There are many reasons for individuals to lose hair. Every type of hair loss is treated differently so it's essential to get a correct diagnosis. The following are handouts for our patients. These provide an alphabetical overview of various patient diagnoses.
1. Acne keloidalis
This condition is a scarring process that occurs at the back of the scalp near the neck. The condition occurs most commonly in young black men and consists of itchy bumps. It consists of itchy bumps. The bumps are sometimes painful and drain fluid.
2. Age-related hair loss (senescent alopecia)
This type of hair loss refers to a type of hair thinning that affects both males and females in their later decades, usually starting around age 50. The precise cause of this type of hair loss is not known. The condition is sometimes referred to as "senescent alopecia."
3. Alopecia Areata
About 1.7 % of the world's population is affected by alopecia areata. About one-half of those who develop alopecia areata will experience hair loss before the age of 20. This type of hair loss is classified as an autoimmune condition, meaning that the body’s own immune system is attacking hair follicles . The precise cause of alopecia areata is unknown.
4. Androgenetic Alopecia
Androgenic alopecia is a common cause of hair loss in men and women. Approximately 50% of men and 35 % of women by age 50 years will have androgenetic alopecia. The condition is inherited from both sides, contrary to popular belief that it is only mom’s side. Men experience hair loss in the temples and the crown which slowly progresses to involve the entire frontal, mid and top of the scalp in some individuals. Women develop hair loss in the central scalp. The condition is usually asymptomatic. In the early stages, many individuals will experience slightly increased shedding of hairs.
5. Breast Implant illness
This is a syndrome of medical conditions that may arise as a long term consequence of having breast augmentation and breast reconstruction. This is a very different form of hair loss than the telogen effluvium that sometimes accompanies the surgery itself (or any surgery for that matter). This has been termed 'breast implant illness.' Whether or not hair loss occurs as a long term consequence in a small proportion of women who have undergone breast augmentation continues to be studied. It's an area of research that we follow closely given how often these scenarios arise in our clinic.
6. Central centrifugal cicatricial alopecia (CCCA)
This is a common type of hair loss condition that mainly affects black women. CCCA usually starts in the mid-to-late 30s. Affected women may have no symptoms or or may notice itching or burning in the central region of the scalp (i.e. the crown). Hair loss then slowly progresses outwards from the central scalp over time leading to permanent hair loss.
7. Chemotherapy Induced Hair Loss
Patients undergoing chemotherapy commonly experience hair loss. Temporary hair loss occurs with over 60 % of chemotherapy drugs. However, permanent hair loss is much less common. Certain drugs have been reported to have an increased chance of causing permanent chemotherapy induced hair loss (or PCIA). These include: TAXANES (docetaxel, paclitaxel) used to treat breast cancer, BUSULFAN used to treat acute myelogenous leukaemia, CISPLATIN used to treat lung cancer and other cancers, ETOPOSIDE used to treat many cancers, CYCLOPHOSPHAMIDE, and THIOTEPA.
8. Chronic telogen effluvium
Chronic telogen effluvium or 'CTE' is one of a number of hair shedding problems known as “hair shedding” conditions. Those affected by CTE notice increased amounts of hair being lost daily. The amount of hair loss varies greatly from day to day. Some days, over 400 hairs may be lost, whereas on other days, 30-40 hairs will be shed. Those affected by CTE will mention excessive hair in their brush, hair falling on clothes, clogged shower drains and plugged vacuums. Some individuals have scalp symptoms such as tingling or pain (medical term: trichodynia).
9. Discoid lupus erythematosus (DLE)
Discoid lupus of the scalp or “DLE” is a form of hair loss condition that often leads to with permanent scarring. Individuals with DLE may first notice itchy pimples in the scalp that then proceed to resolve with permanent scarring. Most individuals who have scalp DLE do not have systemic lupus erythematosus (a more serious type of disease that can affected several organs in the body. Although the vast majority of patients are healthy, approximately 5 % of DLE patients ultimately develop SLE.
10. Dissecting Cellulitis (DSC)
This is an uncommon form of scarring hair loss condition that mainly affects black & hispanic men aged 20-40. Individuals affected by DSC notice pustules and soft boggy nodules on the scalp that drain blood and pus. Hair loss then occurs in the area. Many individuals with DSC also develop boil-like lesion in the armpit or groin (known medically by the name hidradenitis suppurativa) and some patients develop very bad acne-like lesions.
11. Drugs Causing Hair Loss
Many drugs cause cause hair shedding. Some of the more common drugs causing hair shedding include (with percentages): Acitretin 10-75 %, Cidofovir 22 %, Danazol Up to 17 %, Heparin > 10 %, α-IFN 1-10 %, Β-IFN 4 %, PEG IFN 22 %, Lefleunomide 10 %, Levobunolol 1-10 %, Lithium 10-19 %, Moexipril 1-10 %, Ramipril 1-10 %, Terbinafine 1-10 %, Timolol 1-10 %, Valproic acid 1-10 %, Warfarin 1-10 %.
12. Erosive Pustular Dermatosis (EPDS)
EPDS is a relatively uncommon condition and is more likely to affect individuals 50 years of age and over. The cause of EPDS is unknown but it is thought that injury plays an important role in pathogenesis. Patients with a history of extensive ultraviolet radiation skin damage or those with a history of other means of scalp injury seem to be more likely to develop this condition. Individuals affected with EPDS often develop crusted erosions on the scalp some of which may have pus. The crusts can often be lifted from the scalp to expose the erosions that give the condition its name.
13. Eyebrow hair loss
There are several reasons for eyebrow hair loss including: endocrinological problems (including thyroid problems), autoimmune related issues (such as alopecia areata), malignancies, infections, traumatic causes/injury (including over plucking or trichotillomania), genetic diseases, aging and a variety of skin diseases.
14. Eyelash hair loss
Loss of the eyelashes may occur for a number of reasons. Expert consultation is advised for those affected by eyelash loss. Common reasons include: use of cosmetic products, autoimmune conditions such as alopecia areata or frontal fibrosing alopecia, trichotillomania, scarring alopecia, traumatic injury, infections, burns.
15. Female Hair Thinning
Female pattern thinning (also called female patten hair loss or female androgenetic alopecia) is a common type of hereditary hair thinning in women. By age 50, about 35 % of women have this form of hair loss. Although hair density may become quite thin, women do not become completely 'bald' like men. Hair thinning starts as early as the teenage years, but usually in the twenties and thirties and is usually fully expressed by the age of 40.
16. Folliculitis decalvans
This is a commonly misdiagnosed hair loss disorder that leads to permanent scarring hair loss. Both men and women are affected. Hair loss starts in the top and middle of the scalp with pimple-like eruptions, pustules and sometimes even bleeding. This leads to progressive hair loss. Affected patients may have significant itching, burning and pain.
17. Follicular mucinosis
Follicular mucinosis (sometimes referred to as ‘alopecia mucinosa’) can occur at any age and sometimes leads to permanent hair loss. Individuals affected by Follicular mucinosis must be closely followed by their physicians as rarely it can be associated with a malignancy (such as mycosis fungoides, Hodgkin’s lymphoma, etc). If a cancer is going to occur at all, it generally occurs within the first 5 years after diagnosis but can occur later. Therefore, close follow up is necessary.
18. Frontal fibrosing alopecia (FFA)
FFA a type of scarring hair loss condition that affects women. The frontal hairline, sides of the scalp and sometimes the eyebrows, eyelashes and body hair may be affected. The hair loss in the bald areas is generally permanent. Females between 47-63 years of age are most likely to develop FFA. Caucasian women seem to be the most affected group. Many patients with FFA are asymptomatic but rarely there is burning, pain and tenderness in the affected areas scalp. Most patents come to notice loss of hair in the frontal hairline or sides or loss of the eyebrows.
19. Hair Breakage
Hair breakage occurs for several reasons, including overuse of chemicals & overuse of heat. Somegenetic conditions and autoimmune disorders may also lead to hair fragility.
20. Hair Shedding Problem (Telogen Effluvium or "TE")
A number of conditions can cause increased daily hair shedding, including: , thyroid problems, low iron levels, dieting, prescription based drugs, major stress, illness, high fever, labour and delivery (i.e. post partum TE). Shedding will continue provided the 'trigger' that caused the initial shedding is still present. Once the trigger is removed (for example the thyroid levels are restored in someone with thyroid abnormalities), the shedding stops in 4-8 months.
21. Lichen planopilaris (LPP)
Lichen planopilaris a type of scarring hair loss condition. The hair loss in the bald areas is permanent. It is one of the most common causes of scarring alopecia. Adults of all ethnic backgrounds. Females are two times more likely than males to get LPP (but both are affected). The cause remains unknown. Stress may contribute to worsening of itching burning or pain for some people but does not appear to be a cause.
22. Male Pattern Balding (MPB)
Male pattern balding, also called male androgenetic alopecia is common. By age 50, about half of men will have significant amounts genetic hair loss. The condition is inherited from both mother and father's side of the family (contrary to the misconception that it is only mother’s side). Males with MPB experience hair loss in the temples and the crown which slowly expands to involve the entire frontal, mid-scalp and top of the scalp in some men. The back of the scalp (occipital area) is usually not involved as this area tends to be quite resistant to balding.
23. Pityriasis amiantacea
Pityriasis amiantacea is a scalp condition that can lead to hair loss. For some patients, the hair loss is temporary whereas for others it may be permanent. All patients with pityriasis amiantacea, have thick scale that surrounds hair follicles. The scale sometimes looks like “shingles” on a roof. When hairs are removed from the scalp, the scales come off with the hairs.
24. Pseudopelade of Brocq (PPB)
Pseudopelade of Brocq a type of scarring hair loss condition and causes permanent hair loss. Both males and females can develop pseudopelade, although it is 3 times more common in females. Several features lead to this diagnosis, including areas of scarring, rarely pinky-red colour around the hair follicles, depression of the skin (called atrophy), and findings on the biopsy showed very little inflammation, loss of the fat glands and scarring.
25. Seborrheic dermatitis (SD)
SD a common condition which affects up to 3 % of individuals. It causes redness, scaling and flaking in the scalp and sometimes also in the eyebrows, forehead and nose area as well. ‘Dandruff’ is a very mild variant with lots of flaking but not a great deal of redness. SD can be worsened by diet, emotional stress and the winter months. Malessezia globosa is a yeast and the cause of seborrheic dermatitis.
26. Telogen Effluvium
Telogen effluvium refers to hair shedding from a variety of so-called 'triggers.' Well recognized triggers include stressful life events, low iron, thyroid dysfunction, nutritional issues, dieting and certain medications. Shedding occurs about 2-3 months after a trigger. Telogen effluvium is different from chronic telogen effluvium.
27. Traction Alopecia
Traction alopecia refers to a form of hair loss due to repeated stress on hair follicles. Females develop traction hair loss from ponytails, extensions or use of braids, weaves, cornrows or extensions. Men can develop traction alopecia as well.
28. Trichotillomania (TTM)
About 4 % of the world will develop trichotillomania at some point in their lives. TTM can occur in children and adults. A proportion of patients will have underlying depression, anxiety and obsessive compulsive disorder. Treatment of trichotillomania centers around understanding the psychological issues that lead to the pulling. Cognitive behavioural therapy can be effective for many individuals with trichotillomania.
29. Tinea capitis
Tinea capitis is common in young children and is caused by a group of fungi known as dermatophytes. The most common dermatophyte in North America is known as Trichophyton tonsurans. Brushes and combs help spread the condition. This condition starts off as a red bump which then spreads. The scalp then becomes progressively scaly. The hair in the area may be lost. With certain types of fungal infections of the scalp, the scalp may be very soft or “boggy” and the individual may feel unwell. In rare cases, the lymph nodes ("glands") may also be enlarged.