Hair Loss: What Causes It?

         Excessive or abnormal hair loss, also called alopecia, can be influenced by many factors, and is loosely defined as the shedding of more than 100 strands of hair per day. Such influencing factors include thyroid disease, nutritional deficiencies, autoimmune diseases, genetics, and psychosocial stressors. Depending on the cause of alopecia, patients will present with different patterns of hair loss including androgenetic alopecia, telogen effluvium and alopecia areata.  Androgenetic alopecia, or male/female pattern hair loss, is the most prevalent type of hair loss and is inherited. In men, you see a gradual regression of the anterior hair line. In women, you see gradual loss of hair in the mid-scalp region.
       Patients who present with telogen effluvium complain of generalized hair loss and thinning. Causes include psychosocial stressors such as changing jobs, going through a divorce, and financial hardships, as well as other stressors to the hair follicles including pregnancy, hypothyroidism, and nutritional deficiencies. Hair loss tends to stop spontaneously after a few months, but there are several treatments that can restore hair growth in the mean time. This includes over-the-counter-Rogaine (minoxidil) for both men and women, Propecia (finasteride) for men only, and Nizoral (ketoconazole) shampoo. These same treatments are used for patients who present with androgenetic alopecia, although hair restoration tends to be slower and limited in these patients due to the genetic basis of their hair loss.
       Lastly, alopecia areata is described as rapid and complete hair loss in one or more round or oval patches. The exact cause is unknown, but thought to be due to an autoimmune response in the body, related to diseases such as vitiligo, lupus and thyroid diseases. Some patches tend to re-grow without any treatment in several weeks. Stubborn patches may need to be treated with a topical or injectable corticosteroid in order to accelerate re-growth. In any case of alopecia, your provider will order routine blood work to determine the cause of hair loss.