Hair loss (alopecia)

For a lay person:

Alopecia means hair loss, which can be patchy, diffuse or follow a pattern such as male- or female-pattern baldness. Causes include genetics, autoimmune disease (alopecia areata), stress, illness, childbirth, iron or thyroid problems and some medicines. It is usually not harmful to health but can be very distressing.

For a trained medical person:

Non-scarring forms include androgenetic alopecia, alopecia areata (autoimmune) and telogen effluvium after physiological stress, while scarring alopecias destroy follicles. Assessment includes history, scalp examination and dermoscopy, blood tests such as ferritin and thyroid function when indicated, and biopsy for scarring forms. Treatment depends on type: topical minoxidil and antiandrogen therapy for pattern hair loss, intralesional or topical corticosteroids or JAK inhibitors for alopecia areata, and correcting triggers for telogen effluvium.

In Chinese medicine:

Liu and Tseng's textbook differentiates this condition into these patterns: Blood-Heat Generating Wind Syndrome (Rapid Excess Hair Loss); Blood Stasis Obstructing Hair Orifices Syndrome (Patch Hair Loss ); Accumulated Heat in Lung and Stomach Syndrome (Expanding Type of Hair Loss from the Vertex); Qi and Blood Deficiency Syndrome (Chronic Hair Loss); Liver and Kidney Deficiency Syndrome (Large Area of Even Hair Lo ss with White Hair). Treatment follows the pattern a patient presents with, not the Western diagnosis alone.

When to get help: See a doctor for sudden or patchy hair loss, hair loss with scalp pain, redness or scarring, or hair loss with other symptoms such as tiredness or weight change. Some herbal products used for hair loss, such as He Shou Wu, have been linked to liver injury.