Believing in the importance of spreading health awareness in the community, we at cosmolifekw.com present this series of specialized articles on hair and scalp health.
If you suffer from hair loss, know that you are not alone. But the most important truth you should know is that "hair loss" is not a single diagnosis, but a general term that covers a wide range of medical conditions that are completely different in their causes, manifestations, and treatment methods. Understanding the type of hair loss you are experiencing is the crucial step towards getting the right treatment and achieving the desired results.
In this guide, we will review five of the most common types of hair loss and provide you with the tools for a preliminary identification of each case.
1. Androgenetic Alopecia: Hereditary Baldness
This is the most common type of hair loss, affecting millions of men and women worldwide.
What does it look like?
In Men (Male Pattern Hair Loss): It usually appears in a distinctive pattern that begins with a receding hairline at the temples, forming an 'M' shape, followed by gradual thinning in the crown area (Vertex). Over time, these two areas may meet, leading to partial or complete baldness on the top of the head.
In Women (Female Pattern Hair Loss): The pattern is significantly different. Instead of a receding hairline, women usually notice diffuse thinning on the top of the scalp, leading to a noticeable widening of the central part line, often while maintaining the frontal hairline.
The Sinclair scale for female pattern hair loss. Stage 1 – normal; Stage 2 – widening of the central part line; Stage 3 – widening of the part line with translucency of the hairs at its border; Stage 4 – development of a bald area anteriorly along the part line; and Stage 5 – advanced hair loss .
The Scientific Cause (Pathophysiology):
The cause is an interaction between genetic predisposition and male hormones (androgens). In genetically predisposed individuals, an enzyme called "5-alpha-reductase" converts testosterone into a more potent hormone known as dihydrotestosterone (DHT). DHT binds to androgen receptors in sensitive hair follicles, leading to a process known as "miniaturization." During this process, the growth phase (Anagen) shortens, and the follicle gradually shrinks, producing a thinner, shorter, and lighter-colored hair with each new growth cycle, until the follicle stops producing hair altogether.
Preliminary Diagnosis Questionnaire:
Pattern of Loss: Does your hair loss match the pattern of recession at the temples and crown (for men) or a widening of the central part (for women)?
Family History: Do your father, mother, or close relatives suffer from a similar pattern of hair loss?
Progression: Has the hair loss been gradual and slow over several years?
Hair Quality: Do you notice that the hair in the affected areas has become thinner and weaker compared to the hair on the sides and back of your head?
Available Treatment Options (Based on AAD/EADV recommendations):
- Topical Minoxidil: Available in 2% and 5% concentrations, it is approved for both men and women. It works by stimulating hair follicles and prolonging the growth phase.
- Oral Finasteride: A prescription medication for men only. It works by inhibiting the 5-alpha-reductase enzyme, reducing DHT levels in the scalp.
- Low-Level Laser Therapy (LLLT): Devices (such as combs and helmets) that use red light to stimulate follicle activity.
- Other options: Include oral anti-androgens for women (like spironolactone), platelet-rich plasma (PRP) injections, and hair transplantation as a permanent solution.
2. Telogen Effluvium: Reactive Hair Loss
This is the second most common type of hair loss, characterized by sudden and widespread shedding.
What does it look like?
Sudden, heavy, and diffuse hair loss all over the scalp. It does not appear as bald patches but as a general thinning of hair density. Sufferers notice large amounts of hair in the shower drain, on their hairbrush, or on their pillow. The shedding typically occurs 2 to 4 months after the triggering event.
The Scientific Cause:
Telogen effluvium occurs when the body is subjected to severe physiological or emotional stress. This "shock" signals a large number of hair follicles (up to 70%) to prematurely and simultaneously transition from the growth phase (Anagen) to the resting phase (Telogen). After about 3 months (the duration of the resting phase), these follicles begin a new growth cycle, pushing out the old hair all at once, which manifests as heavy shedding.
Common Triggers: Childbirth, high fever, major surgery, rapid weight loss or malnutrition, severe emotional stress (like losing a loved one), or certain illnesses and medications.
Preliminary Diagnosis Questionnaire:
Speed: Did the hair loss start suddenly and over a short period?
Timing: Can you link the start of the shedding to a stressful event (illness, surgery, psychological stress, major dietary change) that occurred 2-4 months prior?
Distribution: Is the hair loss distributed over the entire scalp rather than concentrated in a specific area?
Scalp: Does your scalp look normal and free of any inflammation or scaling?
Treatment Options:
The good news is that acute telogen effluvium is a temporary and fully reversible condition. The main treatment lies in identifying and removing the causative factor. Once the body returns to its normal state, the shedding stops, and hair grows back normally. In most cases (about 95%), the hair fully recovers within 6 to 9 months without the need for medication.
3. Alopecia Areata: An Autoimmune Attack
This condition is characterized by its sudden onset in the form of bald patches.
What does it look like?
One or more perfectly smooth, round or oval bald patches, the size of a coin or larger. They can appear on the scalp, beard, eyebrows, or any hairy area of the body. In some cases, the patient may feel a slight tingling or itching before the patch appears. The condition can progress to complete loss of scalp hair (Alopecia Totalis) or all body hair (Alopecia Universalis).
The Scientific Cause:
Alopecia areata is an autoimmune disease in which the body's immune system mistakenly attacks the hair follicles, thinking they are a foreign body. This attack causes inflammation around the follicle and forces it into the resting phase, stopping hair growth and causing it to fall out. The follicles themselves are not permanently damaged, which means the hair has the potential to grow back.
Preliminary Diagnosis Questionnaire:
Shape: Do you have one or more patches of complete baldness that are smooth to the touch with clear edges?
Location: Did these patches appear suddenly on the scalp, beard, or eyebrows?
Nails: Have you noticed any changes in your nails, such as small pits or roughness? (This is a common associated symptom).
Health History: Do you or a family member have a history of other autoimmune diseases (such as thyroid disease, vitiligo, or type 1 diabetes)?
Treatment Options:
- Topical Corticosteroid Injections: This is the most common and effective treatment for limited patches, where the medication is injected directly into the affected skin to reduce inflammation.
- Topical Contact Immunotherapy: Used in more widespread cases, where a chemical is applied to the scalp to induce a mild allergic reaction that "distracts" the immune system from attacking the follicles.
- Janus Kinase (JAK) Inhibitors: A new class of oral medications that has revolutionized the treatment of severe cases, working to calm the overactive immune response.
- Topical Minoxidil: Can be used as an adjunct to stimulate hair growth.
4. Traction Alopecia: Mechanical Hair Loss
This type of hair loss is caused entirely by external factors and is preventable.
What does it look like?
Gradual hair loss that is primarily concentrated along the frontal and temporal hairline, the areas most subjected to pulling. In the early stages, small pimples or inflammation around the follicles may appear, along with broken hairs.
The Scientific Cause:
The cause is continuous and repetitive mechanical tension on the hair follicles. This constant pulling causes inflammation around the follicle and weakens the hair's attachment to the root, leading to its loss. If the tension continues for a long time, it can lead to permanent damage to the follicles and the formation of scar tissue, making the hair loss permanent.
Causative Practices: Tight hairstyles such as ponytails, buns, cornrows, use of heavy hair extensions, or wearing very tight headwear daily.
Preliminary Diagnosis Questionnaire:
Hairstyles: Do you regularly wear very tight hairstyles?
Location: Is the hair loss concentrated in the areas that experience the most tension (like the frontal hairline and temples)?
Symptoms: Do you feel pain, headaches, or notice small pimples after styling your hair?
Improvement: Do you notice improvement or the growth of vellus hair when you stop these hairstyles for a period?
Treatment Options:
The most effective treatment is prevention. In the early stages, once the causative practices are stopped, the hair can grow back completely. In cases where there is inflammation, a doctor may prescribe topical corticosteroids. In advanced cases where scarring has occurred, the hair loss may be permanent, and hair transplantation may be the only solution.
5. Tinea Capitis: A Fungal Infection
This condition is more common in children but can also affect adults.
What does it look like?
Scaly, itchy patches on the scalp, with hair broken off at the skin's surface, leaving characteristic "black dots." It may be accompanied by redness and swelling. In severe cases, it can develop into a painful, inflamed mass called a "Kerion," which oozes pus and can cause permanent scarring if not treated.
The Scientific Cause:
A fungal infection caused by a group of dermatophyte fungi that invade the hair shaft and follicle. This infection is highly contagious and can be transmitted through direct contact with an infected person, sharing personal items (combs, hats), or from infected pets (especially cats and dogs).
Preliminary Diagnosis Questionnaire:
Appearance: Are there scaly patches on the scalp with broken hair or black dots?
Symptoms: Do you suffer from severe itching in those areas? Is there any discharge or swelling?
Age: Is the affected person a school-aged child? (This group is most affected).
Contagion: Are there other family members or schoolmates with similar symptoms? Has there been recent contact with a new or stray pet?
Treatment Options:
Crucial Point: Topical treatments (creams and shampoos) alone are not sufficient to treat tinea capitis because the infection is deep within the hair follicle. Treatment requires oral antifungal medications prescribed by a doctor, such as Griseofulvin or Terbinafine, for a period of 4 to 8 weeks. Antifungal shampoos can be used as an adjunctive therapy to reduce the spread of the fungus and prevent transmission to others.
Quick Comparison Table for Hair Loss Types
| Type | Distinctive Feature | Main Cause | Nature of Loss | Is it Reversible? |
|---|---|---|---|---|
| Androgenetic Alopecia | Receding hairline (men) / Widening part (women) | Genetics + DHT Hormone | Gradual and slow | Can be slowed with continuous treatment |
| Telogen Effluvium | Sudden, heavy shedding all over the head | Physiological or psychological stress | Sudden and acute | Yes, temporary (takes 6-9 months) |
| Alopecia Areata | Smooth, round bald patches | Autoimmune attack | Sudden and unpredictable | Yes, but may recur |
| Traction Alopecia | Hair loss along the frontal and side hairline | Continuous mechanical tension | Gradual and localized | Yes, if caught early |
| Tinea Capitis | Scaly patches with black dots and itching | Fungal infection | Spreads quickly and is contagious | Yes, with correct drug treatment |
Important Conclusion: Diagnosis First, Then Treatment
This guide is designed to be an introductory tool to help you understand what might be happening to your scalp. However, you should not start any treatment based on a self-diagnosis. An accurate diagnosis requires a clinical examination by a dermatologist, who may use tools like a dermatoscope to see subtle signs, and may sometimes request blood tests or even a scalp biopsy to confirm the diagnosis.
In the next article, "Scalp Health: Diagnosis and Treatment of Common Conditions from Dandruff to Psoriasis", we will move from hair loss to the health of the "ground" from which it grows: the scalp. We will address common problems that cause discomfort for many, from simple dandruff to more complex conditions like psoriasis.
Important Note: The information contained in this article is for educational and informational purposes only and is not a substitute for consulting a doctor or pharmacist. An accurate diagnosis and appropriate treatment always require specialized medical consultation.
Frequently Asked Questions about Hair Loss in the Gulf Region
Q: Is it true that desalinated water in the Gulf causes hair loss?
A: There is no conclusive scientific evidence that desalinated water itself causes hair loss. The most common causes of hair loss in the region are often multifactorial and include iron and vitamin D deficiency (which is very common in the region), thyroid problems, or psychological stress associated with modern life or moving to a new environment.
Q: Why do women suffer from significant hair loss in the region?
A: Women in the region may be more susceptible to triggers for Telogen Effluvium due to frequent hormonal changes (pregnancy, childbirth, breastfeeding), in addition to the prevalence of iron and vitamin D deficiency among them. Social and professional pressures can also play a significant role.
Q: When should I worry about hair loss and see a doctor?
A: You should consult a dermatologist if you notice any of the following: sudden and severe hair loss, the appearance of clear bald patches, a noticeable thinning of hair density to the point where the scalp becomes visible, or if the hair loss is accompanied by other symptoms such as itching, pain, or scaling on the scalp.
Q: Are dietary supplements like biotin useful for hair loss?
A: Dietary supplements are only useful if there is a confirmed deficiency proven by a blood test. Taking large amounts of vitamins without an actual deficiency will not stop genetic or autoimmune hair loss and may be harmful in some cases. The most common deficiencies in the Gulf region that affect hair are vitamin D and iron.
Q: How can I distinguish between normal and pathological hair loss?
A: Normal hair loss ranges from 50-100 hairs per day, and the fallen hair is complete with a small white bulb at its end. Pathological hair loss, however, is in much larger quantities, is concentrated in specific areas, or you may notice that the fallen hair is broken, short, and without a root, or it may be accompanied by other scalp symptoms.
