Hair loss is a common dermatological problem that can affect all age groups and races. There are a number of conditions associated with hair loss which have different treatment approaches. Hair growth is regulated through a cycle that starts with the growing phase “anagen” followed by the resting phase “catagen” and finally the shedding phase “telogen”. The growing phase can last from few months to few years. The duration of the growing phase largely depends on the anatomic location. An example is the relatively long growing phase of the scalp hairs compared to some other areas in the body. The ratio between the different phases is relatively balanced and when more hairs are in the shedding phase “telogen” hair loss becomes more noticeable.

Hair loss is differentiated clinically into 2 main groups: scarring versus non-scarring. That is, the hair loss can either by associated with scarring of the affected areas or not. Non-scarring hair loss represents the commonest type of hair loss disorders and these include alopecia areata, androgenetic alopecia, traction alopecia, telogen effluvium, and hair loss as a result of medication or some internal illnesses. The commonest type of non-scarring hair loss is androgenetic alopecia (also known as common baldness).

Scarring alopecia represents a group of more aggressive disorders with generally an associated inflammatory or infectious underlying cause which necessitates systemic treatments and a chronic course. Scarring hair loss disorders include folliculitis DeCalvans, lichen planopilaris, dissecting cellulitis of the scalp and few rare conditions.

Treatment of hair loss depends on the diagnosis and may range from reassurance to topical or systemic medication. In cases of non-scarring hair loss deficiency of iron stores and an underactive thyroid gland can be contributory and it is always worth checking these 2 levels first. Iron deficiency can be corrected by dietary intervention and iron supplements. 

In inflammatory cases of hair loss such as alopecia areata, anti-inflammatory drugs can be used such as corticosteroids and these can be given either as tablets or injected into the affected areas. The injections may need to be repeated at certain intervals. It is therefore essential that the diagnosis is established first and different treatment options discussed.

Dr. Firas Al-Niaimi has published on hair loss and these publications can be found in the publications section of the website.