Some Causes and Features of Hair Loss
Cause | Common Features* | Tests |
|---|---|---|
Hair loss over the entire scalp | ||
Male-pattern hair loss (androgenetic alopecia) | Often a family history Sometimes a history of using anabolic steroids | A doctor's examination |
Female-pattern hair loss (androgenetic alopecia) | Often a family history Sometimes occurring during menopause Sometimes in women with masculine characteristics (virilization), a history of using anabolic steroids such as dihydrotestosterone, or a tumor that produces male hormones Sometimes polycystic ovary syndrome | A doctor's examination Sometimes measurement of hormones: thyroid hormones, testosterone, DHEAS, FSH, and LH |
Medications, illicit drugs, and toxins | A doctor's examination Sometimes blood tests to check for exposure to toxins or heavy metals | |
Stress (psychological or physical) causing telogen effluvium | Severe psychological stress Recent weight loss, surgery, severe illness with a fever, or delivery of a baby | A doctor's examination Sometimes blood tests to check for anemia and iron deficiency and to evaluate thyroid function |
Thyroid disorders | With hyperthyroidism (an overactive thyroid gland), difficulty tolerating heat, sweating, weight loss, bulging eyes, shakiness (tremor), restlessness, and an enlarged thyroid gland (goiter) With hypothyroidism (an underactive thyroid gland), difficulty tolerating cold, weight gain, coarse and thick skin, and sluggishness | A doctor's examination Blood tests that evaluate thyroid function |
Nutritional disorders, such as or a deficiency of iron or zinc | Symptoms of the specific nutritional disorder | A doctor's examination Sometimes blood tests to check for nutritional disorders |
Typically patchy hair loss, but sometimes loss of all scalp hair (alopecia totalis) Sometimes loss of all body and scalp hair (alopecia universalis) | A doctor’s examination† | |
Hair loss only in a specific area of the scalp | ||
Alopecia areata | Round patches of hair loss with short broken hairs (resembling exclamation points) around the edges of the patches Sometimes a burning sensation or itching Sometimes loss of hair from the side and back edges of the scalp (ophiasis) or central hair loss, with sparing of the hairs at the margin of the scalp (sisaipho) | A doctor’s examination† |
Chronic cutaneous lupus erythematosus | A rash on the scalp characterized by red, raised, and scaly patches with associated hair loss Sometimes areas of scarring Sometimes itching | A doctor's examination Blood tests to check for lupus Biopsy of the scalp |
Central centrifugal cicatricial alopecia | Slowly progressive hair loss and scarring on the top and back of the scalp Possibly caused by the use of hot combs, chemical relaxers, or hair weaves in people who have a genetic predisposition to develop this disorder | A doctor's examination Biopsy of the scalp |
Lichen planopilaris (lichen planus of the scalp) and frontal fibrosing alopecia | Related disorders that cause scattered patches of hair loss and scarring Called frontal fibrosing alopecia when scarring hair loss occurs predominantly along the front of the hairline and the eyebrows | A doctor's examination Biopsy of the scalp |
Burns, injuries, or radiation (for example, from radiation therapy) | A history of burns, radiation therapy, or injury Often scarring | A doctor's examination |
Tinea capitis (ringworm of the scalp) | Bald areas sometimes with small black dots (due to hair that has broken off at the scalp surface) or hairs broken just above the scalp surface Round, scaly areas of skin, which can be red or inflamed May cause scarring | A doctor's examination† Examination of plucked hairs under a microscope and/or culture of plucked hairs Sometimes a wood light examination |
Traction alopecia | Braids, rollers, or ponytails that are left in too long or pulled too tight May cause scarring | A doctor's examination† |
Trichotillomania (compulsive hair pulling) | Typically an asymmetric, bizarre, irregular hair loss pattern Sometimes obsessive-compulsive behavior Affects women 4 times more often than men | A doctor's examination† |
* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. | ||
† Sometimes, biopsy of the scalp is done. | ||
ACE = angiotensin-converting enzyme; DHEAS = dehydroepiandrosterone sulfate; FSH = follicle-stimulating hormone; LH = luteinizing hormone. | ||