Alopecia (hair loss)

We all lose about 100 hairs a day. Other hairs normally grow in their place, but when they aren't replaced fast enough, your hair starts to get thin. Learn more about the causes and treatments of alopecia or hair loss.

What is alopecia?

Alopecia refers to partial or complete hair loss on the head and also applies to loss of hair on other parts of the body. Alopecia occurs most often in Caucasians.

The most common form is androgenetic alopecia, also called “male pattern baldness,” which mainly occurs in men. Hair loss is related to genetic factors and an excess of androgens (male sex hormones), such as testosterone. A derivative of testosterone called dihydrotestosterone (DHT) is responsible for hair loss.

Men can start developing alopecia in their twenties. Around the age of 70, nearly 8 in 10 men will have hair loss. The hair loss usually starts on the sides of the forehead, at the temples, or on the top of the scalp. A rim of relatively thick hair may stay despite the hair loss.

Alopecia in women , also called “female pattern baldness”, is another possible form of hair loss. Although women don't get hair loss as often as men, an estimated 4 out of 10 women will have some form of it after the age of 50. Total hair loss is rare, and women instead will have hair thinning over the entire scalp. Genetics is known to play a role in this type of hair loss, although it isn't known whether menopause plays a role as well.

Other types of alopecia include alopecia areata (spot baldness), alopecia totalis (total hair loss) and trichotillomania (hair loss from excessive or compulsive pulling).

Alopecia causes

The following are the most common causes of alopecia:

• heredity
• age
• significant stress
• certain diseases (e.g., lupus, lichen planus)
• hormonal imbalance (e.g., excess androgens, hypothyroidism)
• certain medications or therapies (e.g., chemotherapy)
• major surgery

Alopecia prevention and treatment

Hair loss prevention

Although you can’t prevent alopecia, you can care for your hair to help keep it healthy. 

• Wash your hair 2 or 3 times a week with a gentle shampoo.
• Dry your hair by blotting it gently with a towel and without rubbing. Air dry your hair as much as possible. If you use a hair dryer, make sure the temperature isn’t set too high.
• Brush your hair gently with a round natural-bristle brush or a comb with wide-spaced teeth. Avoid brushing too hard.
• Limit your use of irritating products (hair sprays, gels, dyes, perm  chemicals) and heating devices (curling irons, flat irons, rollers).
• Adopt a healthy lifestyle that includes a balanced diet and good stress management. 

Hair loss treatment

If you experience unusual hair loss, see your pharmacist or doctor. If your alopecia is being caused by something treatable like a disease, hormone disorder, stress or medication, then the cause should be addressed first.  Hair loss from chemotherapy or radiation therapy often grows back naturally once the treatment is over.

For baldness, minoxidil (Rogaine^TM) is a topical treatment that has been proven to slow hair loss and promote hair growth. This product is sold over the counter (OTC) and can be used by both women and men. Apply it directly to the affected areas. You’ll need to try it for 4 to 6 months to see whether it is effective for you. This expensive product must be used regularly, because stopping it will cause your hair loss to come back in a few weeks.

Anti-androgens, such as finasteride (Proscar^TM), also have proven effectiveness at reducing hair loss. However, these products are only recommended for men and they require a doctor's prescription. These medications are taken orally and, like minoxidil, must be taken regularly to maintain their effectiveness.

If required, your doctor can suggest other treatment options. For example, some oral contraceptives can help women who seem to have excess androgens, as can a diuretic called spironolactone (Aldactone^TM).

There isn't much evidence demonstrating the effectiveness of OTC oral and topical cosmetics. You should always talk to your pharmacist or doctor before buying these products.

Hair implants or hair plugs are a possible treatment if your hair loss has stabilized and you have a surface with enough hair density to take a graft.

How to hide hair loss

Styling products, dyes or perms can be an affordable option to hide thinning hair. A change in hairstyle can also camouflage hair loss. Your cosmetician or hairdresser can help you find the best solution for your situation and needs. You can also consider wearing a wig. Although high-quality wigs are expensive, they look very natural.

Hair can be perceived as an important part of our appearance, and hair loss can therefore affect self-confidence. Don’t hesitate to discuss your concerns with your pharmacist, who can help you decide which solution is best for you.