Hair loss

from Wikipedia, the free encyclopedia

Hair loss is permanent hair loss in which the hair that has fallen out does not grow back. Normally, on average, between 70 and 100 hairs per day fall out and are replaced. Technical terms for unwanted hair loss are effluvium (hair loss greater than the norm) and alopecia or alopecia for a visible clearing with or without abnormally thinning hair ( hypotrichosis ).


Androgenetic hair loss

Classification according to ICD-10
L64.- Androgenetic alopecia
ICD-10 online (WHO version 2019)

Androgenetic hair loss (alopecia androgenetica or androgenetic alopecia (AGA), hair loss caused by androgens ) is a normal phenomenon of aging. Around 80% of all men worldwide are affected. Smoking accelerates hair loss.

In men, the beginning of the AGA is defined by the retreat of the front hair line at the temples with the formation of Geheimratsecken marked. As the hair progresses, the hair thins in the crown region ( tonsure area ). AGA in adolescents is called alopecia prematura .

AGA also occurs in around 50% of women, usually after menopause . Treatment of hormone-dependent tumors such as breast cancer with aromatase inhibitors can also cause young women to develop androgenetic hair loss. In contrast to men, it does not begin in the temples and tonsure area, but in the area of ​​the middle parting. Around a third of female and around 10% of male hair loss patients are also said to suffer from scalp pain ( trichodynia ).

Family-related hair loss indicates a hereditary hypersensitivity of the hair follicles to the steroid hormone dihydrotestosterone (DHT). The hair growth phase ( anagen phase ) is shortened. Therefore, many drugs try to reduce the effect of DHT.

Male hair loss is not a disease, but it does affect the self-image and the image of others. Men with hair loss tend to be perceived as older and more intelligent, but also as less dominant, less dynamic and less masculine. In the self-perception of those affected, the loss of hair z. B. with loss of self-esteem, introversion, depression , neuroticism and feelings of unattractiveness in self-image. This negative self-image can have an impact on partner choice, in the social environment and in professional development.

Alopecia areata

Alopecia areata
Classification according to ICD-10
L63.- Alopecia areata
ICD-10 online (WHO version 2019)

Alopecia areata (also: Alopecia circumscripta / Pelade / Areata celsis / circular hair loss) is a round, locally limited, pathological hair loss (in over 80% of those affected starting from the head; in men also in the beard area or in exceptional cases in the area of ​​body hair ), which was first mentioned by Hippocrates and was named after a fox disease (ancient Greek ἀλώπηξ alopex "fox"), because one could observe that some foxes' hair fell out in spots. It is an autoimmune disease .

Alopecia areata is the most common hair loss disease (approx. 1.4 million people in Germany) and occurs at any age, preferably in the second and third decades of life. Typically, there are one or more circular bald spots on the hairy head. This is why we also speak of circular hair loss. So-called "exclamation mark hair" is often found in the edge area. These are hairs that have been broken off briefly and become thinner and thinner at the end. The bald spots are smooth, sunken, non-flaking, and the hair follicles are preserved. Often there are also changes in the fingernails with pits, grooves or sandpaper-like roughening. The cause is an autoimmune reaction caused by cytotoxic CD8 + T cells that attack the hair follicles . Some skin infections (A. symptomatica) can lead to temporary hair loss, such as impetigo contagiosa , carbuncle , sore throat and shingles .

Alopecia areata under the chin

A special form of Alopecia areata is Alopecia areata atrophicans , which is also called Pseudopelade Brocq . It occurs particularly in women between 30 and 55 years of age and begins gradually with small hairless spots and reddened, shiny skin. This hair loss is progressive and irreversible.

Diffuse hair loss

Classification according to ICD-10
L65.0 Telogen effluvium
ICD-10 online (WHO version 2019)

Diffuse hair loss (diffuse alopecia, telogen effluvium) is when the hair falls off the entire head. This hair loss is more common in women. The causes are varied, e.g. B. hormone fluctuations, thyroid diseases, iron deficiency, infections, scalp diseases, lupus , stress or an unbalanced diet. Some medications (such as the active ingredient methylphenidate , which is used in the treatment of ADHD and narcolepsy ) can also cause hair loss. Hair loss occurs in the course of starvation diets, in metabolic diseases such as diabetes mellitus , Crohn's disease (inflammation of the intestinal wall), in bulimia , in anorexia ( anorexia ), in anemia (a reduction or deformity of red blood cells or their reduced hemoglobin content ) . Sexually transmitted diseases such as syphilis (in the second and third stages) and fungal diseases can also lead to hair loss.

The toxic metal thallium causes hair loss in amounts under one gram. Certain drugs such as anticoagulants (anti-coagulants in high doses), beta-blockers , retinoids (vitamin A derivatives that are used in skin diseases), anti- thyroid drugs (thyroid drugs), gestagens (contraceptives), statins (cholesterol-lowering drugs ), pesticides as well as ionizing radiation can lead to hair loss.

Other forms

In addition to these typical forms of alopecia, there are also the following:

  1. A. actinica : radiation-induced A.
  2. A. mechanis (alopecia traumatica): hair loss due to pressure, traction or friction; z. For example, by pulling out hair, carrying heavy loads on the head or resting the head for a long time in bedridden people or babies. There are also several sub-forms such as the A. liminaris, A. marginalis frontalis traumatica, pillow A., Infant bald head (= A. neonatorum),
  3. A. seborrhoica : hair loss with accompanying overproduction of sebum (see seborrhea ),
  4. A. muciosa : hair loss due to mucinosis ,
  5. A. parvimaculata : hair loss due to infection ,
  6. A. senilis : normal hair loss in old age,
  7. A. specifica / A. syphilitica : hair loss in the course of the 2nd syphilis stage (see syphilis ),
  8. A. triangularis congenita Sabouraud : congenital hairlessness in a triangular area on the temples, the cause of which is a lack of hair follicles in this skin area,
  9. A. congenita : congenital hairlessness all over the body.
  10. A. universalis : Complete loss of hair, including eyebrows and eyelashes. It is an advanced form of A. areata.

Cytostatics and radiation therapy

Cytostatic drugs disrupt the hair roots for a short time. The hair then continues to grow normally out of the hair root. But if the defective area comes to the surface of the skin, which takes about 2-3 weeks depending on the rate of growth, it breaks off. The hair “falls out” in clusters, which actually only results in massive breakage. The hair almost always grows back, as there is actually never any massive damage to all hair roots.

Local, targeted exposure to cold ( hypothermia ) reduces blood circulation in the hair root area, which is intended to counteract hair loss.

The radiotherapy (irradiation) may locally result in hair loss (only in the irradiated field). In the case of intense radiation, the hair roots can be destroyed, so that the hair loss is irreversible.


To find out the possible cause of hair loss, the following blood tests are recommended: blood count , blood sedimentation , thyroid and kidney function parameters , calcium , zinc , selenium and iron in the serum , ferritin , transaminases and immunoglobulin E (IgE) levels. The hormones testosterone , estradiol and progesterone , as well as the antinuclear and thyroid antibodies, are also important . A trichogram helps to assess the severity of the hair loss. In special cases a biopsy may be necessary.


One possible treatment for alopecia areata is topical immunotherapy , which is offered in Germany as a healing attempt without approval . In this case, DCP ( Diphenylcyclopropenone ) or SADBE ( Quadratsäuredibutylester ) was applied to the scalp. Glucocorticoids are also recommended. Another treatment option is PUVA therapy. According to pilot studies, calcipotriol could be effective.

Against AGA, attempts can be made to inhibit the conversion of testosterone into dihydrotestosterone ( finasteride , dutasteride , cyproterone ). These drugs require a prescription and can have serious side effects. Minoxidil is a liquid substance that is applied to the affected area. Alfatradiol is a stereoisomer of the female sex hormone 17β- estradiol . It is approved in Germany as a drug against androgenetic hair loss in men and women.

According to Section 34, Paragraph 1, Clauses 7 and 8 of the Social Code Book V, drugs against hair loss are excluded from reimbursement by statutory health insurance as drugs "for which an increase in the quality of life is in the foreground" ; accordingly, Annex 2 of the Medicines Directive of the Federal Joint Committee contains a list of the excluded preparations.

Over-the-counter products often contain cystine and B vitamins. Cystine is the main component of hair keratin, vitamins B1 and B5 play a role in cell division, including the formation of new hair cells. An effect of such shampoos etc. has not been scientifically proven, they are therefore unsuitable for the treatment of hair loss.

Cosmetic offers are hair thickening (if there is little residual hair ) or hair pieces .

Hair transplants can close bald areas on the head by transplanting your own hair. However, they cannot be used on people with autoimmune diseases or inflammatory hair loss.

A newer therapeutic approach is the treatment with the body's own platelet-rich blood plasma (so-called PRP from Platelet-rich plasma ), which is injected directly into the scalp by plastic surgeons or dermatologists. The experience reports of practicing physicians as well as smaller scientific studies seem to prove a positive effect on stopping hair loss and stimulating new hair growth. As far as can be seen, existing criticism of PRP therapy has so far been limited more to the currently clear study situation than to the conceivable results. However, the advocates of this approach also admit that further and more extensive studies are necessary.

Web links

Commons : Alopecia  - collection of images, videos and audio files
Wiktionary: Hair loss  - explanations of meanings, word origins, synonyms, translations

Individual evidence

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