Alopecia and hair loss: what to know

Hair may thin gradually, shed diffusely, recede at the hairline or disappear in patches. These patterns are descriptions rather than diagnoses. Looking at the scalp and reviewing recent health changes is more useful than choosing treatment from the word alopecia alone.

Androgenetic alopecia typically presents with gradual patterned thinning; the distribution differs among individuals. Telogen effluvium presents with increased shedding across the scalp, sometimes after illness, childbirth, major stress, dietary restriction or a medicine change. Alopecia areata commonly presents with smooth, defined patches.

Traction alopecia develops in areas repeatedly pulled by hairstyles or attachments. Scalp ringworm can present with scaly patches and broken hairs. A red, painful or shiny scar-like scalp suggests an inflammatory or scarring process rather than routine patterned loss. More than one contributor can be present at the same time.

Record when the change began, whether hairs are shedding from the root or snapping, and which areas are affected. Take photographs with consistent lighting and note recent illness, weight change, childbirth, new medicines, supplements and hairstyle tension. Handle hair gently and avoid tight styles while the cause is unclear.

A clinician may inspect the scalp under magnification, perform a gentle pull test or select blood tests based on your history. Treatment might target inflammation, fungus, nutritional deficiency, hormonal pattern loss or mechanical tension. Finasteride is an option only for appropriate patients after a clinician reviews expected benefits, adverse effects and pregnancy-related precautions.

Seek prompt assessment for scalp pain, pus, marked swelling, fever or rapidly spreading inflamed patches. Arrange a timely visit for sudden heavy shedding, loss of eyebrows or eyelashes, smooth bald patches, or skin that appears shiny and scarred. Hair loss accompanied by unexplained fatigue, weakness, menstrual change or other new body symptoms also deserves a broader medical review.

Ask which pattern the examination shows, whether follicles appear scarred and what findings support the working diagnosis. Clarify whether any tests would alter management, how treatment response will be judged and which side effects require contact. Mention pregnancy plans, breastfeeding and sexual-health considerations before discussing medicines that can affect pregnancy.