Hair loss is one of the most common complaints among all patients consulting a dermatologist and is usually associated with severe psychological disturbances, distress and symptoms of depression. [1-3]. It can be temporary or long lasting. Diagnosis of hair loss is based on detailed clinical history, physical exam, clinical diagnostic tests, laboratory testing, and scalp biopsy, which may be necessary to confirm some diagnoses. This article presents an overview of the most common clinical causes of hair loss and provides updated information on the current available therapeutic options for these disorders.
J. V. Schmitt, C. F. Ribeiro, F. H. Souza, E. B. Siqueira and F. R. Bebber, “Hair Loss Perception and Symptoms of Depression in Female Outpatients Attending a General Dermatology Clinic,” Anais Brasileiros de Dermatologia, Vol. 87, No. 3, 2012, pp. 412-417. doi:10.1590/S0365-05962012000300010
S. B. Shrivastava, “Diffuse Hair Loss in an Adult Female: Approach to Diagnosis and Management,” Indian Journal of Dermatology, Venereology and Leprology, Vol. 75, No. 1, 2009, pp. 20-28. doi:10.4103/0378-6323.45215
M. B. Chartier, D. M. Hoss and J. M .Grant-Kels, “Approach to the Adult Female Patient with Diffuse Nonscarring Alopecia,” Journal of the American Academy of Dermatology, Vol. 47, No. 6, 2002, pp. 809-818. doi:10.1067/mjd.2002.128771
A. Tosti, B. M. Piraccini, A. Sisti and B. Duque-Estrada “Hair Loss in Women,” Minerva Ginecologica, Vol. 61, No. 5, 2009, pp. 445-52
E. B. Hawryluk and J. C. English, “Female Adolescent Hair Disorders,” Journal of Pediatric and Adolescent Gynecology, Vol. 22, No. 4, 2009, pp. 271-281. doi:10.1016/j.jpag.2009.03.007
A. L. Mounsey and S. W. Reed, “Diagnosing and Treating Hair Loss,” American Family Physician, Vol. 80, No. 4, 2009, pp. 356-362.
J. Shapiro, M. Wiseman and H. Lui “Practical Management of Hair Loss,” Canadian Family Physician, Vol. 46, No. 7, 2000, pp. 1469-1477.
F. Mulinari-Brenner and W. F. Bergfeld, “Hair Loss: An Overview,” Dermatology Nursing, Vol. 13, No. 4, 2001, pp. 269-272, 277-278.
H. H. Celik, H. Tore, S. Tunali, I. Tatar and M. M. Aldur, “Light and Scanning Electron Microscopic Examination of Hair in Griscelli Syndrome,” Saudi Medical Journal, Vol. 28, No. 8, 2007, pp. 1275-1277.
V. V. Smith, G. Anderson, M. Malone and N. J. Sebire “Light Microscopic Examination of Scalp Hair Samples as an Aid in the Diagnosis of Pediatric Disorders: Retrospective Review of More Than 300 Cases from a Single Center,” Journal of Clinical Pathology, Vol. 58, No. 12, 2005, pp. 1294-1298. doi:10.1136/jcp.2005.027581
K. A Adya, A.C Inamadar, A. Palit, R. Shivanna and N. S Deshmukh, “Light Microscopy of the Hair: A Simple Tool to ‘Untangle’ Hair Disorders,” International Journal of Trichology, Vol. 3, No. 1, 2011, pp. 46-56. doi:10.4103/0974-7753.82124
R. Paus and K. Foitzik, “In Search of the ‘Hair Cycle clock’: A Guided Tour,” Differentiation, Vol. 72, No. 9-10, 2004, pp. 489-511. doi:10.1111/j.1432-0436.2004.07209004.x
M. Kimura-Ueki, Y. Oda, J. Oki, A. Komi-Kuramochi, E. Honda, M. Asada, M. Suzuki and T. Imamura, “Hair Cycle Resting Phase is Regulated by Cyclic Epithelial FGF18 Signaling,” Journal of Investigative Dermatology, Vol. 132, No. 5, 2012, pp. 1338-1345. doi:10.1038/jid.2011.490
M. Courtois, G. Loussouarn, C. Hourseau and J. F. Grollier, “Hair Cycle and Alopecia,” Skin Pharmacology, Vol. 7, No. 1-2, 1994, pp. 84-89. doi:10.1159/000211279
S. Harrison and R. Sinclair, “Telogen Effluvium,” Clinical and Experimental Dermatology, Vol. 27, No. 5, 2002, pp. 389-395. doi:10.1046/j.1365-2230.2002.01080.x
O. T. Norwood, “Incidence of Female Androgenetic Alopecia (Female Pattern Alopecia),” Dermatologic Surgery, Vol. 27, No. 1, 2001, pp. 53-54. doi:10.1111/j.1524-4725.2001.00124.x
R. Sinclair, M. Patel, T. L. Dawson Jr., A. Yazdabadi, L. Yip, A. Perez and N. W. Rufaut, “Hair Loss in Women: Medical and Cosmetic Approaches to Increase Scalp Hair Fullness,” British Journal of Dermatology, Vol. 165, Suppl. 3, 2011, pp. 12-18. doi:10.1111/j.1365-2133.2011.10630.x
V. H. Price, “Androgenetic Alopecia in Women,” Journal of Investigative Dermatology Symposium, Vol. 8, No. 1, 2003, pp. 24-27. doi:10.1046/j.1523-1747.2003.12168.x
V. K. Soni, “Androgenic Alopecia: A Counterproductive Outcome of the Anabolic Effect of Androgens,” Medical Hypotheses, Vol. 73, No. 3, 2009, pp. 420-426. doi:10.1016/j.mehy.2009.03.032
D. A.Whiting, “Male Pattern Hair Loss: Current Understanding,” International Journal of Dermatology, Vol. 37, No. 8, 1998, pp. 561-566,
C. Jamin, “Androgenetic Alopecia,” Annales De Dermatologie Et De Venereologie, Vol. 129, 2002, pp. 801-803.
H. Zaun, “Influence of Contraceptive Hormones on Hair Growth,” Deutsche Medizinische Wochenschrift, Vol. 103, No. 6, 1978, p. 240.
H. Zaun, “Skin Changes from Taking Hormonal Contraceptives,” Medizinische Monatsschrift für Pharmazeuten, Vol. 4, No. 6, 1981 pp. 161-165.
H. Paterson, J. Clifton, D. Miller, J. Ashton and M. Harrison-Woolrych, “Hair Loss with Use of the Levonor- gestrel Intrauterine Device,” Contraception, Vol. 76, No. 4, 2007, pp. 306-309. doi:10.1016/j.contraception.2007.06.015
D. Wasserman, D. A. Guzman-Sanchez, K. Scott and A. McMichael, “Alopecia Areata,” International Journal of Dermatology, Vol. 46, No. 2, 2007, pp. 121-131. doi:10.1111/j.1365-4632.2007.03193.x
F. M. Delamere, M. J. Sladden, H. M. Dobbins and J. Leonardi-Bee, “Interventions for Alopecia Areata,” Cochrane Database of Systematic Reviews, No. 2, 2008, Article ID: CD004413. doi:10.1002/14651858.CD004413.pub2
A. Gilhar and R. S. Kalish, “Alopecia Areata: A Tissue Specific Autoimmune Disease of the Hair Follicle,” Autoimmunity Reviews, Vol. 5, No. 1, 2006, pp. 64-69. doi:10.1016/j.autrev.2005.07.001
S. Madani and J. Shapiro, “Alopecia Areata Update,” Journal of the American Academy of Dermatology, Vol. 42, No. 4, 2000, pp. 49-66.
M. J. García-Hernández, S. Ruiz-Doblado, A. RodriguezPichardo and F. Camacho, “Alopecia Areata, Stress and Psychiatric Disorders: A Review,” The Journal of Dermatology, Vol. 26, No. 10, 1999, pp. 625-632.
S. Ruiz-Doblado, A. Carrizosa and M. J. García-Hernández, “Alopecia Areata: Psychiatric Comorbidity and Adjustment to Illness,” International Journal of Dermatology, Vol. 42, No. 6, 2003, pp. 434-437. doi:10.1046/j.1365-4362.2003.01340.x
H. Khalaf, H. Negmi, G. Hassan, M. Al-Sebayel, “Postoperative Alopecia Areata: Is Pressure-Induced Ischemia the Only Cause to Blame?” Transplantation Proceedings, Vol. 36, No. 7, 2004, pp. 2158-2159. doi:10.1016/j.transproceed.2004.08.126
R. M. Trüeb, “Chemotherapy-Induced Hair Loss,” Skin Therapy Letter, Vol. 15, No. 7, 2010, pp. 5-7.
D. Gude, “Tackling Chemotherapy-Induced Alopecia,” International Journal of Trichology, Vol. 4, No. 1, 2012, pp. 47-48. doi:10.4103/0974-7753.96098
I. R. Kim, J. Cho, E. K. Choi, I. G. Kwon, Y. H. Sung, J. E. Lee, S. J. Nam and J. H. Yang, “Perception, Attitudes, Preparedness and Experience of Chemotherapy-Induced Alopecia among Breast Cancer Patients: A Qualitative Study,” Asian Pacific Journal of Cancer Prevention, Vol. 13, No. 4, 2012, pp. 1383-1388. doi:10.7314/APJCP.2012.13.4.1383
H. Roe, “Chemotherapy-Induced Alopecia: Advice and Support for Hair Loss,” British Journal of Nursing, Vol. 20, No. 10, 2011, pp. S4-S11.
N. Shoenfeld, O. Rosenberg, M. Kotler and P. N. Dannon, “Tricotillomania: Pathopsychology Theories and Treatment Possibilities,” The Israel Medical Association Journal, Vol. 14, No. 2, 2012, pp. 125-129.
C. A. Flessner, V. S. Knopik and J. McGeary, “Hair Pulling Disorder (Trichotillomania): Genes, Neurobiology, and a Model for Understanding Impulsivity and Compulsivity,” Psychiatry Research, Vol. 199, No. 3, 2012, pp. 151-158. doi:10.1016/j.psychres.2012.03.039
G. Hamdan-Allen, “Trichotillomania in Childhood,” Acta Psychiatrica Scandinavica, Vol. 83, No. 4, 1991, pp. 241-243. doi:10.1111/j.1600-0447.1991.tb05532.x
G. L. Hanna, “Trichotillomania and Related Disorders in Children and Adolescents,” Child Psychiatry and Human Development, Vol. 27, No. 4, 1997, pp. 255-268. doi:10.1007/BF02353354
M. E. Franklin, C. A. Flessner, D. W. Woods, N. J. Keuthen, J. C. Piacentini, P. Moore, et al., “The Child and Adolescent Trichotillomania Impact Project: Descriptive Psychopathology, Comorbidity, Functional Impairment, and Treatment Utilization,” Journal of Developmental and Behavioral Pediatrics, Vol. 29, No. 6, 2008, pp. 493-500. doi:10.1097/DBP.0b013e31818d4328
C. D. Labouliere and E. A. Storch, “Pediatric Trichotillomania: Clinical Presentation, Treatment, and Implications for Nursing Professionals,” Journal of Pediatric Nursing, Vol. 27, No. 3, 2012, pp. 225-232. doi:10.1016/j.pedn.2011.01.028
J. T. Headington, “Telogen Effluvium. New Concepts and Review,” Archives of Dermatology, Vol. 129, No. 3, 1993, pp. 356-363. doi:10.1001/archderm.1993.01680240096017
A. M. Kligman, “The Human Hair Cycle,” The Journal of Investigative Dermatology, Vol. 33, 1959, pp. 307-316. doi:10.1038/jid.1959.156
S. Harrison and R. Sinclair, “Telogen Effluvium,” Clinical and Experimental Dermatology, Vol. 27, No. 5, 2002, pp. 389-395. doi:10.1046/j.1365-2230.2002.01080.x
A. Kligman, “Pathological Dynamics of Reversible Hair Loss in Humans,” Archives of Dermatology, Vol. 83, 1961, pp. 175-198.
A. Tosti, B. M. Piraccini and D. J. van Neste, “Telogen Effluvium after Allergic Contact Dermatitis of the Scalp,” Archives of Dermatology, Vol. 137, No. 2, 2001, pp. 187-190.
E. A. Olsen, K. B. Reed, P. B. Cacchio and L. Caudill, “Iron Deficiency in Female Pattern Hair Loss, Chronic Telogen Effluvium, and Control Groups,” Journal of the American Academy of Dermatology, Vol. 63, No. 6, 2010, pp. 991-999. doi:10.1016/j.jaad.2009.12.006
A. Rook and R. Dawber, “Diffuse Alopecia: Endocrine, Metabolic and Chemical Influences on the Follicular Cycle,” Blackwell Science Publications, Oxford, 1982.
W. F. Bergfeld and F. Mulinari-Brenner, “Shedding: How to Manage a Common Cause of Hair Loss,” Cleveland Clinic Journal of Medicine, Vol. 68, No. 3, 2001, pp. 256-261. doi:10.3949/ccjm.68.3.256
R. Paus, V. A. Botchkarev, N. V. Botchkareva, L. Mecklenburg, T. Luger and A. Slominski, “The Skin POMC System (SPS). Leads and Lessons from the Hair Follicle,” Annals of the New York Academy of Sciences, Vol. 885, 1999, pp. 350-363. doi:10.1111/j.1749-6632.1999.tb08690.x
P. C. Arck, B. Handjiski, E. Hagen, R. Joachim, B. F. Klapp and R. Paus, “Indications for a ‘Brain-Hair Follicle Axis (BHA)’: Inhibition of Keratinocyte Proliferation and Up-Regulation of Keratinocyte Apoptosis in Telogen Hair Follicles by Stress and Substance P,” FASEB Journal, Vol. 15, No. 13, 2001, pp. 2536-2538.
A. Tosi, C. Misciali, B. M. Piraccini, A. M. Peluso and F. Bardazzi, “Drug-Induced Hair Loss and Hair Growth. Incidence, Management and Avoidance,” Drug Safety, Vol. 10, No. 4, 1994, pp. 310-317. doi:10.2165/00002018-199410040-00005
M. Gautam, “Alopecia Due to Psychotropic Medications,” The Annals of Pharmacotherapy, Vol. 33, No. 5, 1999, pp. 631-637. doi:10.1345/aph.18346
J. H. Eastham, “Postpartum Alopecia,” The Annals of Pharmacotherapy, Vol. 35, No. 2, 2001, pp. 255-258. doi:10.1345/aph.10153
L. Millikan, “Hirsutism, Postpartum Telogen Effluvium, and Male Pattern Alopecia,” Journal of Cosmetic Dermatology, Vol. 5, No. 1, 2006, pp. 81-86. doi:10.1111/j.1473-2165.2006.00229.x
E. A. Olsen, F. E. Dunlap, T. Funicella, J. A. Koperski, J. M. Swinehart, E. H. Tschen and R. J. Trancik, “A Randomized Clinical Trial of 5% Topical Minoxidil versus 2% Topical Minoxidil and Placebo in the Treatment of Androgenetic Alopecia in Men,” Journal of the American Academy of Dermatology, Vol. 47, No. 3, 2002, pp. 377-385. doi:10.1067/mjd.2002.124088
R. L. De Villez, “Androgenetic Alopecia Treated with Topical Minoxidil,” Journal of the American Academy of Dermatology, Vol. 16, No. 3, 1987, pp. 669-672. doi:10.1016/S0190-9622(87)70085-1
E. Arca, G. A?ikg?z, H. B. Ta?tan, O. K?se and Z. Kurumlu, “An Open, Randomized, Comparative Study of Oral Finasteride and 5% Topical Minoxidil in Male Androgenetic Alopecia,” Dermatology, Vol. 209, No. 2, 2004, pp. 117-125. doi:10.1159/000079595
K. J. McElwee and J. S. Shapiro, “Preventing Androgenic Alopecia,” Skin Therapy Letter, Vol. 17, No. 6, 2012, pp. 1-4.
S. M. Stout and J. L. Stumpf, “Finasteride Treatment of Hair Loss in Women,” The Annals of Pharmacotherapy, Vol. 44, No. 6, 2010, pp. 1090-1097. doi:10.1345/aph.1M591
M. Iorizzo, C. Vincenzi, S. Voudouris, B. M. Piraccini and A. Tosti, “Finasteride Treatment of Female Pattern Hair Loss,” Archives of Dermatology, Vol. 142, No. 3, 2006, pp. 298-302. doi:10.1001/archderm.142.3.298
D. Rathnayake and R. Sinclair, “Innovative Use of Spironolactone as an Antiandrogen in the Treatment of Female Pattern Hair Loss,” Dermatologic Clinics, Vol. 28, No. 3, 2010, pp. 611-618. doi:10.1016/j.det.2010.03.011
D. Rathnayake and R. Sinclair, “Use of Spironolactone in Dermatology,” Skinmed, Vol. 8, No. 6, 2010, pp. 328-332.
J. D. Peereboom-Wynia, A. H. Van der Willigen, T. Van Joost and E. Stolz, “The Effect of Cyproterone Acetate on Hair Roots and Hair Shaft Diameter in Androgenetic Alopecia in Females,” Acta Dermato-Venereologica, Vol. 69, No. 5, 1989, pp. 395-398.
R. Sinclair, M. Wewerinke and D. Jolley, “Treatment of Female Pattern Hair Loss with Oral Antiandrogens,” British Journal of Dermatology, Vol. 152, No. 3, 2005, pp. 466-473. doi:10.1111/j.1365-2133.2005.06218.x
K. H. Chang, S. Rojhirunsakool and L. J. Goldberg, “Treatment of Severe Alopecia Areata with Intralesional Steroid Injections,” Journal of Drugs in Dermatology, Vol. 8, No. 10, 2009, pp. 909-912.
A. Tosti, B. M. Piraccini, M. Pazzaglia and C. Vincenzi, “Clobetasol Propionate 0.05% under Occlusion in the Treatment of Alopecia Totalis/Universalis,” Journal of the American Academy of Dermatology, Vol. 49, No. 1, 2003, pp. 96-98. doi:10.1067/mjd.2003.423
R. Hoffmann and R. Happle, “Topical Immunotherapy in Alopecia Areata. What, How, and Why?” Dermatologic Clinics, Vol. 14, No. 4, 1996, pp. 739-744. doi:10.1016/S0733-8635(05)70400-9
C. J. Van den Hurk, M. Peerbooms, L. V. van de Poll-Franse, J. W. Nortier, J. W. Coebergh and W. P. Breed, “Scalp Cooling for Hair Preservation and Associated Characteristics in 1411 Chemotherapy Patients—Results of the Dutch Scalp Cooling Registry,” Acta Oncologica, Vol. 51, No. 4, 2012, pp. 497-504. doi:10.3109/0284186X.2012.658966
P. K. Auvinen, U. A. M?h?nen, K. M. Soininen, P. K. Paananen, P. H. Ranta-Koponen, I. E. Saavalainen, R. T. Johansson, M. Duvic, et al., “The Effectiveness of a Scalp Cooling Cap in Preventing Chemotherapy-Induced Alopecia,” Tumori, Vol. 96, No. 2, 2010, pp. 271-275.
C. E. Yeager and E. A. Olsen, “Treatment of Chemotherapy-Induced Alopecia,” Dermatologic Therapy, Vol. 24, No. 4, 2011, pp. 432-442. doi:10.1111/j.1529-8019.2011.01430.x
P. J. Hesketh, D. Batchelor, M. Golant, G. H. Lyman, N. Rhodes and D. Yardley, “Chemotherapy-Induced Alopecia: Psychosocial Impact and Therapeutic Approaches,” Supportive Care in Cancer, Vol. 12, No. 8, 2004, pp. 543-549. doi:10.1007/s00520-003-0562-5
W. E. Minichiello, R. L. O’Sullivan, D. Osgood-Hynes and L. Baer, “Trichotillomania: Clinical Aspects and Treatment Strategies,” Harvard Review of Psychiatry, Vol. 1, No. 6, 1994, pp. 336-344. doi:10.3109/10673229409017100
M. E. Franklin, K. Zagrabbe and K. L. Benavides, “Trichotillomania and Its Treatment: A Review and Recommendations,” Expert Review of Neurotherapeutics, Vol. 11, No. 8, 2011, pp. 1165-1174.
M. Moeinvaziri, P. Mansoori, K. Holakooee, Z. S. Naraghi and A. Abbasi, “Iron Status in Diffuse Telogen Hair Loss among Women,” Acta Dermatovenerologica Croatica, Vol. 17, No. 4, 2009, pp. 279-284.
D. H. Rushton, “Nutritional Factors and Hair Loss,” Clinical and Experimental Dermatology, Vol. 27, No. 5, 2002, pp. 396-404. doi:10.1046/j.1365-2230.2002.01076.x
V. Boccaletti, E. Zendri, G. Giordano, L. Gnetti and G. De Panfilis, “Familial Uncombable Hair Syndrome: Ultrastructural Hair Study and Response to Biotin,” Pediatric Dermatology, Vol. 24, No. 3, 2007, pp. E14-E16. doi:10.1111/j.1525-1470.2007.00385.x
W. B. Shelley and D. Shelley, “Uncombable Hair Syndrome: Observations on Response to Biotin and Occurrence in Siblings with Ectodermal Dysplasia,” Journal of the American Academy of Dermatology, Vol. 13, No. 1, 1985, pp. 97-102. doi:10.1016/S0190-9622(85)70150-8