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Hair loss is defined as loss of scalp hair. It is more common in males than in females. There are various causes of hair loss

  • Fungal infection (alopecia areata)
  • Excessive plucking (tricotillomania) or pulling (tractiealopecia) of the hair
  • Scar tissue formation (alopecia atrophicans)
  • Genetic

There are about 100,000 hair follicles on the hair of which 90% are in the growth phase. The growth phase lasts about 2 to 6 years. The next three months is the rest phase and after that the hair falls off. It is normal to lose about 50 to 100 hair strands per day.

Growth phase of hair can be affected and prematurely interrupted due to the following conditions

  • Chronic disease like cancer or kidney disease
  • Folium and Iron deficiency
  • Medication use
  • Hormonal changes such as during pregnancy or thyroid gland problems
  • Diabetes mellitus

A genetic condition called alopecia androgenetica is most common in males than in females and occurs when hair follicles are highly sensitivity to androgenic hormones. These hormones cause atrophy or thinning of the hair follicles

The GP should ask for

  • How long the hair loss has been
  • If it occurs in the family
  • Any use of medication of pre-existing conditions
  • Presence of dandruff
  • if you are stressed or overworked
  • Any previous trauma or scar
  • Repetitive plucking or pulling

How to test for abnormal hair loss

  • After you shampoo and rinse your hair, take 30-40 strands between your thumb and index finger, then pull on it. If more than 6 hair strands are pulled along then this could be a reason to contact your GP

There is no effective management for alopecia androgenetica. It is important for men or women to accept this hair loss and not resort to various treatments that do not work. However the GP can consider

  • Minoxidil scalp lotion 5% twice a day for 12 months
    • In case of irritation then a 2% solution can be used
  • Finasteride 1mg tablets one day for 12 months; this has shown to have some positive effect in hair growth.
    • Stopping this medication could result in hair loss again.

In the event of alopecia areata, the GP could prescribe local injection with corticosteroids.

The GP can make a referral to specialist in the event of obsessive plucking of the hair in children or adults.

Hair loss can cause anxiety for many people. In the majority of cases alopecia areata will resolve spontaneously without any treatment in 6 months. For those with a hormonal cause of hair loss, the chance of spontaneous hair growth is low. Scar tissue that causes hair loss does not resolve.