Anderson Cancer Center in Houston, with affiliated centers at UCSF, the University of Colorado, University of Minnesota, and Columbia University.

Vera H. Price, MD, professor of clinical dermatology, is the UCSF collaborator for the national project.

Alopecia areata is an autoimmune disease, one in which the body's natural defense system attacks healthy cells. In alopecia areata, the target of the attack is the hair follicle, and the result is hair loss ranging from patchy baldness to complete loss of all scalp and body hair. It affects both males and females of all races, and often begins in childhood. There is no known permanent cure.

Registry scientists will seek out and classify medical and family history data for patients with three major forms of alopecia areata: alopecia areata (patchy scalp hair loss); alopecia totalis (100 percent scalp hair loss); and alopecia universalis (100 percent scalp and 100 percent body hair loss). Families with multiple affected members will be especially helpful to further research studies. The project will offer a future central information source where researchers can obtain statistical data associated with the disease. A website is currently being developed for the registry.

The registry will serve as a liaison between affected families and investigators interested in studying this disorder. Scientists hope the registry will be useful in locating the gene or genes associated with alopecia areata. It will also link patients with other researchers studying the cause or treatment of this disease.

Baldness or hair loss is usually something only adults need to worry about. But in a few cases, teens lose their hair, too — and it may be a sign that something's going on.

Hair loss during adolescence can mean a person may be sick or just not eating right. Some medications or medical treatments, like chemotherapy treatment for cancer, also cause hair loss. People can even lose their hair if they wear a hairstyle that pulls on the hair for a long time, such as braids.

Losing hair can be stressful during a time when you're already concerned about appearance. Most of the time, hair loss during the teen years is temporary. With temporary hair loss, the hair usually grows back after the problem that causes it is corrected.

Hair Basics

Our hair is made of a type of protein called keratin. A single hair consists of a hair shaft (the part that shows), a root below the skin, and a follicle, from which the hair root grows. At the lower end of the follicle is the hair bulb, where the hair's color pigment, or melanin, is produced.

Most people lose about 50 to 100 head hairs a day. These hairs are replaced — they grow back in the same follicle on your head. This amount of hair loss is totally normal and no cause for worry. If you're losing more than that, though, something might be wrong.

If you have hair loss and don't know what's causing it, talk to your doctor. A doctor can determine why the hair is falling out and suggest a treatment that will correct the underlying problem, if necessary.

What Causes Hair Loss?

Here are some of the things that can cause hair loss in teens:

• Illnesses or medical conditions. Endocrine (hormonal) conditions, such as uncontrolled diabetes or thyroid disease, can interfere with hair production and cause hair loss. People with lupus can also lose hair. The hormone imbalance that occurs in polycystic ovary syndrome can cause hair loss in teen girls as well as adult women.
• Medications. Some medications that have hair loss as a side effect may be prescribed for teens. These include acne medicines like isotretinoin, and lithium, which is used to treat bipolar disorder. Diet pills that contain amphetamines also can cause hair loss. Chemotherapy drugs for cancer are probably the most well-known medications that cause hair loss
• Alopecia areata . This skin disease causes hair loss on the scalp and sometimes elsewhere on the body. It affects 1.7% of the population, including more than 5 million people in the United States. Alopecia areata (pronounced: al-uh-pee-shuh air-ee-ah-tuh) is thought to be an autoimmune disease, in which the hair follicles are damaged by a person's own immune system. (In autoimmune diseases, the immune system mistakenly attacks healthy cells, tissues, and organs in a person's body.) Alopecia areata usually starts as one or more small, round bald patches on the scalp. These can get bigger, and in a small number of cases, can progress to total hair loss. Both guys and girls can get it, and it often begins in childhood. The hair usually grows back within a year, but not always. Sometimes people with alopecia areata lose their hair again.
• Trichotillomania (pronounced: trik-o-til-uh-may-nee-uh). Trichotillomania is a psychological disorder in which people repeatedly pull their hair out, often leaving bald patches. It results in areas of baldness and damaged hairs of different lengths. People with trichotillomania usually need professional help from a therapist or other mental health professional before they are able to stop pulling their hair out.
• Hair treatments and styling. Having your hair chemically treated, such as getting your hair colored, bleached, straightened, or permed, can cause damage that may make the hair break off or fall out temporarily. Another type of baldness that results from hair styling actually can be permanent: Wearing hair pulled so tightly that it places tension on the scalp can result in a condition called traction alopecia. Traction alopecia can be permanent if the style is worn for a long enough time that it damages the hair follicles.
• Poor nutrition. Poor eating can contribute to hair loss. This is why some people with eating disorders like anorexia and bulimia lose their hair: The body isn't getting enough protein, vitamins, and minerals to sustain hair growth. Some teens who are vegetarians also lose their hair if they don't get enough protein from non-meat sources. And some athletes are at higher risk for hair loss because they may be more likely to develop iron-deficiency anemia.
• Disruption of the hair growth cycle. Some major events can alter the hair's growth cycle temporarily. For example, delivering a baby, having surgery, or going through a traumatic event can temporarily cause shedding of large amounts of hair. Because the hair we see on our heads has actually taken months to grow, a person might not notice any disruption of the hair growth cycle until months after the event that caused it. This type of hair loss corrects itself.
• Androgenetic alopecia. Among adults, the most common cause of hair loss is androgenetic (pronounced: an-druh-juh-neh-tik) alopecia, sometimes called male-pattern baldness. This condition is caused by a combination of factors, including hormones called androgens and genetics. Sometimes, the hair loss can start as early as the mid-teen years. It also can occur in people who take steroids like testosterone to build their bodies.

What Can Doctors Do?

If you see a doctor about hair loss, he or she will ask questions about your health and family health (called a medical history) and check your scalp. In some cases, the doctor might take hair samples and test for certain medical conditions that can cause hair loss.

If medication is causing hair loss, ask the doctor if you can take a different drug. If your hair loss is due to an endocrine condition, like diabetes or thyroid disease, proper treatment and control of the underlying disorder is important to reduce or prevent hair loss.

If your doctor recommends it, a product like minoxidil that can speed up hair growth also might be helpful. Alopecia areata can be helped by treatment with corticosteroids. If nutritional deficiencies are found to be causing your hair loss, the doctor might refer you to a dietitian or other nutrition expert.

Catastrophic Hair Loss

Hair loss can be the first outward sign that a person is sick, so it may feel scary. Teens who have cancer and lose their hair because of chemotherapy treatments (especially girls) might go through a difficult time.

It can help to feel like you have some control over your appearance when you're losing your hair. When getting chemotherapy, some people like to cut their hair or shave their heads before the hair falls out. Some even take the hair they cut off and have it made into a wig. Many options can help disguise hair loss — such as wearing wigs, hair wraps, hats, and baseball caps. For most teens who lose their hair, the hair does return — including after chemotherapy.

Taking Care of Your Hair

Eating a balanced, healthy diet is important for a lot of reasons, and it really benefits your hair.

If you're losing hair, some doctors recommend using baby shampoo, shampooing no more than once a day, and lathering gently. Don't rub your hair too vigorously with a towel, either. Many hair experts suggest you consider putting away the blow dryer and air drying your hair instead. If you can't live without your blow dryer, try using it on a low heat setting.

Style your hair when it's dry or damp. Styling your hair while it's wet can cause it to stretch and break. And try to avoid teasing your hair, which can cause damage. Finally, be careful when using chemicals — such as straighteners or color — on your hair, and avoid frequent use of chemical treatments.

Maui, Hawaii - While medical treatment and patient education on proper hair care practices are the mainstays of management for traction alopecia and central centrifugal scarring alopecia (CCSA) in black women, hair transplantation can have an important role as a second-line measure to correct hair loss, Valerie D. Callender, M.D., said at the annual Hawaii Dermatology Seminar, sponsored by the Skin Disease Education Foundation.

"Medical treatment and changing hair practices are critical for stabilizing disease and preventing progression of these hair loss disorders. However, existing hair loss has devastating psychosocial consequences on affected patients and is not addressed by those measures. While, historically, blacks have been shunned away from hair transplant procedures because of the challenges of hair harvesting and concern about the risks of hypertrophic and keloidal scarring, with use of proper techniques in appropriately selected patients, hair transplantation allows us to do something positive to improve appearance for these suffering women," said Dr. Callender, clinical assistant professor of dermatology, Howard University College of Medicine, Washington, and in private practice in Mitchelville, Md.

No-No's Before surgery is attempted to address areas of hair loss affected by traction alopecia or central centrifugal scarring alopecia, patients should be under medical management with stable disease for at least six months and be convinced about changing their hair styling techniques.

African-American female, age 30, with traction alopecia of temporal area of scalp.

"If, after hair transplantation is performed, patients with traction alopecia return to tight hair braiding or those with scarring alopecia begin again to use chemical relaxers or extreme heat for styling, they will jeopardize survival of the transplanted hairs and cause additional loss of non-transplanted hairs as well. Then, all the time and money spent on surgery was in vain. On the other hand, the surgical prognosis is generally good to excellent for patients who are motivated to change their grooming practices," Dr. Callender said.

The techniques used for harvesting and transplantation depend on the underlying cause of alopecia and differ in some respects from those used in white persons because of race-related differences in hair morphology. Follicular unit transplantation is performed in patients with traction alopecia while the punch graft technique is used to optimize follicle survival in patients with scarring alopecia.

In black women, donor tissue for follicular unit transplantation is harvested using a strip technique, usually taking a 1-cm x 6-cm elliptical strip, which is based on the calculated number of hairs transplanted to cover the recipient site. The strip is then cut into follicular units and micrografts that typically contain two to four hairs, and the units are placed into recipient incisions created with a 16 or18-gauge Nokor needle.

"When dissecting follicular units from donor material of black patients, there is an increased risk of follicle transection because of the curly nature of the follicle. Therefore, the grafts are generally larger than those used in Caucasians, and thus, larger recipient sites are needed as well," Dr. Callender said.

When performing the punch graft technique in black women, Dr. Callender uses older methodology that is based on obtaining donor material with either a 3-mm or 4- mm punch size, and creating a smaller, 2.5-mm or 3.5-mm, recipient site plug.

African-American female, age 36, with central centrifugal scarring alopecia of vertex scalp.

"Since hair is being transplanted into scar tissue, this approach is preferred over follicular unit transplantation in order to improve graft survival and optimize the cosmetic outcome," Dr. Callender said.

She added that usual objections about poor aesthetic result with use of the punch graft technique are not relevant when treating central centrifugal scarring alopecia since the transplantation site is at the vertex, not the anterior hair line, and because the curly nature of the black woman's hair helps to further camouflage the plugs.

However, before proceeding with hair transplantation to treat this scarring alopecia, Dr. Callender will do a test area, transplanting around five round punch grafts and waiting three months to evaluate survival and growth.

Scarring Concerns The potential for abnormal scarring reactions remains a concern in black patients, but seems to be addressed well with prophylactic use of a high potency topical corticosteroid, such as clobetasol propionate foam (Olux).

"Surgeons should not let fear of keloid or hypertrophic scarring stop them from performing hair transplantation in black women. Rather, they should anticipate the problem and use preventive measures to decrease the risk," Dr. Callender said.

Corticosteroid prophylaxis is initiated at the donor site immediately after suture removal, regardless of the technique used for harvesting, and is instituted at the recipient sites when punch graft hair transplantation is performed in patients with CCSA if cobblestoning appears. Keloidal and hypertrophic scarring is less likely to occur at the recipient site for follicular unit/micrograft hair transplants in patients with traction alopecia, Dr. Callender said.

African-American male, age 40, with keloid formation of occipital scalp secondary to strip donor harvesting technique for hair transplantation. (Photographs courtesy of Valerie D. Callender, M.D.)

The duration of use of the topical corticosteroid ranges from one to three months and is determined based on whether the patient has a history of hypertrophic or keloidal scarring.

Typical cases of trichotillomania, due to repeated pulling out of hairs: the new hairs grow at different rates and therefore different lengths, as can be felt when the scalp is touched

 The condition is common but not severe in children between the ages of two and six. In teenagers it is twice as common in girls as in boys, and can indicate the presence of a serious emotional difficulty.

Traction and trauma

So-called traction alopecia is seen in people whose hair is regularly subjected to strong traction (pulling). This can occur with ponytails or from backcombing or heavy-handed brushing. The braided styles and hair
weaves often worn by Afro-Caribbean people put considerable tension on the hair, and can give rise to the condition.

The effect of braiding, leading to traction hair loss

Hair loss due to traction and cosmetic abuse

Treatments and transplants can boost thin tresses.

By Lisa Kovalovich

When you think of hair loss, what image comes to mind? If you're like most of us, it's probably not a picture of a healthy woman -- but by the age of 50, over 50 percent of women are experiencing some hair loss. And believe it or not, the solution isn't as simple as a bottle of Rogaine. In fact, there actually four types of hair loss common in women, each with its own appearance, causes, and treatments. We spoke to Matt L. Leavitt, MD, a board-certified dermatologist and author of Women and Hair Loss (www.womenandhairloss.com), for some insight:

Folliculitis decalvans, also known as alopecia folliculitis or acne decalvans, is an inflammatory reaction in hair follicles on the scalp that causes redness (erythema) and pus-filled blisters (pustules). It leads to scarring and permanent hair loss.

Traction alopecia occurs as a result of improper hair care and prolonged use of certain hair-styling techniques. Cosmetic treatments (e.g., dyes, tints, bleaches, permanents) are generally safe; however, if treatments are done incorrectly, or if the chemicals are used for too long, the hair becomes brittle and breaks easily.

Hairstyles that pull the hair tightly, and excessive shampooing or brushing can also cause hair loss. Braiding, permanents, excessive heat, and hair straightening cause hair shaft weakness. Hair styling techniques such as hair weaving, corn rowing, and the use of hot combs to straighten hair can cause permanent hair thinning and scarring.

Stress alopecia, a type of telogen effluvium, is temporary, reversible, diffuse hair loss on the scalp that results from severe emotional or physiological stress. Normally, about 90% of scalp hair follicles are in the growing anagen phase, and about 10% to 15% are in the resting catagen and telogen phases. Stress causes anagen hairs to convert prematurely into telogen hairs, which means that more than the normal number of hairs are in the telogen phase and ready to shed.

Exposure to various drugs can induce a temporary alopecia. Patients concerned about hair loss or thinning should notify their doctor or other health care provider about medications they are taking. A number of prescription drugs, including certain medicines for arthritis, depression, heart problems, and high blood pressure can cause hair loss. Spontaneous regrowth usually occurs after the drug is stopped. The hair loss effect of some drugs can be prevented by cooling the scalp with a tight-fitting ice bag for 20 minutes or so while receiving the drug treatment.

Toxic alopecia (anagen effluvium) occurs when hair growth is disrupted during the anagen phase. The newly synthesized hair shafts weaken, and the hair breaks. Hair loss is usually quick and involves all the hairs in the anagen phase. Chemotherapy, radiotherapy to the scalp, and overdoses of vitamin A can cause toxic alopecia. Chemotherapy can cause 90% hair loss. The hair regrows when treatment ends.

During hormonal changes after childbirth, when the hormones revert to normal levels, all of the hair that has not been cycling suddenly enters the resting, telogen phase. For several months following childbirth, women may notice that more hair than usual falls out when they comb or brush.

Women who are susceptible to androgenetic alopecia and take birth control pills may experience hair loss. Switching birth control pills sometimes helps. Women who stop using oral contraceptives may notice their hair thinning 2 or 3 months later. The hair starts to grow normally after about 6 months.

Illness can cause hair loss. Often, for the first couple of months after serious illness, the hair enters a resting phase and starts to shed. Hair loss also may follow major surgery. Patients with a chronic illness may lose hair continually. Hypothyroidism can lead to diffuse hair loss on the scalp and dry, brittle hair. Syphilis can sometimes cause spotty hair loss.

Ringworm (tinea capitas), a contagious childhood disease, can lead to the development of inflammatory, boggy masses full of broken hairs and ooze (called kerions). Kerions usually heal but can leave permanent bald patches.

Seborrheic dermatitis, or eczema, is often associated with diffuse hair thinning and greasy, yellow scales on the scalp. Treatment usually involves tar shampoo and topical steroids.

Trichotillomania, compulsive hair pulling, can eventually lead to alopecia. As many as 6 to 8 million Americans suffer from this condition.

If a person does not eat enough protein, the body tries to make up for the deficiency by stimulating an abnormally large number of hairs to enter the resting phase of the hair growth cycle. A couple months later, those hairs shed.

Iron deficiency also can produce hair loss. For example, a woman who bleeds heavily during her periods may develop iron deficiency and associated hair loss.

Robin Parks, MS

Everyone loses some hair every day. Losing up to 100 hairs a day is normal.

But if hair loss runs in your family, you could lose a lot more hair. Over time, you may end up with bald spots or hair that slowly gets thinner. About half of all people have this type of hair loss by around age 50.^{1, 2}

Other factors, such as diseases and medicines, also can cause you to lose more hair than normal.

Although hair loss is fairly common, it can be a tough thing to live with, especially when it changes how you look. But there are ways you can treat your hair loss.

What causes hair loss?

Common causes of hair loss include:

• Heredity. In most cases, hair loss is inherited, which means it’s passed down from one or both of your parents. This is called male-pattern or female-pattern hair loss.
• Stress, including physical stress from surgery, illness, or high fever.
• Chemotherapy, which is powerful medicine that destroys cancer cells.
• Damage to your hair from pulling it back too tightly, wearing tight braids or ponytails, or using curling irons or dyes.
• Age, since you grow less hair as you get older. Hair also gets thinner and tends to break more easily as you age.
• Poor diet, especially not getting enough protein or iron.
• Thyroid diseases, like hypothyroidism and hyperthyroidism.
• Ringworm of the scalp, which is common in children.

What are the symptoms?

Your symptoms will depend on what kind of hair loss you have.

If your hair is thinning, it happens slowly over time, so you may not notice the hairs falling out. If your hair is shedding, then clumps of hair fall out. You may lose hair all over your scalp, which is called general hair loss. Or you may lose hair only in one area, which is called focal hair loss.

With inherited hair loss, men usually get bald spots around the forehead or on the top of the head, while women have thinning all over the scalp.

See a picture of typical inherited hair loss.

Since your hair has a lot to do with your appearance, losing it may cause you to have lower self-esteem if you don't like how you look. This is especially true in women and teens.

How is hair loss diagnosed?

Your doctor will ask you some questions, like how much hair you're losing, when it started, and whether your parents have hair loss. He or she will look closely at your scalp and hair-loss pattern and may gently pull out a few hairs for tests.

If it’s not clear what’s causing you to lose your hair, your doctor may do a blood test or look at a sample of your hair or scalp with a microscope.

How is it treated?

How you choose to treat your hair loss depends on the cause. It also depends on your feelings. You may decide that you need treatment, or you may not be worried about thinning hair or baldness. The choice is up to you.

Hair loss that runs in the family can be treated with medicines or with surgery, such as a hair transplant. Some people choose to wear hairpieces, like wigs or toupees (say "too-PAYZ"). Finding different ways of styling your hair, like dyeing or combing, also can help. If hair loss is caused by something you can control, like stress or medicines, you can treat it by getting rid of the cause.

When you are deciding about treatment, think about these questions:

• Which treatment is most likely to work?
• How long will it take?
• Will it last?
• What are the side effects and other risks?
• How much will it cost, and will insurance cover it?

Will your hair grow back?

When your hair loss is inherited, your hair won't grow back naturally. Treatment can help some hair grow back and prevent more from falling out, but you probably won't get all your hair back. And treatment doesn't work for everyone.

When medicines, stress, or hair damage cause you to lose your hair, it often will grow back after you take away the cause. If this doesn't help, you may need other treatment.

If you're unhappy with how hair loss makes you look, treatment may boost your self-esteem. It’s natural to want to like the way you look.

But keep in mind that treatment, especially medicines and surgery, can have some side effects and risks. Be sure to discuss your

• Tinea capitis: is a scalp infection that is caused by a fungus. It can cause patches of hair loss, with broken off hairs (black dot ringworm), scales, enlarged lymph glands, or the formation of a kerion, a large, red, boggy nodule on the scalp. Your doctor may do a KOH examination of the hairs, have a fungal culture done, or he may just treat your child with an antifungal agent, such as griseofulvin. These medicines are taken for at least 6 weeks, usually with fatty meals which can help it to be absorbed better. You can also wash your child's hair with a shampoo that contains selenium sulfide at least twice a week to make him less contagious.
• Trichotillomania: this is a condition in which a child actually pulls the hair out, leaving an irregular patch of hair loss with broken off hairs of different sizes. It can be a habit, especially in times of stress.
• Traction alopecia: this occurs when hair is braided too tight, or other tight hairstyles.
• Alopecia areata: children with this condition have a complete loss of hair in one to three areas of the scalp, without scalp redness or scaling. Another finding can be pitting of the nails in children with this condition. Although there is no reliable treatment for this condition, most children will have regrowth of the hair on their own within a year.
• Telogen effluvium: this usually occurs in young infants as a part of the normal process in which mature hair replaces baby hair. It can also occur in older children, usually a few months after an illness, and it is caused by the hair growth cycle being interrupted, with many hairs moving from a growing state to a resting state. As many hairs are shed, you may notice diffuse hair loss and it may seem like all of your child's hair is falling out, but there should be no other signs of infection or inflammation. The hair usually grows back in about 6 months.
• Congenital alopecia: newborns can have small areas of hair loss that are present from birth from a few different conditions, including aplasia cutis congenita and nevus sebaceous, a yellow-orange birthmark.
• Scarring alopecia: some conditions, including trauma or inflammatory reactions on the scalp can lead to scar formation, inside which hair does not grow, causing a bald spot on the scalp.