Thinning hair, receding hairlines and bald spots: hair loss is a nuisance, but nobody has to put up with it. These remedies and therapies curb hair loss and stimulate growth.
Whether you realize it or not, you lose hair, anytime and anywhere on your head. This is normal and not a cause for concern at first. After six years every hair says goodbye. And a new one grows back. We lose about a hundred hairs a day. Temporarily it can be more. Typically, more hair falls out in spring or fall. Hormonal fluctuations can also temporarily clear the head.
However, if the hair hangs in abundance on collars and pillows or if they hang in tufts in the brush, then that is a bad sign. There are many reasons for this loss: In some people, the hair roots are particularly sensitive to hormones. Or they suffer from iron deficiency. Various medications can also get on the hair. Experts only speak of pathological hair loss if you lose more than a hundred hairs a day over a long period of time.
Hair loss is a matter for dermatologists
Experts differentiate between four different types of pathological hair loss. They can affect men and women alike: predisposition hair loss usually manifests itself in the form of a receding hairline, light hair on the back of the head or hair loss on the crown. Circular hair loss begins with coin-sized bald patches. With diffuse hair loss, too much hair goes out everywhere. Pitted hair loss leaves bald, scarred areas.
The sooner you see a doctor, the greater the chance of successful treatment. Hair is so-called skin appendages – therefore dermatologists are responsible for hair problems. It is best to go to a hair specialist in the university clinic or in a special practice. With the help of various tests, he can determine what type of hair loss you have pretty quickly.
The doctor determines the disease with pinpoint accuracy
The pull test gives the doctor an initial indication of how severe your hair loss is. For the test, he grabs a tuft of hair between his thumb and forefinger, pulls it gently and plucks the hair out. If this works painlessly in different places, then this is a sign of hair loss.
In order to determine more precisely what your hair is like and how it is looking at hair loss, the doctor makes a so-called trichogram. He also plucks hair for this: He pulls the first tuft out where the hair is already thinning. He takes the second sample – as a control – from a healthy area. He counts the hairs under the light microscope and calculates how many hairs are in the growth or resting phase. Usually around 85 to 90 percent of hair grows.
The doctor also uses the so-called Trichoscan to check how much hair is in the growth phase and how quickly it is growing. To do this, he shaves a small area on your scalp. Three days later, he dyes the shaved hair and saves a video image of it at twenty times magnification. A software helps the doctor to calculate the total number of hairs and the ratio of hairs to each other that are in the growing and resting phase.
For some forms of hair loss , your doctor will recommend a biopsy. To do this, after a local anesthetic, he will remove a small piece of tissue about four millimeters in size from your scalp. He examines this tissue under a microscope and can then determine which disease you have.
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Hereditary hair loss
Did you have a receding hairline as a young man? Or is the hair thinning on the back of your head? Perhaps your grandfather, father, and uncle had thinning hair too. Then you probably suffer from hereditary hair loss. It was born in your cradle. Doctors also speak of androgenetic alopecia, which is hormone-related. This means that the hair cells are more sensitive to the male hormone dihydrotestosterone (DHT). The hair roots suffer from this . If they die off completely, the corresponding areas remain bare.
Constitutional hair loss is the most common reason for a light head in men and women. Men lose their hair on the forehead, parting and back of the head. Women lose their hair along the middle parting.
Countless products promise remedies: biotin, panthenol, zinc, vitamins, algae, phytoflavonoids or grapeseed oil. However, it has only been proven that two preparations actually stop hair loss: tablets with the active ingredient finasteride and the minoxidil solution. However, as soon as you stop using these drugs, they no longer work.
This remedy only helps men
The prescription finasteride is only approved for men. It is ineffective in older women and dangerous in pregnant women: it damages male fetuses. The agent prevents the conversion of the hormone testosterone into the “hair-damaging” sex hormone DHT. The result: the testosterone no longer causes hair loss. Studies over a period of five years confirm the effect. Finasteride was able to stop hair loss in 90 percent of men. In every second man, the hair thickened visibly within six to twelve months.
But the undesirable effects of the drug are sometimes considerable: the desire for sex can decrease and the number of sperm in the seminal fluid also decreases. If the product is discontinued, the quality of the semen improves again, but the use of the product, especially for young men, is controversial.
This solution stops hair loss and stimulates hair growth
The non-prescription and hormone-free minoxidil supports the growth of hair cells. It works in women and men. Women apply a two percent solution to the scalp twice a day, men take a five percent mixture. Studies prove the effect: After that, hair loss stopped in 80 percent of those involved. In every fifth woman, the hair thickened visibly.
Occasionally, however, the skin of the head is sensitive to the agent. It’s itchy, reddened, or allergic. Rarely does it grow more hair on the face. Pregnant and breastfeeding women must avoid minoxidil. People with arrhythmias, low blood pressure or migraines should also be careful.
So-called antiandrogens also help some women. They are designed to prevent active testosterone from acting on the scalp. But there is no major scientific study to prove this. Also, taking these pills increases the risk of gaining weight and developing a thrombosis or embolism. This is especially true for women who smoke.
Circular hair loss (alopecia areata)
The circular hair loss is shocking: for no apparent reason, tufts of hair fall out, often within a few days. Bald circles remain on the scalp. They are lined with short hair that gets thinner and thinner towards the tip – the so-called exclamation point hair.
In fact, all of your head hair can fall out – including your brows, eyelashes, and nasal hairs. However, those affected rarely lose their body hair. But the fingernails are as rough as sandpaper and interspersed with grooves or pits.
Those who suddenly go bald don’t have to put up with it. Because there is hope of spontaneous healing: With every third sufferer, the bald spots grow over again on their own within six months. After a year, the matter is forgotten for every second person. However, the hair can fall out again at any time.
A zinc treatment can help with bald spots
Experts estimate that around one to two percent of the population will experience circular hair loss at some point in their lives, men and women of all ages.
Experts argue about the cause. Circular hair loss is almost certainly an autoimmune disease: the immune system evaluates its own hair root cells as foreign. That is why the immune cells defend themselves against the hair cells. The hair follicles become inflamed and the hair goes out.
Scientists have carried out many studies in recent years to test the effectiveness of immune-weakening substances such as tacrolimus and anti-inflammatory drugs such as sulfasalazine or cortisone. Treatment with different lasers was also examined. So far, however, there is no standard therapy for circular hair loss that has proven to be really effective in scientific studies.
If you have few bald spots, a three-month zinc treatment may help. The trace element is said to stimulate the immune system. You can also coat the bald spots with corticosteroid solutions or creams that your doctor prescribes for you. However, this treatment should not be a permanent solution.
Circular hair loss: In severe cases, doctors trick the immune system
If none of the therapies work for you, your doctor will suggest a rather aggressive but effective treatment: immune therapy with the active ingredient diphenylcyclopropenone (DCP). He applies the product directly to the scalp. The chemical triggers allergic contact eczema. It attracts the immune cells away from the inflamed hair roots – towards the scalp. There they can no longer cause damage. The therapy works for about every second person affected, even if the hair loss was years ago. However, DCP is not officially approved for circular hair loss. Therefore, only special treatment centers offer the therapy.
Diffuse hair loss
You are slowly but surely losing your hair all over your head. You can already see your scalp. Then you may have diffuse hair loss. With a little luck it will pass. Because your hair is not destroyed. Their growth is only hindered.
A disease can be to blame for this, but also a lack of iron or protein. A high fever can trigger hair loss, as can serious surgery or a so-called crash diet. Even for specialists, the cause is not easy to find. Also eligible are:
- Infections such as the flu or tuberculosis,
- impaired function of the thyroid gland,
- hormonal changes shortly after giving birth or after stopping the pill,
- Medication, such as after chemotherapy, or heparin injections that thin the blood,
- Poisoning or environmental influences.
During the conversation, the doctor will therefore ask you whether you are taking medication and, if so, which ones. He will take your blood and, depending on the suspicion, have your iron or thyroid levels determined in the laboratory. A trichogram is also helpful when looking for the causes: The doctor can use this light microscopic examination to determine how much of your hair is growing and how much is in the resting phase. He can tell the extent of the hair loss from the result.
Once the cause of the hair loss has been identified, it is easy to treat. If the problem is with one medicine, your doctor will recommend another one. If you have an iron deficiency, he will suggest an iron supplement. If the thyroid is sick, he will prescribe appropriate medication. Basically, once the underlying disease has been treated or the deficiency has been remedied, the hair usually grows back completely within three to six months.
Pitted hair loss
If your doctor speaks of pitted hair loss, it unfortunately means for you: The hair will not grow back. Where your hair has fallen out, scars, pustules, scales or hairless spots form . The mostly rounded scars can look pale inside. Outside it is surrounded by an inflammatory, red-colored edge.
The scars occur because the hair stem cells become inflamed before the hair falls out. They lie in the hair follicle at the lower end of a narrow hair tunnel that medical professionals call the hair follicle . The hair stem cells control the growth of the hair. If the hair follicles are destroyed by the inflammation, they are completely destroyed. The scarred scalp remains.
This inflammation is a result of
- Skin damage, injuries ,
- Burns , scalds or chemical burns,
- Autoimmune diseases such as lupus erythematosus,
- Infections caused by viruses, bacteria or fungi,
- Tumor-related hair loss, for example in basaliomas and daughter tumors.
In some cases it is possible to stop the inflammation in time. The doctor then tries to calm the immune system: with antibiotics, virus-inhibiting agents or preparations such as cortisone ointments . He will only recommend cortisone tablets in very severe cases , as these have too many side effects if they are taken over a long period of time. The treatment is intended to prevent the hair follicles from disappearing completely and only leaving scars.
It is important that the doctor gets an exact picture of the disease before treatment. A tissue sample from the scalp can help. He will also thoroughly examine the remaining skin, oral mucosa and nails. In order to be able to observe the further course, he measures the size of the affected area and possibly also photographs it.
Hans Wolff, hair expert at the Ludwig Maximilian University of Munich, answers your questions:
I have circular hair loss. Do I have to have it treated or can I wait for the hair to come back?
One to two percent of people are affected by circular hair loss at some point in their life. The position is often limited, the size of a two-euro coin and often grows back in after three to six months. Fortunately, with this type of hair loss, the hair roots do not break. So for now you can wait and see. Then we try a three-month zinc cure in Munich. If it doesn’t help, we move on to immunotherapy with diphenylcyclopropenone, or DCP for short. Occasionally we also inject cortisone crystals under the scalp. Cortisone pills or infusions leave marks all over the body. They sometimes have severe side effects such as weight gain, bone loss and skin changes. This treatment is therefore usually not justified.
How quickly does a treatment for hereditary hair loss work?
Medicines and other therapies can only influence the hair during the growth phase. If they are already in the resting phase, they will definitely fail – with or without treatment. The drug can only work again on regrowing hair and lead to less hair going out. So whether the funds help can be assessed after three to six months at the earliest.
Can alternative methods such as acupuncture or Chinese medicine also help?
Alternative procedures and acupuncture do not work at all in treating hair loss. I also advise against having an expensive hair analysis for missing minerals. Such an analysis has no informative value – neither for recognizing nor for treating the disease.
I don’t lose a lot of hair and still my hair is getting lighter. Why is that?
With some, the hair on the head thins out, although hair is barely noticeable; others lose more than a hundred hairs a day and still do not go bald. Constitutional hair loss often develops slowly over the years without severe hair loss becoming noticeable.
Does frequent washing make the hair thin?
It does not matter how often you wash your hair for the course of hair loss. Only the hair that is already in the resting phase will fall out.