There are many different ways one can categorize hair loss, but you must first examine the scalp to determine if the hair loss is due to the physical damage, and loss of hair follicles.
If the scalp appears normal (with plenty of empty hair follicles), this is called non-scarring hair loss, whereas, if the follicles are permanently destroyed, it is scarring hair loss. Non-scarring hair loss can also be seen in situations where there is physical or chemical damage to the hair shaft, leading to breakages.
Occasionally, it may be necessary to do a biopsy of the scalp to make out these conditions, but a physician may pull a hair to examine the appearance of the hair shaft. He may also do that to determine the percentage of growing hairs.
A common hair condition, alopecia areata, usually starts as a single quarter-sized circle of perfectly smooth bald skin, which usually grows back in three to six months without treatment. The most widespread form is called Alopecia Totalis, in which the entire scalp goes bald.
Alopecia areata is an autoimmune condition in which the body attacks its own hair follicles, and it has been observed that patients who have localized hair loss generally don’t lose hair all over the scalp. Alopecia areata can affect hair on other parts of the body, like the beard or eyebrows, too.
Alopecia areata is frequently blamed on stress, and most patients do not have systemic problems and need no medical tests. While alopecia areata may be blamed on stress, in fact, it may be the other way around, in that, having alopecia may cause stress.
Treatments for alopecia areata include injecting small amounts of steroids (like triamcinolone) into affected patches to trigger the growth of hair. Localized injections may not be realistic for large areas, but this is a very effective treatment in helping the hairs return quicker.
Other treatments, such as oral steroids, immune-suppressive, or ultraviolet light therapy, are available for more widespread or severe cases. However, these treatments may be impractical for most patients because of potential side effects or risks.
Patchy Hair Loss
Some conditions of patchy hair loss produce small areas of hair loss, while others affect large areas of the scalp. Common causes of patchy hair loss are alopecia areata, thinning from tight braids or ponytails, the habit of twisting or pulling hair out, tinea capitis, which is a fungal infection), and secondary syphilis.
Diffuse Hair Loss
Some common causes of diffuse hair loss are pattern alopecia, drug-induced alopecia, protein malnutrition, and systemic disease-induced alopecia like cancer, and endocrine disease.
Traction alopecia is a small or localized hair loss area caused by repetitive or persistent pulling or traction on hair roots. It’s best to choose hairstyles that put less tension on hair since tight braids and ponytails can pull hard enough on hairs to make them fall out.
This refers to the habitual pulling or twisting of one’s own hair, where hair patches show broken-off hairs. Treatment of Trichotillomania is often entirely behavioral, as one has to consciously stop it. Severe or resistant cases may require stress counseling with a therapist or medical treatment with a psychiatrist. Also, some antidepressants have been shown to help with this condition.
Tinea means fungal infection, while Capitis means head. Thus, Tinea capitis means fungal infection of the (head) scalp. Tinea capitis is more common in black African or African-American scalp and is rare in healthy adults. Sharing hats or combs and brushes may transmit tinea capitis, but oral antifungals can penetrate the hair roots and cure the infection, after which hair will grow back.
Under normal conditions, scalp hairs live for about three years, after which they enter the telogen, or resting, phase. During the three-month telogen period, the hair root shrivels up, then, the hair falls out. During this time, it is therefore normal to lose about 100 hairs every day. You may even lose more on days when shampooing loosens the hairs that are ready to fall out.
Normally, about 10% of scalp hairs are in the telogen phase, and there are several circumstances that alter the hair growth rhythm. These include childbirth, high fever, sudden weight loss, surgery, severe illness, and severe emotional stress or loss.