The Toronto Dermatology Centre is one of the premiere places in Canada to manage your skin, hair and nails. Our staff of outstanding dermatologists can offer both a comprehensive assessment and diagnosis of your hair, and also discuss all the treatment options including prescription lotions, prescription pills and hair transplants.
Society has placed a great deal of social and cultural importance on hair and hairstyles. Unfortunately, many conditions, diseases, and improper hair care result in excessive hair loss.
Dermatologists, physicians who specialize in treating diseases of the hair and skin, will evaluate a patient’s hair problem by asking questions about diet, medications including vitamins and health food taken in the last six months, family history of hair loss, recent illness, and hair care habits. Hormonal effects may be evaluated in women by asking about menstrual cycles, pregnancies, and menopause.
Normal Hair Growth
About 90% of the hair on a person’s scalp is growing at any one time. The growth phase lasts 2-6 years. 10% of the hair is in a resting phase that lasts 2-3 months. At the end of its resting stage, the hair is shed. When a hair is shed, a new hair from the same follicle replaces it and the growing cycle starts again. Scalp hair grows about one-half inch a month. Most hair shedding is due to the normal hair cycle, and losing 50-to-100 hairs per day is no cause for alarm.
Causes of Excessive Hair Loss
Improper Hair Cosmetic Use/Improper Hair Care – Many men and women use chemical treatments on their hair, including dyes, tints, bleaches, straighteners, and permanent waves. These treatments rarely damage hair if they are done correctly. However, the hair can become weak and break if any of these chemicals are used too often. Hair can also break if the solution is left on too long, if two procedures are done on the same day, or if bleach is applied to previously bleached hair. If hair becomes brittle from chemical treatments, it’s best to stop until the hair has grown out.
Hairstyles that pull on the hair, like ponytails and braids, should not be pulled tightly and should be alternated with looser hairstyles. The constant pull causes hair loss, especially along the sides of the scalp.
Shampooing, combing and brushing too often, can also damage hair, causing it to break. Using a cream rinse or conditioner after shampooing will make it more manageable and easier to comb. When hair is wet, it is more fragile, so vigorous rubbing with a towel, and rough combing and brushing should be avoided. Use wide toothed combs and brushes with smooth tips.
Hereditary Thinning or Balding – Hereditary balding or thinning is the most common cause of hair loss. The tendency can be inherited from either the mother’s or father’s side of the family. Women with this trait develop thinning hair, but do not become completely bald. The condition is called androgenetic alopecia and it can start in the teens, twenties, or thirties. There is no cure, although medical treatments have recently become available that may help some people. One treatment involves applying a lotion (minoxidil/Rogaine), to the scalp. Another treatment for men is a daily pill containing finasteride (Propecia) or for women spironolactone (Aldactone), drugs that block the hormone effects in the hair follicle. Occasionally, dutasteride is also used and helpful. Good over the counter treatments to consider starting with include: Anacaps (vitamin pill to strengthen hair), Neoptide or Amana (lotions which stimulate blood supply to hair follicles).
Hair transplantation is a permanent form of hair replacement. The procedure of hair transplantation involves moving some hair from hair-bearing portions (donor sites) of the head to bald or thinning portions (recipient sites) and/or removing bald skin. Because the procedure involves surgery as well as time and money, they should not be undertaken lightly. Your dermatologist can recommend you to a hair transplant surgeon.
Childbirth – When a woman is pregnant, more of her hairs will be growing. However, after a woman delivers her baby, many hairs enter the resting phase of the hair cycle. Within 2-3 months, some women will notice large amounts of hair coming out in their brushes and combs. This can last several months, but resolves completely in most cases.
High Fever, Severe Infection, Severe Flu – Illnesses may cause hairs to enter the resting phase. 1-3 months after a high fever, severe illness, or infection, a person may be shocked to see a lot of hair falling out. This shedding usually corrects itself.
Thyroid Disease – Both an over-active thyroid and an under-active thyroid can cause hair loss. Your physician can diagnose thyroid disease with laboratory tests. Hair loss associated with thyroid disease can be reversed with proper treatment.
Inadequate Protein in Diet – Some people who go on diets that are low in protein, or have severely abnormal eating habits, may develop protein malnutrition. The body will save protein by shifting growing hairs into the resting phase. Massive hair shedding can occur 2-3 months later. Hair can then be pulled out by the roots fairly easily. This condition can be reversed and prevented by eating the proper amount of protein and, when dieting, maintaining adequate protein intake.
Medications – Some prescription drugs may cause temporary hair shedding. Examples include some of the medicines used for the following: gout, arthritis, depression, heart problems, high blood pressure, or blood thinners. High doses of vitamin A may also cause hair shedding.
Birth Control Pills – Women who lose hair while taking birth control pills usually have an inherited tendency for hair thinning. If hair thinning occurs, a woman may want to switch to another birth control pill. When a woman stops using oral contraceptives, she may notice that her hair begins shedding 2-3 months later. This may continue for 6 months when it usually stops. This is similar to hair loss after the birth of a child.
Cancer Treatments – Some cancer treatments will cause hair cells to stop dividing. Hairs become thin and break off as they exit the scalp. Patients can lose up to 90% of their scalp hair. The hair will regrow after treatment ends. Patients may want to get wigs before treatment.
Low Serum Iron – Iron deficiency occasionally produces hair loss. Some people don’t have enough iron in their diets or may not fully absorb iron. Women who have heavy menstrual periods may develop iron deficiency. Low iron can be detected by laboratory tests and can be corrected by taking iron supplements or by increasing iron in one’s diet (e.g. red meat/eggs).
Major Surgery/Chronic Illness – Anyone who has a major operation may notice increased hair shedding within 1-3 months afterwards. The condition reverses itself within a few months but people who have a severe chronic illness may shed hair indefinitely. This is termed “Telogen Effluvium.”