Hair loss (alopecia): types, causes and treatment

In our society, luxuriant hair is a symbol of health, happiness and success. Hair Loss is therefore fought with all means. Unfortunately, hair loss is a very complex problem for which neither a cause nor an effective treatment can always be found immediately.

Skin and hair are sometimes called "mirrors of our body". Hair loss can indeed be the result of a physical or mental illness, and conversely, problems with hair or hair growth can lead to serious psychological problems and even depression. It is not surprising, therefore, that this is one of the most popular areas where all kinds of quacks are active and for which the most fantastic remedies are recommended. At best, these miracle cures have no effect at all, sometimes they do more harm than good.

There are many possible causes of hair loss (or alopecia) and also different types of hair loss. Determining the exact cause is a first step in the treatment.

How does hair grow?

Hair is made from skin cells in the hair follicles or hair follicles. The number of hair follicles on the scalp fluctuates around 100,000 and the number of hair follicles is genetically determined. Blond hair, for example, has more hair follicles than dark and red hair.

With increasing age, the number of hair follicles decreases slightly, and thus automatically the number of hairs.

Hair growth is a cyclical process with phases of growth ("anagenic phase"), transition ("catagenic phase") and decomposition ("telogenic phase"). The growth phase of cranial hair lasts about 3 years. At the end of this period the cell division stops and the hair becomes thinner and thinner. During the transition phase, the hair gradually loosens from the hair follicle and falls out during the decomposition phase. This build-up phase lasts about 3 months. In contrast to some animals, where the hair falls out en masse after winter, the hair cycle in humans is much more regular. Although there is some seasonal influence with a peak of hair loss around August-September.

In humans, 60 to 90% of hair is always in the growth phase and 10 to 20% in the resting or decomposition phase. If we assume that 10,000 hairs stand on a head and that one hair remains standing for 100 days (3 months), then an average of 100 hairs will naturally go out in one day.

The speed at which the hair grows varies from person to person, but on average the hair grows 0.5 mm longer per day. The hair of the Women is growing slightly faster than that of the Menand the "peak age" is between 50 and 70 years.

Measuring hair loss

If you have the impression that you are losing too much hair, follow-up examinations can be performed:

- During 24 hours, 4 days after washing (or if you wash your hair more often, 24 hours before the next wash) collect and count the hair loss;
- the pull test: pull carefully on a bundle of about 100 hairs. If more than 20 hairs are unloaded, further testing is required;
- the trichogram or hair root status: With this method, about 50 hairs are cut off to an accuracy of 1 cm, which are then pulled with a quick jerk in the direction of the hair growth. The hair roots are then examined under a microscope, which provides objective information about the growth phases and the abnormal shapes of the hair roots.

Androgenetic alopecia

The most common form of hair loss is androgenetic alopecia, which occurs under the influence of androgens, the male hormones. This type of hair loss occurs in both men and women, although to a lesser extent.

It is the typical hair loss that occurs after a certain age. In men, it usually begins with a shift of the hairline at the temples, later also on the forehead. At the same time, the crown can become bald. The final stage, in which only horseshoe-shaped hair remains, is reached only from 10 to 15% of men. In women, hair loss is more discreet and never develops into true baldness.

This form of hair loss is hereditary. It is believed that there is a genetic predisposition that makes the hair root in some people more sensitive to the male hormone, even at normal concentrations, which causes the hair to end its cycle more quickly and therefore more hair to fall out than is produced.

This form of hair loss cannot be "cured", but there are a number of methods to stop its development or even cause new hair growth:

- A hair lotion containing 2% Minoxidil, a drug originally used to treat high blood pressure, can help hair grow back. However, the product must be used for life, otherwise hair loss will start again.
- Recent studies also show that a lotion containing an antibacterial and an antimycotic agent can also inhibit hair loss and the associated itching.
- In women, it is possible in about 50% of cases to inhibit hair loss with hormone preparations that block the action of the male hormone testosterone.
- Surgical methods such as hair transplantation and scalp reduction can provide very satisfactory results.

alopecia areata

Alopecia areata, after androgenetic alopecia the most common form of hair loss, is characterized by one or more round to oval, completely bald patches, which are well defined and usually limited in size. However, these patches may merge and develop into complete baldness.

The bald spots occur mainly on the scalp, but they can also affect the beard area, eyebrows, eyelashes or the pubic bone. The duration of this disease varies between 4 and 10 months. The healing process begins with the growth of small, white downy hairs, which gradually change colour.

The reason for this is not yet clear, but here too there could be a hereditary factor. It is also believed that certain autoimmune diseases (these are diseases caused by the production of antibodies to parts of the body, in this case to the hair roots), a hereditary predisposition to develop an allergy, thyroid problems, some infections of the mouth, nose, throat and ears (e.g. sinusitis, tooth and mouth cavitis, etc.) and psychological factors (such as stress) may play a role.

Since the cause and course of this type of hair loss is unknown, there is no causal treatment. Therapeutic options include general or local application of corticosteroids or PUVA therapy, which is a treatment with UVA light rays that can temporarily cause hair growth. Due to the suspicion of a malfunction of the immune system, a substance has already been used which causes a contact allergy to the bald areas. The immune response directed against this contact allergen then suppresses the reaction directed against the hair root so that the hair can grow back.

Diffuse hair loss

This form of hair loss spreads over the entire scalp and rarely leads to complete baldness.

The most common form is telogen hair loss or telogen effluvium, which terminates the hair cycle prematurely and reaches the telogen or degradation phase more quickly. This form of hair loss can be a result of physical or psychological stress, such as high fever, infections, anemia, surgery, an accident, emotional problems, a strict diet, alcohol abuse and so on. Some medications (e.g. some blood-thinning and blood pressure-lowering drugs) can also cause such hair loss.

Usually hair loss occurs about 3 months after the triggering factor.

Hair loss, which often occurs about three months after delivery, is also a form of telogen effluvium. The proportion of anagen hair (hair in the growth phase) is 95% during pregnancy, so that normal Telogen hair loss is greatly reduced at this time. After delivery, these hair follicles quickly enter the telogen phase under the influence of the decrease in estrogen levels. The result is an increase in hair loss about 3 to 4 months later.

With telogenic effluvium, there is not much more that can be done but to address the cause and wait: Over the next 6 to 12 months, there will be a spontaneous ingrowth of hair. If necessary, supplements of cystine and methionine, the building blocks of our hair, can be given for several months.

The situation is similar with hair loss in cancer patients treated with chemotherapy. Here, however, the hair roots are so severely damaged that the hair still falls out during the growth phase and hair loss can occur within the week after the start of therapy. This form of hair loss also recovers by itself after stopping the therapy.


This type of hair loss, scar alopecia, is a consequence of the scarring of the cranial skin, which causes the permanent loss of a number of hair follicles. This can be present from birth or occur later in life due to burns, accidents or infection. It can also be the final stage of a fungal infection. To determine this, a specialist examination to remove a small piece of skin is required.
Recovery is not possible, but in the event of a fungal infection, for example, another disaster can be prevented.

Traumatic Alopecia

Traumatic alopecia is caused by the stretching of the hair. A typical example is hair loss in women who often have a ponytail. This sometimes leads to thinning of the hair at forehead level.

Another typical example is the so-called Trichotill mania, the mania of constantly playing with tufts of hair. This can lead to extensive bald spots.

A complete recovery is possible if the hair is left alone.

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