Abnormal hair loss

Also known as non-hereditary or temporary hair loss

Abnormal hair loss (alopecia) is temporary and stops when the cause of the hair loss is removed. Alopecia can affect your scalp alone or your whole body.

This page focuses on temporary or abnormal hair loss. Read about hereditary or normal hair loss.

Key points about temporary or abnormal hair loss

  1. Abnormal or temporary hair loss can be due to many causes, including nutritional deficiencies, health conditions, medicines, reactions to hair products, stress or pregnancy.
  2. In abnormal hair loss, you may notice your hair suddenly sheds in a large amount, or sheds a lot after combing or brushing, or that it is broken or unable to grow longer.
  3. See your doctor if you experience sudden hair loss at the same time as having fever, pain, weight loss, poor appetite, breathing problems, gut problems or skin problems.
  4. Treatment depends on the cause of your hair loss. Removal of the cause usually stops your hair loss. Your doctor will advise the most suitable treatment for you.
  5. Temporary hair loss can’t be prevented, but there are things you can do to help protect and keep your hair healthy.

What are the causes of abnormal hair loss?

Hair cycle of growth and rest

Like your skin and nails, your hair goes through a finely tuned cycle of growth and rest. There are 3 phases in a hair cycle:

  • In the first stage, your scalp hair is continually growing. During this anagen phase, your hair grows about 1–2cm per month. About 90% of your hair is in this stage at any one time. It lasts between 2–5 years.
  • The second stage, called the catagen phase, is when growth stops. About 1–3% of your scalp hair is in this phase at any one time. It lasts for 2–3 weeks.
  • The third stage, the telogen phase, is a resting phase that lasts between 1–4 months. About 10% of your scalp hair is in this phase at any one time.

Hair shedding phase

At the end of its resting stage, your hair goes through a shedding phase, which normally results in growth of new hair. When a hair is shed, it’s replaced by a new hair from the same hair follicle located just beneath the skin surface. Of the 100,000 hairs on your body, you may lose 50–100 every day, while what is lost is replaced.

Disturbances to any phases of the hair cycle can cause abnormal hair loss.

Possible causes of abnormal hair loss include:

  • alopecia areata (an autoimmune condition affecting the hair follicles)
  • telogen hair loss (excessive hair shedding)
  • anagen hair loss (decreased hair growth)
  • trichotillomania (hair-pulling disorder)
  • skin conditions
  • traumatic hair loss
  • radiation therapy
  • medication – a large number of medicines prescribed may influence hair growth, including those for cancer, depression, arthritis, gout and high blood pressure as well as blood-thinners.

Alopecia areata

Alopecia areata is an autoimmune disease, in which your immune system mistakenly assumes your skin is foreign and creates antibodies that attack your hair follicles, causing them to shrink and stop producing hair. 

This condition causes your hair to fall out abruptly, resulting in totally smooth, round patches about the size of a coin, or larger, on your scalp. The condition may run in families and can affect children and adults of any age, commonly affecting those under the age of 20.

Severe stress is a possible cause of alopecia areata, but this is difficult to prove. It is not unusual for this condition to either stop suddenly or last for months or years. Nails can also be affected in some people, with pitting or fracturing.

There are a number of autoimmune diseases, and women are twice as likely as men to have one. Read more about autoimmune diseases.

Telogen hair loss

Telogen hair loss, also known as telogen effluvium, is a condition in which you shed too many hairs. Many of your hairs have been pushed into the resting (telogen) phase, causing excessive shedding. This may lead to losing up to 500 hairs a day.

You may realise you’re shedding more hair than usual or handfuls of hair can be found on your pillow, comb, hairbrush or in the plughole. Causes include:

  • childbirth
  • fever or severe infection
  • thyroid disease
  • low iron
  • weight loss and malnutrition
  • excessive bleeding
  • major surgery or chronic illness (with a period of up to 3–4 months before you see the hair loss)
  • stress, eg, a major life event in the family
  • low protein intake or a rapid weight loss diet
  • low zinc intake
  • medicines such as contraceptives, anticoagulants and anticonvulsants.

Anagen hair loss

Anagen hair loss, also known as anagen effluvium, is when your hair is held in the growing (anagen) phase. Your hair can’t grow longer and is broken. Your hair loss is sudden and can be caused by the following factors:

  • cancer treatment such as chemotherapy, radiotherapy or medicines that can suppress your immune system
  • short anagen syndrome – an inherited condition in which children can’t grow their hair long.

If you have anagen hair loss caused by medicines, hair growth will resume when the medicine is stopped.

Trichotillomania

Trichotillomania, also known as hair-pulling disorder, is a behavioural disorder that mainly affects adolescents. It can be associated with other mental health conditions such as obsessive compulsive disorder, depression or anxiety. This condition causes recurrent urges to pull your hair, which leads to hair loss.

Skin conditions

Skin conditions that affect your scalp can also cause hair loss. Examples include:

  • seborrheic dermatitis, eg, dandruff
  • psoriasis
  • lichen planus
  • discoid lupus erythematosus
  • tinea capitis – a fungal infection of your scalp
  • impetigo (school sores) – a bacterial skin infection.

If you have a skin condition causing hair loss, you may have other skin symptoms such as skin redness, rashes, scarring or itchiness.

Traumatic hair loss

Traumatic hair loss or traumatic alopecia (also known as traction alopecia) may be due to the use of hair reshaping products (relaxers, straighteners, hot combs) or the persistent physical stress involved with tight rollers and tight braiding. Using these styling methods over a long period of time can lead to irreversible hair loss (your hair won’t grow back). If you have hair loss, stop these hair styling practices.

While hair dyes (that contain paradye) may cause scalp irritation, hair loss is uncommon from that cause.

What are the symptoms of abnormal hair loss?

Hair loss may affect just your scalp, hair on another part of your body or all hair on your body. You may notice increased hair shedding that occurs suddenly, short or broken hair, or patchy hair loss, depending on the cause. 

Round ring-like patches either on your scalp or elsewhere may indicate ringworm as the cause. You would be wise to check your cat or dog for the source – your vet can easily diagnose the fungus causing ringworm.

If your hair loss is caused by a medical condition affecting other parts of your body, you may also notice other symptoms. These are listed below.

See your doctor if you experience hair loss at the same time as any of the following symptoms:

  • skin problems
  • breathing problems
  • poor appetite or unexplained weight loss
  • vomiting
  • fever
  • pain, particularly back pain or eye pain
  • constipation or diarrhoea (runny poos)
  • swelling of your hands and feet
  • a rapid heartbeat.

How is abnormal hair loss diagnosed?

Your doctor will ask you questions about your hair loss, including the pattern of your hair loss and whether you have any other medical conditions. Your doctor will also examine your hair and your skin. Investigations such as blood tests or skin testing may be done to find out the cause of your hair loss.

How is abnormal hair loss treated?

Treatment depends on the cause of your hair loss. For example, any infection will be treated. If your medicines appear to be causing your hair loss, your doctor may stop them. Hair loss caused by a medical condition will stop when you recover from that medical condition. Deficiencies of either iron or vitamin B12 can be treated by your doctor. 

Alopecia areata itself is usually treated with corticosteroids, powerful anti-inflammation medicines. These are used as local injections, creams or tablets. A skin consultant will advise you about this treatment.

If you wish to slow or stop the progression of hair loss, there may be treatments available such as medicines or hair transplantation. The latter therapy does not have the custom generated some 30 years ago, partly because of its cost and the few practitioners of that art. There are over-the-counter products available, eg, Regaine, while doctors may prescribe minoxidil or finasteride in some cases.

Complementary and alternative therapies, such as acupuncture and ultra-violet therapy, have been promoted by some health advocates. However, the evidence does not exist that these are effective options.

You may consider wearing a wig. Your doctor will help you find a source. See also information on the wigs and hairpieces subsidy. 

Can I prevent abnormal hair loss?

Most types of hair loss can’t be prevented. However, there are a few things you can do that may help keep your hair healthy and strong for longer, including to avoid:

  • tight hairstyles, such as braids, buns or ponytails
  • twisting, rubbing or pulling your hair
  • hair lotions that are heavily perfumed
  • excessive heat treatments
  • undue exposure to ultra-violet (UV) light from the sun or sunbeds, which expose you to higher levels of UV radiation than the sun.

Other useful actions to take involve stopping smoking. as well as having a balanced diet. This should include eggs, berries, avocados and nuts; all are thought to help healthy hair grow, along with Vitamins A and C, biotin and, in some cases, vitamin B12.

What support is available with abnormal hair loss?

Hair loss can be distressing and difficult to accept initially. Talking with others who have experienced hair loss may help. If you need to talk to someone, ask your doctor about counselling sessions available in your area, or for a referral to a counsellor.

Below are also some support groups you may find helpful.

NZ Alopecia Facebook support group
NZ Alopecia website Information from fellow New Zealanders living with alopecia. Links to support groups, personal experiences through to information about the wig subsidy.
Wigs and hairpieces subsidy Information from the Ministry of Health regarding wigs and hairpieces subsidy for people who suffer from serious hair loss because of a medical condition or from certain cancer therapies.

Learn more

The following links provide further information about abnormal hair loss. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Hair loss DermNet NZ
Hair loss (alopecia) HealthInfo Canterbury, NZ
Wigs and hairpieces subsidy Ministry of Health, NZ
Hair loss NHS, UK

References

  1. Hair loss DermNet NZ
  2. Alopecia Patient Info, UK
  3. Hair loss NHS, UK

Reviewed by

After 45 years of GP experience, and 8 years as an examiner and practice assessor, Dr Bryan Frost has completed a Diploma in Editing and is pursuing a new career. He also has a Diploma in Health Administration, with honours in management, and has also completed a paper in Health Care Law.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Bryan Frost, FRNZCGP, Morrinsville Last reviewed: 18 Jan 2021