Hair loss

Symptoms and causes

What is it?

Hair loss or effluvium is a process in which more hair falls out than what is considered normal. The average loss can be 100 to 150 hairs per day. Hair loss is often noticed by reduced hair density or density, among other things.

Our hair follows a fixed cycle. The duration of the different phases will vary depending on the location of the hair on the body.

Thus, hairs on the scalp grow during the so-called anagen phase, which lasts two to six years. They then move into a brief involution phase, the catagen phase, which lasts only about three weeks. They then move into the resting, telogen phase, which lasts for three months. At the end of this telogen phase, the hair falls out. This is the so-called exogenous phase. Then a new anagen hair sits ready to grow.

Different types of hair loss

We distinguish between hair disorders in which scarring of the hair follicles does or does not occur, cicatricial and non-cicatricial alopecia, respectively. The non-scarring form of hair loss is the most common.

Non-cicatricial alopecia (no scarring)

Three common forms of non-scarring hair loss are discussed here. Other forms of hair loss without cicatrisation or scarring have been described in addition to these three conditions.

Telogen effluvium (temporary)

Telogen effluvium is a common form of hair loss. This involves an increased number of hairs (minimum 20%) passing from the anagen to the telogen phase, resulting in diffuse hair loss. A telogen effluvium has several causes:

blood deficiencies (e.g. iron, zinc, vitamin B12)
certain medication
giving-birth
stress
weight loss
surgical procedures
infection
...

The hair usually falls out three to four months after exposure to the cause.

This temporary hair loss can last up to three months and is completely reversible.

Sometimes hair loss lasts longer than six months. Then we speak of chronic telogen effluvium. This can be primary with no obvious cause or secondary, for example due to a longer-standing iron deficiency or a thyroid problem.

Androgenetic alopecia (most common form of hair loss)

This is the most common form of hair loss in men. However, alopecia also occurs in women. People speak of 'male pattern hair loss' (MPHL) and 'female pattern hair loss' (FPHL), respectively.

MPHL (men) usually starts between the ages of 16 and 30. It can also occur in old age. This type of hair loss is mainly genetic and hormonal. There is a loss of hair density as hair follicles become smaller. In men with MPHL, usually the front hairline and crown will be affected.

FPHL (women) occurs in 40% of women. It is observed in some patients during puberty and, in others, only after menopause. Hormonal and genetic factors also play a major role in women. In women, thinning is typically observed in the 'crown' region of the hairy scalp.

Androgenetic alopecia is a chronic condition, where it is important to undergo long-term treatment. It also takes time (six months to a year) to observe an effect from treatment.

Alopecia areata (patchy baldness)

Alopecia areata or patchy baldness occurs in 2% of the population at some point in life. In 90% of these patients, there is patchy hair loss on the scalp. The other hairy regions may also be affected. In some patients, another autoimmune condition is found or there is a family history of alopecia areata. It can be triggered by stress and infections, among other things. Depending on the extent, treatment will consist of local treatments or pill medication.

Cicatricial alopecia (scarring)

In these often rarer conditions, there is usually significant inflammation and scarring of the hair follicles. This makes hair regrowth more difficult. The physician usually determines a diagnosis based on the pattern of hair loss and the marks on the scalp . Sometimes, a biopsy is necessary to arrive at a correct diagnosis and suggest appropriate treatment.

Diagnosis and treatment

When to consult a physician?

When the hair loss is temporary and generalised (e.g. after a period of stress or illness, surgery or childbirth), it is not always necessary to contact a physician. This usually lasts a few months and resolves on its own.

In case of chronic hair loss, spot hair loss or hair loss with scarring, a check-up and treatment by a physician may be necessary. The GP can make an initial assessment of the urgency of the problem, possibly conduct a blood test, initiate treatment, and make an appropriate referral.

You can visit our Dermatology Department for these problems.

Diagnosis

To arrive at a diagnosis, the physician will ask you several questions :

How long has the hair loss been going on?
Do you see the hairs falling out or notice reduced hair density?
Is there pain and/or itching on the scalp?
Are you in good health?
Are you taking medication? If so, which one?
Take your contraception. If so, which one?
Are there any hair disorders in the family?
Have you followed any treatment yet? If so, for how long and what was the effect?

You can think about this ahead of time and note down or bring your previous treatments, if necessary.

Afterwards, the entire scalp, eyebrows, eyelashes and beard area will be examined. Sometimes, it is necessary to look at the entire body and the nails.

This involves looking with the naked eye, but also with the dermatoscope to see the skin, scalp and hairs in greater detail.

Before your appointment

Want to make an appointment for a hair problem? Schedule your appointment by phone (not online) and clearly state that you wish to come for a hair problem. This way, the secretarial staff can schedule the right appointment for you.
Preferably, hair should not be washed from 48 hours prior to the consultation to avoid affecting the examination.
Sometimes it is necessary to take hair samples to examine under the microscope; the physician can explain when this is useful or not.
In certain cases, we recommend blood tests . With this, we want to see if there is a hormonal influence or if there are certain 'deficiencies’, such as iron, vitamin B12 and zinc. Autoimmunity can also sometimes be looked for in the blood. In specific cases, it is necessary to determine the hormones in the blood. It all depends on the story and the type of hair loss.
In some cases, a skin biopsy (removing a small amount of the scalp) may be necessary to establish the correct diagnosis. The physician will also give you more information about this, if necessary.

Treatment

Depending on the type of hair loss, a treatment will be suggested and initiated. Treatment may consist of a topical lotion, gel, cream or foam to be applied to the scalp. Sometimes injections into the scalp or pill treatments are advised.

Hair supplements or hair vitamins are useful only in specific cases of hair loss.

No hair transplants are performed at our Dermatology Department.

Further advice can also be provided by colleagues who specialise in hair camouflage, volume cuts, headgear and wigs.

Treatment centres and specialisations

Dermatology

Skin disorders

Latest publication date: 17/05/2024