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Hair Loss

Author: Dr Roy Palmer


Hair loss often causes a great deal of distress. Most cases are caused by the following conditions.

Alopecia areata results in the loss of hair in localised patches. It is due to the body’s immune system making an immune response to hair follicles. It often gets better without treatment, but if necessary there are therapies available; in particular, the injection into the patches of a substance called triamcinolone is frequently highly effective.

In women, common causes of a reduction in hair density are ‘female pattern hair loss’ (= the reduction in density that occurs with aging) and ‘chronic telogen effluvium’. Minoxidil lotion can be used, and occasionally oral treatments. It is important to check the function of the thyroid gland, and the level of iron in the blood.

In recent years, a condition called ‘frontal fibrosing alopecia’ has become much more frequent, for reasons which are unknown. When I was training, 20 years ago, a patient with this condition was brought to a meeting of dermatologists, for discussion, because it was so rare; many of the experienced dermatologists present had never seen it. I now see one new case approximately every month. In this condition, hair is lost from the front of the scalp and the eyebrows. It almost exclusively affects women (usually around the menopause). It is a scarring process and mostly irreversible, and therefore it is important that treatment begins at an early stage, to attempt to stop the condition progressing.

In men, loss of hair on the top of the scalp is very common (=androgenic alopecia). The two most effective and commonly used treatments are minoxidil lotion and finasteride tablets.

Rarer causes of hair loss can be identified by their clinical features, or sometimes by taking a biopsy.

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