Baldness

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 it can happen anywhere on the body where hair grows.

What causes baldness?

Hair loss can occur for many reasons. Some of the more common causes include the following:

• Aging

• Change in hormones

• Illness leading to shedding of hair (called telogen effluvium)

• Family history of baldness

But hair loss is not caused by:

• Poor circulation to the scalp

• Dandruff

• Wearing hats

Generally, the earlier hair loss starts, the more severe it will become.

What are the symptoms of baldness?

Depending on the type, the symptoms of baldness will vary. There are male and female types of baldness:

• Male-pattern baldness. Male-pattern baldness is usually inherited. The condition may start at any age. Hair loss often starts 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.

• Female-pattern baldness. Although less common, female-pattern baldness differs from male-pattern baldness in that the hair generally thins all over the head. The hairline is maintained. Usually, the first sign that women may see is a widening of the part. Female-pattern baldness rarely results in total hair loss.

Other common causes of hair loss

• Alopecia areata. This hair loss disorder is characterized by sudden loss of hair, most commonly in small patches. 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. Researchers believe that this type of hair loss is due to an autoimmune condition. If hair loss is complete on the scalp, it is called alopecia totalis. If all body hair is lost, it's called alopecia universalis.

• Trichotillomania (hair pulling). Hair pulling may cause hair loss. This condition is common in young children.

• 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.

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 or its cause. In a punch biopsy, a small core of tissue is taken out. A culture may be done if infection is suspected.

How is baldness treated?

Your healthcare provider will talk with you about the treatments available and together you will decide on the best treatment for you.

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

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

• Hair transplants

• Scalp reduction

• Skin lifts and grafts

• Platelet rich plasma (PRP)

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 surgical 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 shrink 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 possible complications of baldness and hair transplantation procedures?

Baldness may lower self-esteem. In addition, there are complications from hair transplantation procedures that include:

• Patchy hair growth. Sometimes, the growth of newly placed hair has a patchy look, especially if it's placed next to a thinning area. This can often be fixed with more surgery.

• Bleeding or wide scars. Tension on the scalp from some of the scalp reduction techniques can cause wide scars or bleeding.

• Grafts not taking. Occasionally, there is a chance that the graft may not survive in its new location. 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.

• Hair loss is not caused by poor circulation to the scalp, dandruff, or wearing hats.

• 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 or develop a problem or complication.