Hair and Scalp Problems

Alopecia areata is a type of hair loss caused by the immune system targeting hair follicles. It typically presents suddenly with well-defined round or oval patches of hair loss. Although it most commonly affects the scalp, it may also involve the beard, eyebrows, eyelashes, and other hair-bearing areas. It is not contagious.

Importantly, the hair follicles are not destroyed in this condition; they are temporarily suppressed. Hair regrowth is therefore possible. However, the course varies from person to person: in some people it remains limited to a single area, while in others it may recur or become more widespread.

Symptoms

• Sudden, round or oval, smooth patches of hair loss on the scalp
• “Exclamation-mark” hairs that are thinner near the scalp and wider toward the tip at the edges of the patch
• Occasional mild itching or tingling before hair loss
• Nail changes such as pinpoint pitting

Types

The localized type limited to one or a few patches is the most common. alopecia totalis, which affects the entire scalp; alopecia universalis which affects all body hair; and ophiasis which follows the hairline, may also occur.

Possible causes and associated factors

An autoimmune process and genetic predisposition are the main factors involved. Alopecia areata may occur together with other autoimmune conditions such as thyroid disease. Factors such as stress and previous infections may act as triggers in some individuals.

Everyday considerations

Protecting the scalp gently, managing stress where possible, and maintaining realistic expectations about the condition may be helpful. Because visible hair loss can be emotionally challenging, a supportive approach is important.

When should you see a specialist?

A dermatologic evaluation is recommended for sudden, enlarging, or recurrent patches of hair loss, especially when the beard, eyebrows, eyelashes, or nails are also affected. Early assessment is important for accurate diagnosis and follow-up.

How is it diagnosed?

Alopecia areata can often be recognized by the typical appearance of the hairless patches and dermoscopic examination. The dermatologist evaluates the borders of the affected area, follicular openings, broken hairs, and characteristic “exclamation-mark” hairs. In widespread or recurrent cases, or when other symptoms are present, additional evaluation may be needed for thyroid disease, iron stores, or other associated conditions. Not every localized area of hair loss is alopecia areata; fungal infection, traction-related hair loss, and scarring disorders should also be considered in the differential diagnosis.

How is the treatment approach determined?

Treatment is planned according to the size of the affected area, how quickly the condition is progressing, age, and previous episodes. Topical or localized treatments may be used for limited areas, while broader medical options may be considered in more extensive cases. The aim is not only to support new hair growth but also to control disease activity.

During breastfeeding

In general, dermatologic evaluation and appropriate treatment for alopecia areata can be carried out during breastfeeding. If medication, a topical product, or a procedure is required, an appropriate option is selected by the specialist.

Telogen effluvium is a diffuse and temporary type of hair loss that occurs when a large number of hair follicles enter the resting (telogen) phase earlier than normal. It is usually noticed about 2–3 months after a triggering event. Hair loss is diffuse across the scalp rather than occurring in patches and rarely leads to complete baldness.

Because it is usually temporary, hair tends to regain density over time once the underlying trigger has resolved. Recovery can require patience and often takes several months.

Symptoms

• Noticeably increased hair shedding during brushing or washing, or on the pillow
• Diffuse thinning, particularly over the crown, with widening of the part line
• No distinct bald patches (diffuse thinning)
• Symptoms often begin several months after the triggering event

Possible causes and triggers

• Severe stress, serious illness, or infections with high fever
• Surgery and the postpartum period
• Rapid weight loss and restrictive or unbalanced diets
• Iron or vitamin deficiencies and thyroid disorders
• Certain medications

Everyday considerations

A balanced diet, addressing the underlying trigger, treating the hair gently, and avoiding harsh procedures may support recovery. Because the process takes time, a reduction in shedding may not be immediate.

When should you see a specialist?

A dermatologic evaluation is recommended when hair loss lasts longer than three months, continues to worsen, or is accompanied by other symptoms such as fatigue. Assessment may also be appropriate for possible iron or vitamin deficiency or thyroid problems.

Why does the timing of hair loss matter?

In telogen effluvium, hair shedding usually begins about two to three months after the triggering event rather than immediately afterward. This delay reflects the natural hair-growth cycle. High-fever illnesses, severe stress, rapid weight loss, surgery, nutritional deficiencies, and certain medications can cause a larger proportion of hairs to enter the resting phase. For this reason, the clinical history focuses not only on the previous few days but also on events in the preceding months.

Which tests may be needed?

Extensive laboratory testing is not necessary for every patient. However, in prolonged or pronounced hair loss, a complete blood count, iron stores, thyroid function, and—depending on the clinical history—selected vitamin and mineral levels may be assessed.

During breastfeeding

In general, dermatologic evaluation and an appropriate approach to the underlying cause of telogen effluvium can be carried out during breastfeeding. If medication, a topical product, or a procedure is required, an appropriate option is selected by the specialist.

Androgenetic alopecia is the most common type of hair loss. It is a progressive condition in which genetic predisposition and hormonal factors play a role. Over time, hair follicles become smaller and thinner (miniaturization), causing the hair shafts to become progressively finer and shorter and the hair to appear less dense.

In men, it typically presents as recession of the frontal hairline and thinning at the crown (male-pattern hair loss). In women, the frontal hairline is usually preserved while diffuse thinning develops over the crown (female-pattern hair loss). The course is slow and progressive.

Symptoms

• Recession of the frontal hairline and thinning at the crown in men
• Widening of the part line and diffuse thinning over the crown in women
• Progressive thinning and shortening of hair shafts
• A slow but progressive course

Possible causes

Genetic predisposition and sensitivity of the hair follicles to androgen hormones—especially DHT—are the main factors involved. The condition may become more noticeable with age. Hormonal changes can also contribute in women.

Everyday considerations

Early evaluation is generally advantageous for managing the process. Treating the hair gently can be helpful, but it is important to understand that this type of hair loss is not caused by washing or shampoo and to proceed with realistic expectations.

When should you see a specialist?

A dermatologic evaluation is recommended for progressive thinning, a family history of similar hair loss, or—particularly in women—sudden or pronounced thinning accompanied by hormonal signs such as irregular menstrual periods or excessive hair growth. Early management may help slow progression.

What changes occur in the hair follicle?

In androgenetic alopecia, genetically susceptible hair follicles gradually shrink over time; this process is called miniaturization . Thick, long terminal hairs gradually become finer, shorter, and lighter. Because the process progresses slowly, people often notice a widening part line or reduced density at the crown rather than sudden shedding.

How are diagnosis and follow-up performed?

Scalp examination and dermoscopy can help demonstrate variation in hair-shaft diameter and signs of miniaturization. When appropriate, accompanying causes such as telogen effluvium, iron deficiency, or thyroid disorders may also be investigated.

During breastfeeding

In general, dermatologic evaluation and appropriate treatment planning for hair loss can be carried out during breastfeeding. If medication, a topical product, or a procedure is required, an appropriate option is selected by the specialist.