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Introduction

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Look it’s only death. It’s not like losing your hair.

Harold Brodkey upon learning he had AIDS, New Yorker Magazine 1994

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The hair of our scalp is referred to as our crowning glory and the threat of hair loss in both sexes provokes extraordinary anxiety bordering on grief in some people. It behoves us as medical practitioners to treat the patient presenting with ‘I’m losing my hair’ with appropriate support and understanding. Likewise, the problem of hirsutism provokes similar anxiety and concerns about body image. Interestingly, women present with hair loss more than men.

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Key facts and checkpoints

  • There are two types of hair: terminal hair, which is coarse and well pigmented, and vellus hair, which is fine, soft and relatively unpigmented.

  • Alopecia is a generic term for hair loss.

  • Hair loss (alopecia) generates considerable anxiety and the fear of total hair loss should be addressed with the patient and a realistic prognosis given.

  • Androgenic alopecia is the most common cause of human hair loss, affecting 50% of men by age 40 and up to 50% of women by age 60.2 Other common causes are alopecia areata, seborrhoeic dermatitis and tinea capitis (see Table 128.1).

  • In telogen effluvium, the traumatic event has preceded the hair loss by about 2 months (peak loss at 4 months).

  • Although severe stress could precipitate alopecia areata, day-to-day stressors are not considered to be a trigger. Stress seems to be a consequence of alopecia rather than the cause of it.3

  • Hair loss can be patchy or diffuse where it involves the entire scalp.

  • Patchy loss—alopecia areata and trichotillomania.

  • Generalised loss—telogen effluvium, systemic disease, drugs (see Table 128.2).

  • Alopecia areata has a poor prognosis if it begins in childhood, if there are several patches and there is loss of eyebrows or eyelashes.

  • Scarring alopecia can be an indicator of lupus erythematosus or lichen planus.

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Table Graphic Jump Location
Table 128.1

Hair loss: diagnostic strategy model

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Table Graphic Jump Location
Table 128.2

Causes of diffuse hair loss

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