Alopecia (Hair Loss)

It’s normal to lose hair. We can lose between 50 and 100 hairs a day, often without noticing.

Hair loss isn’t usually anything to be worried about, but occasionally it can be a sign of a medical condition.

Some types of hair loss are permanent, like male and female pattern baldness (Androgenic Alopecia). This type of hair loss usually runs in the family.

The cause of male-pattern hair loss is a combination of genetics and male hormones whilst the cause of female pattern hair loss is unclear.

Alopecia Areata is an autoimmune condition, which often starts with isolated patches of hair loss, commonly in one or more coin-sized (usually round or oval) patches on the scalp and/or across the body including the beard, eyebrows, eyelashes or body hair, including pubic hair.

Alopecia Areata can affect both men and women of any age. In about 50% of cases, it starts in childhood.

The trigger for the immune response that precipitates alopecia areata is not known.

Alopecia Areata does not cause permanent hair loss. The hair follicles are not destroyed, and hair can re-grow. Usually, in patchy Alopecia Areata, hair will regrow over a period of months or years but is not guaranteed.

Most of the hairs on the body are actively growing (the anagen phase) and the others are resting (the telogen phase). A hair stays in the growing phase for two to four years, before moving into the resting phase. A hair rests between two and four months, and then falls out and is replaced by a new, growing hair.

The average person loses about 100 hairs a day (10% of their hair). However, in Telogen Effluvium (TE) more hairs move into the resting phase, so instead of shedding 10% of your hair every day, about 30% of the hairs are shed. If you have Telogen Effluvium, you may lose an average of 300 hairs a day instead of 100.

There are some common triggers for TE, however, in about 30% of people affected, no cause can be found.

Common causes for TE include:

• Surgery
• Physical injury
• Psychological stress
• High fever, infection or illness
• Weight loss
• Change in diet
• Hormonal changes, such as pregnancy and menopause
• Iron deficiency
• Hypothyroidism or hyperthyroidism
• Some medications

Telogen Effluvium usually resolves itself completely within six to nine months.

Less common causes of hair loss without inflammation or scarring include the hair pulling (Trichotillomania), certain medications including chemotherapy, HIV/Aids, under active thyroid (hypothyroidism) and malnutrition (including iron deficiency).

The causes of hair loss that occurs with scarring or inflammation (“Cicatrical Alopecia”) include fungal infection, lupus erythematosus, radiation therapy, and sarcoidosis.

Most hair loss doesn’t need treatment and is either:

• temporary and it’ll grow back
• a normal part of getting older

Hair loss caused by a medical condition usually stops or grows back once you have recovered.

Treatment of pattern hair loss may simply involve accepting the condition, which can also include shaving one’s head.

Alopecia areata may be treated by steroid injections into the affected area, but these need to be frequently repeated to be effective and are therefore rarely recommended.

There are things you can try if your hair loss is causing you distress. But most treatments aren’t available on the NHS, so you’ll have to pay for them.

No treatment is 100% effective.

Finasteride and Minoxidil

Finasteride and Minoxidil are the main treatments for male pattern baldness. Minoxidil can also be used to treat female pattern baldness but women shouldn’t use Finasteride.

These treatments:

• aren’t available on the NHS
• don’t work for everyone
• only work for as long as they’re used
• can be expensive

Wigs

Some wigs are available on the NHS, but you may have to pay unless you qualify for financial help.

Synthetic wigs:

• last 6 to 9 months
• are easier to look after than real-hair wigs
• can be itchy and hot
• cost less than real-hair wigs

Real-hair wigs:

• last 3 to 4 years
• are harder to look after than synthetic wigs
• look more natural than synthetic wigs
• cost more than synthetic wigs

Find out more about NHS wigs and costs

Emotional help

Losing hair can be upsetting. For many people, hair is an important part of who they are. If your hair loss is causing you distress, your GP may be able to help you get some counselling. You may also benefit from joining a support group or speaking to other people in the same situation on online forums.

• Hair-loss – nhs.uk
• Alopecia Areata – patient information leaflet – British Association of Dermatologists
• Find out more about cancer and hair loss – nhs.uk
• Advice for children & young people with Alopecia – Alopecia UK

If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

• Waiting Times
• Local Support – Find services near me

Supporting for managing alopecia

• Alopecia UK
• Changing Faces
• HealthUnlocked.com