Hair loss can appear in many different ways depending on the cause. Common signs include gradual thinning on the top of the head for both men and women, circular or patchy bald spots, and sudden loosening of hair after an event like childbirth or illness. Hair loss may be temporary from stress or medical treatments, or permanent from hereditary baldness or scarring conditions. See a doctor if hair loss is distressing or sudden, or if there are other concerning scalp symptoms like scaling, to determine the cause and best treatment options. Preventable hair loss can be avoided by gentle hair care and a healthy lifestyle.

1. Hair Loss
Alopecia is the medical term for hair loss

2. Normal hair fall
• People typically lose 50 to 100 hairs a day.
• This usually isn’t noticeable because new hair is growing in at the
same time.

3. What is hair loss?
• Hair loss occurs when new hair doesn’t replace the hair that has fallen out
• Hair loss is a common issue affecting millions of people worldwide.
• Understanding its causes, treatments, and prevention methods can help you take control of your hair health.
• We will discuss various factors contributing to hair loss, different hair loss conditions, their effective treatments, and other steps you can take to maintain healthy hair.
• Hair loss (alopecia) can affect just your scalp or your entire body, and it can be temporary or
permanent. It can be the result of heredity, hormonal changes, medical conditions or a normal
part of aging. Anyone can lose hair on their head, but it's more common in men.
• Baldness typically refers to excessive hair loss from your scalp. Hereditary hair loss with age is the
most common cause of baldness. Some people prefer to let their hair loss run its course untreated
and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others
choose one of the treatments available to prevent further hair loss or restore growth.
• Before pursuing hair loss treatment, talk with your doctor about the cause of your hair loss and
treatment options.

4. CAUSES
• Family History (heredity) – Most common cause of hair loss is a hereditary condition
that happens with aging. This condition is called androgenic alopecia, male-pattern
baldness and female-pattern baldness. It usually occurs gradually and in
predictable patterns — a receding hairline and bald spots in men and thinning hair
along the crown of the scalp in women.
• Hormonal changes and medical conditions. A variety of conditions can cause
permanent or temporary hair loss, including hormonal changes due to pregnancy,
childbirth, menopause and thyroid problems. Medical conditions include alopecia
areata (al-o-PEE-she-uh ar-e-A-tuh), which is immune system related and causes
patchy hair loss, scalp infections such as ringworm, and a hair-pulling disorder called
trichotillomania (trik-o-til-o-MAY-nee-uh)
• Medications and supplements. Hair loss can be a side effect of certain drugs, such
as those used for cancer, arthritis, depression, heart problems, gout and high blood
pressure.

5. CAUSES
• Radiation therapy to the head. The hair may not grow back the
same as it was before.
• A very stressful event. Many people experience a general
thinning of hair several months after a physical or emotional shock.
This type of hair loss is temporary.
• Hairstyles and treatments. Excessive hairstyling or hairstyles that
pull your hair tight, such as pigtails or cornrows, can cause a type
of hair loss called traction alopecia. Hot-oil hair treatments and
permanents also can cause hair to fall out. If scarring occurs, hair
loss could be permanent.

6. What factors can cause hair loss?
1. Genetic Factors: Hereditary hair loss, also known as androgenetic alopecia, is the most common cause of hair loss. It
affects both men and women and is characterized by a receding hairline and thinning hair.
2. Hormonal Imbalances: Hormonal fluctuations due to pregnancy, menopause, or conditions like polycystic ovary
syndrome (PCOS) can lead to hair loss.
3. Nutritional Factors: A balanced diet is crucial for hair health. Deficiencies in nutrients such as iron, zinc, vitamin D, and
B vitamins can contribute to hair loss.

7. What factors can cause hair loss?
4. Medical Conditions: can cause hair loss.
• Thyroid disorders,
• Autoimmune diseases like alopecia areata
• Scalp infections
5. Medications and Treatments:
* Certain medications and treatments including chemotherapy, can lead to temporary or permanent hair loss.
6. Stress:
Both physical and emotional stress can cause hair loss by triggering telogen effluvium, a temporary hair-
shedding condition.

8. RISK FACTORS
• A number of factors can increase your risk of hair loss,
including:
• A family history of balding on your mother's or father's side
• Age
• Significant weight loss
• Certain medical conditions, such as diabetes and lupus
• Stress
• Poor nutrition

9. We need to identify your type of hair loss
• There are many hair loss types, and knowing which one you have can be very beneficial when treating it.
• First, it's essential to understand the difference between androgenetic alopecia (male or female pattern baldness) and
non-androgenetic alopecia (non-pattern hair loss).
• Androgenetic alopecia: affects men and women differently - men generally have a receding hairline at their temples, while
women tend to experience general thinning throughout the scalp.
• Non-androgenic alopecia: are rarer forms, such as alopecia totalis (total scalp baldness), alopecia universalis (total body
baldness), and telogen effluvium (i.e. brief shedding after childbirth or major surgery).

10. SYMPTOMS
• Male-pattern baldness
• Female-pattern baldness
• Patchy hair loss (alopecia areata)
• Traction alopecia
• Receding hairline (frontal fibrosing alopecia)

11. Male Pattern Baldness (MPB):
(Androgenic Alopecia)
• Male pattern baldness is a common form of hair loss among men caused by genetic and
hormonal factors.
• Has a shortened anagen phase and progressive shrinking of terminal hairs into vellus
hairs.
• Hormone: Action of dihydrotestosteroneon dermal papilla cells suppresses (signaling pathway)  results
in defective hair growth and retarding hair cycling
• Usually seen in men by age of 50 years,
• It usually begins with the thinning of hairlines, on the temples and crown (top) of the head,
resulting in a receding hairline or bald spots. In some cases, it can even lead to complete
baldness.
Symptoms of male pattern baldness:
● Gradual thinning of hair at the crown or top of the head
● Frontal recession & thinning
● Receding hairline around the temples and a generally sparse appearance
● Increased shedding
● Excessive oiliness or dryness of the scalp
● Irritation or inflammation
● In advanced cases, bald spots may form on the scalp or forehead

12. Female Pattern Hair loss - Baldness
Female pattern hair loss is the most common cause of hair loss affecting millions of women worldwide.
It usually begins in the 40s and can continue until menopause.
It typically starts with scalp hairs becoming progressively less dense.
The primary cause is an excess of androgens or male hormones, which causes hair follicles to shrink, leading to
thinning hair on the scalp, decrease hair density
Other potential causes could be genetics and environmental conditions
Symptoms of female pattern baldness
Many women first experience hair thinning and hair loss where they part their hair and
on the top-central portion of the head.
Common signs and symptoms include:
● Gradual thinning on top of the head
● Receding hairline, especially at temples
● Widening of the center hair part, frontal, parietal regions
● Increased hair shedding on a pillow in the morning
● An overall decrease in scalp coverage
● Visible bald patches (in advanced cases)
● Hair shedding or breakage

17. Alopecia Areata:
(non-androgenic alopecia)
• Alopecia areata is an autoimmune disorder that causes nonscarring patchy hair loss on the
scalp, face, and other parts of the body in males and females at any age. The body’s immune
system attacks hair follicles (what holds the hair in place), leading to hair loss in small, round
patches.
• Patchy hair loss occurs suddenly and usually starts
with one or more circular bald patches that may
overlap
Symptoms of alopecia areata (continued):
● Sudden onset of one or more round, smooth patches of hair loss on the scalp or other body
parts
● The skin in these areas is usually not inflamed or scaly
● Scaling and inflammation on the scalp
● Dandruff-like flaking
● Hair loss on other areas of the body, such as the beard or eyebrows
● Sometimes, the affected area may have a burning or itchy sensation

18. Telogen Effluvium (non-androgenic)
• Telogen effluvium is a temporary increase in hair shedding caused by various factors, such as stress, illness, surgery, or
significant weight loss. Hair shedding typically occurs 2-3 months after the triggering event and can last for several months
before resolving.
Symptoms of telogen effluvium:
● Rapid, noticeable thinning or shedding of scalp hair
● Excessive amounts of hair in the shower drain or on pillows after sleeping
● Small "peach fuzz" hairs on the scalp
● Visible scalp through thinning hair
● Itching, burning, or redness of the scalp
● Loss of eyebrows or eyelashes in some cases

19. Anagen Effluvium
• Anagen effluvium is a type of hair loss caused by an interruption to the normal growth cycle of the hair follicle. This can
occur when the cells producing new hairs are damaged or destroyed, leading to rapid hair shedding. Chemotherapy
treatments, some medications, certain medical conditions, and nutritional deficiencies can trigger anagen effluvium.
Symptoms of anagen effluvium:
● Rapid hair loss, usually within 2 to 4 weeks after the triggering event
● Hair thinning, with a reduction in overall hair volume
● Patches of baldness on the scalp or other areas of the body where hair is present
● Brittle, easily broken hair
● An itchy, scaly scalp or lesions on the scalp or other body areas with hair loss
● Eyebrows and eyelashes may be affected in some cases

20. Traction Alopecia
• Traction alopecia is hair loss caused by prolonged, constant tension on the scalp.
It can occur from hairstyles that pull too tightly on the follicles, such as tight buns,
braids, and ponytails. Traction alopecia is commonly seen in African Americans,
but anyone can be affected by it.
• Hair loss can occur if you wear pigtails, braids,
or use tight hair rollers
Symptoms of traction alopecia:
● Thinning hair and bald patches in areas repeatedly exposed to tight hairstyles
● Tenderness or burning sensations on the scalp and itching
● Inflammation or open sores (known as folliculitis) due to excessive tension
placed on the hair follicles
● Hair loss may spread beyond the initial area of damage, and other scalp issues,
such as scarring or infections, may occur

21. Receding hairline
• Also known as: Frontal fibrosing alopecia
• Early treatment of a receding hairline might help avoid significant
permanent baldness.
• Cause of condition is unknown, but it primarily affects older women

22. Scalp Psoriasis
• Scalp psoriasis is a prevalent skin condition that affects millions of people globally. It is characterized by red, scaly patches on
the scalp, leading to itching, burning, discomfort, and even hair loss. By understanding the symptoms and recommended
treatments for scalp psoriasis, you can better manage this condition and reduce its impact on your hair health.
Symptoms of scalp psoriasis:
• Depending on the severity, symptoms of scalp psoriasis can vary. Common symptoms include:
● Itchy, scaly patches on the scalp
● Redness and inflammation
● Thick, silvery scales or plaques that may appear as large patches
● Hair loss in patchy areas
● Burning or soreness
● Stiffness in the scalp
● Flaking skin that may appear on clothes or furniture

23. Trichotillomania
• Trichotillomania, or hair-pulling disorder, is a psychological condition marked by a recurrent urge to pull out one's hair. This behavior can lead to
noticeable hair thinning, patchy baldness, or even complete hair loss in severe cases
Symptoms of trichotillomania
• Common symptoms associated with trichotillomania include:
● Obsessive thoughts or urges to pull out hair
● Feelings of tension before and relief after hair-pulling
● Frequent playing with, twirling, or rubbing pulled-out hair
● Inability to resist hair-pulling in specific situations or when experiencing certain emotions
● Noticeable bald patches on the scalp and other areas of the body
● Emotional distress related to hair-pulling, such as guilt or shame
● Excessive grooming behaviors leading to hair loss, such as over-combing or brushing
● Feelings of satisfaction when looking at pulled-out hair
● Using techniques to disguise bald patches, such as wearing hats or frequently changing hairstyles

24. Hairline recession & thinning at the crown
Hairline recession and thinning at the crown can be distressing for many people, especially those who had a full head of hair
in their younger years. This issue affects both men and women but is more common in men.
Symptoms of hairline recession & thinning at the crown
● Widening of the central and frontal hair part line
● Visible scalp on forehead, temples, or crown areas
● Reduced amount of hairs in specific areas
● An overall decrease in fullness and body of hair along the parting line
● Widening of the scalp line with a receding hairline
● Hair loss in patches, mainly on the crown area
● Breakage or shedding hairs along the parting lines or around the crown area

25. Cicatrical alopecia (scarring hair loss)
 Rare hair loss from several different often overlapping conditions: destruction to hair follicles then scarring
o Central centrifugal cicatrical alopecia (CCCA)
o Frontal fibrosing alopecia (FFA)
o most commo typeof cicatrical alopecia = progressive recession of frontal & temporoparietal hairline along with
perifollicular erythema and papules leading to band-shaped scarring alopecia in the frontotemporal area
o Lichen planopilaris (LLP)
o A chronic inflammatory scarring alopecia – follicular hyperkeratosis, perifollicular erythema, loss of follicular orifices on vertex
& parietal area of scalp.
o Traction alopecia
o Physical trauma
o Burn
o Severe infections
 All these disease result in FOLLICILE damage  eventually permanent replacement with fibrous tissue
•
 Histopath diagnosis & management can be challenging – primary goal: Minimize inflammation and preserve
existing hairs

26. Other Potential causes of hair loss
• Lupus
• Nutritional Deficiencies
• Childbirth
• Infections
• Low levels of protein or iron
• Surgery
• Hypothyroidism
• Medication
• Ringworm

27. • Hereditary hair loss
• Chemotherapy
Radiation
• Syphilis
• Stress
• Obesity
• Aging
• Hormone imbalances
• Crashing diet
• Scalp infection
• Tight burns or Ponytails

28. SUMMARY
• Hair loss can appear in many different ways, depending on what's causing it. It can come
on suddenly or gradually and affect just your scalp or your whole body.
• Signs and symptoms of hair loss may include:
• Gradual thinning on top of head. This is the most common type of hair loss, affecting
people as they age. In men, hair often begins to recede at the hairline on the forehead.
Women typically have a broadening of the part in their hair. An increasingly common hair
loss pattern in older women is a receding hairline (frontal fibrosing alopecia).
• Circular or patchy bald spots. Some people lose hair in circular or patchy bald spots on
the scalp, beard or eyebrows. Your skin may become itchy or painful before the hair falls
out.
• Sudden loosening of hair. A physical or emotional shock can cause hair to loosen.
Handfuls of hair may come out when combing or washing your hair or even after gentle
tugging. This type of hair loss usually causes overall hair thinning but is temporary.
• Full-body hair loss. Some conditions and medical treatments, such as chemotherapy for
cancer, can result in the loss of hair all over your body. The hair usually grows back.
• Patches of scaling that spread over the scalp. This is a sign of ringworm. It may be
accompanied by broken hair, redness, swelling and, at times, oozing.

29. When to see a doctor?
• See your doctor if you are distressed by persistent hair loss in
you or your child and want to pursue treatment.
• For women who are experiencing a receding hairline (frontal
fibrosing alopecia), talk with your doctor about early treatment
to avoid significant permanent baldness.
• Also talk to your doctor if you notice sudden or patchy hair loss
or more than usual hair loss when combing or washing your or
your child's hair. Sudden hair loss can signal an underlying
medical condition that requires treatment.

30. PREVENTION
• Most baldness is caused by genetics (male-pattern baldness and female-pattern
baldness). This type of hair loss is not preventable.
• These tips may help you avoid preventable types of hair loss:
• Be gentle with your hair. Use a detangler and avoid tugging when brushing and
combing, especially when your hair is wet. A wide-toothed comb might help
prevent pulling out hair. Avoid harsh treatments such as hot rollers, curling irons,
hot-oil treatments and permanents. Limit the tension on hair from styles that use
rubber bands, barrettes and braids.
• Ask your doctor about medications and supplements you take that might cause
hair loss.
• Protect your hair from sunlight and other sources of ultraviolet light.
• Stop smoking. Some studies show an association between smoking and
baldness in men.
• If you're being treated with chemotherapy, ask your doctor about a cooling cap.
This cap can reduce your risk of losing hair during chemotherapy.

31. TREATMENT
• Goals: to promote hair growth by activating different signaling pathways that lead to proliferation
and differentiation of hair follicle cells and triggering new hair cycle.
• After evaluation
• Possible Common Side Effects
• Transient Redness (erythema)
• Transient Swelling (edema)
• Mild headaches
• Drowsiness
• Temporary and tolerable mild pain
• Temporary swelling
• Scalp sensitivity – minimal itching
• No major side effects like scarring, infections, hematoma, allergic reaction
• After treatment, patients can resume normal daily activities, no antibiotics are needed to prevent
infection. Can return to work the following day