Types of Hair Loss

Female Hair Thinning

Breakage of hair strands

Female pattern hair loss (FPHL) primarily occurs in adult women and is a common form of nonscarring hair loss. It is characterized by progressive loss of terminal hairs in the frontal and vertex regions of the scalp. Female-pattern baldness typically starts with scalp hairs becoming progressively finer and shorter as you age. Many women first experience hair thinning and hair loss where they part their hair and on the top-central portion of the head.

Male Pattern Balding

Man looking at thinning hair in mirror

Male pattern baldness is related to your genes and male sex hormones. It usually follows a pattern of receding hairline and hair thinning on the crown, and is caused by hormones and genetic predisposition.

Each strand of hair you have sits in a tiny hole (cavity) in the skin called a follicle. Generally, baldness occurs when the hair follicle shrinks over time, resulting in shorter and finer hair. Eventually, the follicle does not grow new hair. The follicles remain alive, which suggests that it is still possible to grow new hair.

Alopecia Areata

Bald man smiling

The main symptom of alopecia areata is loss of hair in small, round patches (roughly the size of a quarter) on the scalp. However, other types of diseases can cause hair to fall out in this same pattern. This symptom alone should not be used to diagnose alopecia areata.

Patients with alopecia areata experience hair loss in random patches on the scalp. Other forms of alopecia include alopecia totalis, when the hair loss starts happening across the entire head and alopecia universalis, which causes total loss of all body hair.

Hair Breakage

Cutting hair

Hearing a snap, crackle, or pop while brushing your hair is never a good sign and causes hair loss. While losing the customary 100 strands per day is considered normal, breakage is a problem that’s easily avoidable. It may be caused by if:

1. You’re a hair puller: Tugging on your hair can cause stress and eventually breakage. 

2. You style wet: Using a brush or comb on wet hair causes strands to snap. 

3. You love a tight ponytail: Pulling hair back into a tight bun or ponytail is a great option for second-day hair. But be cautious about the effect it could have on your coiffure. Too tight and it can cause stress at the hairline. You can also cause breakage if you continually put hair in the same style. 

4. You flat iron…daily: You probably already know that heat can damage your hair. But it can dry out your strands and exacerbate breakage, too. 

5. You have a standing bleaching appointment: Overprocessed hair can turn brittle. 

6. You skip regular haircuts: If you avoid cutting your split ends, eventually they might just break off. 

7. You’re a wild sleeper: Noticing a bit of breakage at the back of your head? It may be caused by the friction between your hair and the cotton pillowcase. 

8. Your diet is lacking: Your hair needs protein to stay strong. Protein can repair weak spots in the hair shaft, warding off breakage. But be forewarned: Too much protein can make the hair brittle, and too much moisture makes strands too flexible. It’s important to find the right balance of moisture and protein.

Telogen effluvium

Girl coming wet hair

The symptom of both acute and chronic telogen effluvium is increased hair shedding. Patients usually only complain that their hair is falling out at an increased rate. Occasionally, they note that the remaining hair feels less dense. In both forms of telogen effluvium, hair is lost diffusely from the entire scalp. Complete alopecia is not seen.

Acute telogen effluvium is defined as hair shedding lasting less than 6 months. Patients with acute telogen effluvium usually complain of relatively sudden onset of hair loss. Careful questioning usually reveals a metabolic or physiologic stress 1-6 months before the start of the hair shedding. Physiologic stresses that can induce telogen effluvium include febrile illness, major injury, change in diet, pregnancy and delivery, and starting a new medication. Immunizations also have been reported to cause acute hair shedding. Papulosquamous diseases of the scalp, such as psoriasis and seborrheic dermatitis, can produce telogen effluvium.

Chronic telogen effluvium is hair shedding lasting longer than 6 months. The onset is often insidious, and it can be difficult to identify an inciting event. Because of the duration of the hair shedding, patients are more likely to complain of decreased scalp hair density, or they may note that their hair appears thin and lifeless.

Trichotillomania (Nervous Hair Pulling)

Girl pulling on ponytail

This is an impulse control disorder characterized by a long term urge that results in the pulling out of one’s hair.

This occurs to such a degree that hair loss can be seen. 

Efforts to stop pulling hair typically fail.

Hair removal may occur anywhere; however, the head and around the eyes are most common.

The hair pulling is to such a degree that it results in distress.

People who have trichotillomania have an irresistible urge to pull out their hair, usually from their scalp, eyelashes, and eyebrows.

Trichotillomania is a type of impulse control disorder. People with these disorders know that they can do damage by acting on the impulses, but they cannot stop themselves. They may pull out their hair when they’re stressed as a way to try to soothe themselves.