Alopecia (Baldness)

What is baldness?

Baldness, also known as alopecia, is hair loss, or absence of hair. Baldness is usually most noticeable on the scalp, but can occur anywhere on the body where hair grows. The condition is more common in men than in women.

What causes hair loss?

Hair loss is believed to be primarily caused by a combination of the following:

• Aging

• Change in hormones

• Illness

• Family history of baldness

• Burns

• Trauma

• Untreated ringworm of the scalp

• Deficiency in iron or protein intake

• Excess vitamin A intake

• Rapid weight loss 

However, hair loss is not caused by the following:

• Poor circulation to the scalp

• Dandruff

• Excessive hat-wearing

Generally, the earlier hair loss begins, the more severe the baldness will become.

What are the different types of baldness?

Baldness can be classified into various types, depending on the cause. Several of the many different types of baldness include the following:

• Female-pattern baldness Although less common, female-pattern baldness differs from that of male-pattern baldness in that the hair generally thins all over the head, but the frontal hairline is maintained. Female-pattern baldness rarely results in total hair loss.

• Male-pattern baldness Male-pattern baldness usually is a hereditary condition. The condition may begin at any age. Hair loss often begins on the front, sides, and/or on the crown of the head. Some men may develop a bald spot or just a receding hair line, while others may lose all of their hair.

• Alopecia areata This hair loss disorder is characterized by sudden loss of hair in one particular area, which grows back after several months. However, if all body hair is suddenly lost, regrowth may not occur. The cause of this type of hair loss is unknown.

• Toxic alopecia Toxic alopecia may occur following a high fever or severe illness. Certain medications, especially thallium, high doses of vitamin A, and retinoids, may cause toxic alopecia. Medical conditions, such as thyroid disease, and after giving birth may also trigger toxic alopecia. The condition is characterized by temporary hair loss. Also, some cancer medications can cause hair loss.

• Scarring alopecia Scarred areas may prevent the hair from growing back. Scarring may occur from burns, injury, or x-ray therapy. However, other types of scarring that may cause hair loss can be caused by diseases such as lupus, bacterial or fungal skin infections, lichen planus, sarcoidosis, tuberculosis, or skin cancer.

• Trichotillomania (hair pulling) Hair pulling, a habit most common among children, may cause hair loss.

How is the type of baldness diagnosed?

In addition to a medical history and physical examination, a biopsy of the skin area may help to identify the type of baldness and/or its cause.

Treatment for baldness:

Specific treatment for baldness will be determined by your physician based on:

• Your age, overall health, and medical history

• Extent of the condition

• Your tolerance for specific medications, procedures, and therapies

• Expectation for the course of the disease

• Your opinion or preference

Most forms of baldness have no cure. Some types of baldness will disappear on their own. Treatment may include:

• Certain medications to promote hair growth (such as minoxidil and finasteride)

• Corticosteroid injections (when treating alopecia areata)

• Treating any underlying condition or disease

• Hair transplants

• Scalp reduction

• Skin lifts and grafts

What is hair replacement surgery?

The interest in hair replacement has significantly increased over the past several years. There are a number of hair replacement techniques that are available, although hair replacement surgery cannot help those who suffer from total baldness. Candidates for hair replacement must have a healthy growth of hair at the back and sides of the head. The hair on the back and sides of the head will serve as hair donor areas where grafts and flaps will be taken.

There are four primary different types of hair replacement methods, including the following:

• Hair transplantation During hair transplantation, the surgeon removes small pieces of hair-bearing scalp grafts from the back or sides of the head. These grafts are then relocated to a bald or thinning area.

• Tissue expansion In this procedure, a device called a tissue expander is placed underneath a hair-bearing area that is located next to a bald area. After several weeks, the tissue expander causes the skin to grow new skin cells. Another operation is then required to place the newly expanded skin over the adjacent bald spot.

• Flap surgery Flap surgery is ideal for covering large balding areas. During this procedure a portion of the bald area is removed and a flap of the hair-bearing skin is placed on to the bald area while still attached at one end to its original blood supply.

• Scalp reduction Scalp reduction is done in order to cover the bald areas at the top and back of the head. This technique involves the removal of the bald scalp with sections of the hair-bearing scalp pulled together filling in the bald area.

Possible complications associated with hair transplantation procedures:

Possible complications associated with hair transplantation procedures may include, but are not limited to, the following:

• Patchy hair growth Sometimes, the growth of newly placed hair has a patchy look, especially if it is placed next to a thinning area. This can often be corrected by additional surgery.

• Bleeding and/or wide scars Tension on the scalp from some of the scalp reduction techniques can result in wide scars and/or bleeding.

• Grafts not taking Occasionally, there is a chance that the graft may not "take." If this is the case, surgery must be repeated.

• Infection As with any surgical procedure, there is the risk of infection.