Hair disorders is a broad category that includes the following types.
- Alopecia: the loss or thinning of hair (two types of alopecia are scarring, in which hair follicles are destroyed, and nonscarring, which can be reversible)
- Male-pattern baldness (androgenic alopecia): the most prominent type of hair disorder affecting, to varying degrees, half of all men over 50 years of age
- Hirsutism: male-pattern hair growth affecting eight percent of adult women
- Hair shaft disorders: usually hereditary abnormalities
Signs and SymptomsHair disorders are accompanied by the following signs and symptoms, depending on the type.
- Alopecia (nonscarring) involves hair loss all over or in circular areas, receding hair line, broken hairs, smooth scalp, inflammation, and possibly loss of lashes, eyebrows, or pubic hair.
- Alopecia (scarring) is limited to particular areas and involves inflammation at the edge and follicle loss toward the center of lesions, violet-colored skin abnormalities, and scaling.
- Hirsutism involves male-pattern hair growth in women, irregular menstruation, lack of ovulation, acne, deepening of voice, balding, and genital abnormalities.
- Hair shaft disorders involve split ends, and hair that is dry, brittle, and coarse, as well as skin and other abnormalities.
What Causes It?Hair disorders can be caused by any of the following.
- Alopecia (nonscarring) — skin disorders, certain drugs, certain diseases, autoimmunity, iron deficiency, severe stress, scalp radiation, pregnancy, or pulling at your own hair
- Alopecia (scarring) — skin disorders, diseases, or bacterial infections
- Hirsutism — excess of androgen (steroid hormone that stimulates development of male sex organs and secondary sexual characteristics). This overproduction of androgen could result from certain drugs or conditions.
- Hair shaft disorders — overprocessed hair (coloring, permanent waves, excessive heating) or certain diseases.
Who's Most At Risk?People with the following conditions or characteristics are at risk for developing hair disorders.
- Alopecia — male gender, genetic predisposition, pregnancy, physical or emotional stress, poor diet
- Hirsutism — genetic predisposition, lack of ovulation
- Hair shaft disorders — genetic predisposition, damaging grooming practices
What to Expect at Your Provider's OfficeIf you are experiencing symptoms associated with a hair disorder, you should see your health care provider. A physical exam can help identify the type of hair disorder, and laboratory tests can reveal any underlying diseases. In the case of hirsutism, imaging may help diagnose the cause.
PreventionHaving a well-balanced diet and avoiding potentially damaging hair treatments can help prevent some types of hair loss.
Treatment PlanThe primary goals of treatment are to treat the underlying cause, re-grow the hair when possible, and correct damaging grooming practices.
Drug TherapiesYour provider may prescribe the following medications.
- Minoxidil (Rogaine), for hair regrowth and possibly to prevent further loss
- Tretinion (Retin-A), to decrease thick scalp layer and increase minoxidil penetration
- Topical or injectable steroids
- Oral contraceptives
- Drugs for underlying diseases
Surgical and Other Procedures
- Cosmetic therapies, such as surgical placement of follicle-supporting plugs or folds
- For hirsutism, possibly removal of ovarian tumor
Complementary and Alternative TherapiesA comprehensive treatment plan for hair disorders may include a range of complementary and alternative therapies.
- Eat foods high in B vitamins and minerals, such as whole grains, dark leafy greens, and sea vegetables; eat adequate protein.
- Avoid sugar, caffeine, and refined foods.
- B-complex vitamins, especially B5 (100 mg four times per day), biotin (300 mcg per day), PABA (30 to 100 mg three times per day), and inositol (250 to 1,000 mg per day)
- Minerals, especially calcium (1,000 mg per day), magnesium (400 mg per day), selenium (100 to 200 mcg per day), manganese (10 mg per day), and zinc (20 to 30 mg per day)
- Vitamin C (500 to 1,000 mg three times per day), vitamin E (400 IU per day), and vitamin A (10,000 IU per day) or beta carotene (25,000 IU per day)
- Omega-3 fatty acids (EPA, DHA, flaxseed oil, fish oil) or omega-6 fatty acids (borage or evening primrose oil), 1 tbs. or equivalent two to three times per day
Herbal remedies may offer relief from symptoms. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp per cup of water steeped for 10 minutes (roots need 20 minutes).
For alopecia and hair shaft disorders:
- Ginkgo leaf (Ginkgo biloba), rosemary (Rosemarinus officinalis), prickly ash bark (Xanthoxylum clava-herculis), horsetail (Equisetum arvense), yarrow (Achillea millefolium), and elderberry (Sambucus nigra)
- For bacterial infections, add coneflower (Echinacea purpurea) with goldenseal (Hydrastis canadensis); for fungal infections, add oregano (Origanum vulgare)
- For stress, substitute oatstraw (Avena sativa) for elderberry
- Saw palmetto (Serenoa repens) 200 mg two to three times per day
Some of the most common remedies include Ignatia, Pulsatilla, and Sepia. Acute dose is three to five pellets of 12X to 30 C every one to four hours until symptoms are relieved.
Acupuncture and Massage
These approaches may help address the underlying cause of a hair disorder.
Alopecia areata. NMIHI. Accessed at http://www.nmihi.com/a/alopecia-areata.htm on August 17, 2018.
Behrman RE, ed. Nelson Textbook of Pediatrics. 15th ed. Philadelphia, PA: W.B. Saunders; 1996.
Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, PA: W.B. Saunders; 1996.
Dambro MR. Griffith's 5-Minute Clinical Consult. 1999 ed. Baltimore, MD: Lippincott Williams & Wilkins, Inc.; 1999.
Dawber RPR. An update of hair shaft disorders. Dermatologic Clinics. 1996; 14(4).
Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine, 14th ed. New York, NY: McGraw-Hill; 1998.
Fiedler VC, Alaiti S. Treatment of alopecia areata. Dermatologic Clinics. 1996; 14(4).
Finasteride. NMIHI. Accessed at http://www.nmihi.com/f/finasteride.html on August 17, 2018.
Goroll AH, ed. Primary Care Medicine. 3rd ed. Philadelphia, PA: Lippincott-Raven Publishers; 1995.
Habif TP. Clinical Dermatology. 3rd ed. St. Louis, MO: Mosby-Year Book; 1996.
Hair Loss. MedlinePlus. Accessed at https://medlineplus.gov/hairloss.html on August 17, 2018.
Lawless J. The Encyclopedia of Essential Oils. The Complete Guide to the Use of Aromatics in Aromatherapy, Herbalism, Health & Well-being. New York, NY:Barnes & Noble, Inc.; 1992:199.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993.
Rakel RE, ed. Conn's Current Therapy. 50th ed. Philadelphia, PA: W.B. Saunders; 1998.
Tadalafil. NMIHI. Accessed at http://www.nmihi.com/t/tadalafil.html on March 22, 2018.
What is common baldness? American Academy of Family Physicians Accessed at https://familydoctor.org/ on August 17, 2018.
What is alopecia areata? NIH. Accessed at https://www.niams.nih.gov/ on March 22, 2018.