What is baldness?

Baldness is hair loss, or absence of hair. It’s also called alopecia. Baldness is usually most noticeable on the scalp, but can happen anywhere on the body where hair grows. The condition is more common in men than in women.

What causes baldness?

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

  • Aging
  • Change in hormones
  • Illness leading to shedding of hair (called telogen effluvium)
  • Family history of baldness
  • Burns
  • Injury
  • Untreated ringworm of the scalp
  • Iron or protein deficiency
  • Excess vitamin A intake
  • Rapid weight loss
  • Certain medicines, such as cancer chemotherapy 
  • Certain medical conditions, such as lupus

However, hair loss is not caused by the following:

  • Poor circulation to the scalp
  • Dandruff
  • Wearing hats

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

What are the symptoms of baldness?

Depending on the type, the symptoms of baldness will vary. There are several types of baldness including:

  • 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. The hairline is maintained. Female-pattern baldness rarely results in total hair loss.
  • Male-pattern baldness. Male-pattern baldness is usually inherited. The condition may begin at any age. Hair loss often begins on the front, sides, or on the crown of the head. Some men may develop a bald spot or just a receding hairline. Others may lose all of their hair.
  • Alopecia areata. This hair loss disorder is characterized by sudden loss of hair in one particular area. The hair grows back after several months. However, if all body hair is suddenly lost, regrowth may not happen. The exact cause of this type of hair loss is unknown. There is a genetic link as well as a link with autoimmune conditions and allergies. If hair loss is complete on the scalp, it is called alopecia totalis, and if all body hair is lost, it is called alopecia universalis.
  • Toxic alopecia. Toxic alopecia may happen after a high fever or severe illness. Certain medicines, especially thallium, high doses of vitamin A, retinoids, and cancer medicines may also cause it. Medical conditions, such as thyroid disease, and giving birth may also trigger toxic alopecia. The condition is characterized by temporary hair loss.
  • Scarring or cicatricial alopecia. Scarred areas may prevent the hair from growing back. Scarring may happen from burns, injury, or X-ray therapy. However, other types of scarring that may cause hair loss can be caused by diseases. These include lupus, bacterial or fungal skin infections, lichen planus, sarcoidosis, tuberculosis, or skin cancer.
  • Trichotillomania (hair pulling). Hair pulling may cause hair loss. This condition is common in young children.

How is baldness diagnosed?

In addition to a medical history and physical exam, a punch biopsy of the skin may help to identify the type of baldness and/or its cause. A culture may be done if infection is suspected.

How is baldness treated?

Your healthcare provider will figure out the best treatment for you based on:

  • How old you are
  • Your overall health and past health
  • How sick you are
  • How well you can handle specific medicines, procedures, and therapies
  • How long the condition is expected to last
  • Your opinion or preference

Most forms of baldness have no cure. Some types of baldness will go away without treatment. Treatment may include:

  • Corticosteroid injections. These can treat alopecia areata or other inflammatory diseases that lead to hair loss.
  • Treating any underlying condition or disease
  • Hair transplants
  • Scalp reduction
  • Skin lifts and grafts

Certain medicines can also treat baldness by helping hair to grow. One of these is finasteride. Finasteride is available in pill form by prescription only. It works by blocking an enzyme called 5-alpha reductase. This enzyme changes the male hormone testosterone into a stronger form called DHT (dihydrotestosterone). It's believed that DHT is a key factor in male pattern hair loss. Finasteride lowers DHT levels in a man's scalp. This slows hair loss and promotes hair growth.

Another medicine is minoxidil. You can buy it over the counter.

Hair replacement surgery

The interest in hair replacement has gone up over the past several years. There are a number of hair replacement techniques available. But, hair replacement surgery can’t help those with 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 4 primary different types of hair replacement methods, including the following:

  • Hair transplant. During a hair transplant, the surgeon removes small pieces of hair-bearing scalp from the back or sides of the head to be used as grafts. These grafts are then relocated to a bald or thinning area.
  • Scalp 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 needed 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 to cover the bald areas at the top and back of the head. It involves first removing the bald scalp. Then sections of the hair-bearing scalp are pulled together filling in the bald area. This can be done alone or with hair transplantation. 

What are the complications of baldness and hair transplantation procedures?

Baldness may lower cause self-esteem. There are complications associated with hair transplantation procedures that include:

  • 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 fixed with more surgery.
  • Bleeding and/or wide scars. Tension on the scalp from some of the scalp reduction techniques can cause 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.

Key points about baldness

  • Baldness, also known as alopecia, is hair loss, or absence of hair.
  • Baldness is usually most noticeable on the scalp, but can happen anywhere on the body where hair grows.
  • Treatment for baldness depends on the type of baldness and its underlying cause.
  • Most forms of baldness have no cure. Some types of baldness will disappear on their own.
  • It is important to talk with your healthcare provider about your baldness and how it can be treated.

Next steps

Tips to help you get the most from a visit to your healthcare provider: 

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Online Medical Reviewer: Cunningham, Louise, RN

Online Medical Reviewer: Finke, Amy, RN, BSN

Online Medical Reviewer: Lehrer, Michael Stephen, MD

Date Last Reviewed: 12/1/2016

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