There are many reasons for individuals to lose hair. Every type of hair loss is treated differently so it's essential to get a correct diagnosis. The following are handouts for our patients and provide an alphabetical overview of various patient diagnoses. They are subject to all international copyright laws. Use of these information sheets is at one’s own risk - these information sheets are for patients of Dr Donovan’s practice.
1. Acne keloidalis
This condition is a scarring process that occurs at the back of the scalp near the neck. The condition occurs most commonly in young black men and consists of itchy bumps. It consists of itchy bumps. The bumps are sometimes painful and drain fluid.
Patient Handout on Acne Keloidalis
2. Adrenal Suppression
Children and adults on prednisone and dexamethasone can sometimes develop adrenal suppression. It’s important to know how to recognize the signs that something might not be right as patients taper to lower and lower doses (ie adrenal crisis) and to know how to increase the dose of stress steroids in the event a patient has infection, illness, fever or trauma.
Handout on Adrenal Suppression
3. Age-related hair loss (senescent alopecia)
This type of hair loss refers to a type of hair thinning that affects both males and females in their later decades, usually starting around age 50. The precise cause of this type of hair loss is not known. The condition is sometimes referred to as "senescent alopecia."
Patient Handout on Senescent Alopecia
4. Alopecia Areata
About 1.7 % of the world's population is affected by alopecia areata. About one-half of those who develop alopecia areata will experience hair loss before the age of 20. This type of hair loss is classified as an autoimmune condition, meaning that the body’s own immune system is attacking hair follicles . The precise cause of alopecia areata is unknown.
Patient Handout on Alopecia Areata
5. Androgenetic Alopecia
Androgenic alopecia is a common cause of hair loss in men and women. Approximately 50% of men and 35 % of women by age 50 years will have androgenetic alopecia. The condition is inherited from both sides, contrary to popular belief that it is only mom’s side. Men experience hair loss in the temples and the crown which slowly progresses to involve the entire frontal, mid and top of the scalp in some individuals. Women develop hair loss in the central scalp. The condition is usually asymptomatic. In the early stages, many individuals will experience slightly increased shedding of hairs.
Patient Handout on Androgenetic Alopecia in Men
Patient Handout on Androgenetic Alopecia in Women
6. Breast Implant illness
This is a syndrome of medical conditions that may arise as a long term consequence of having breast augmentation and breast reconstruction. This is a very different form of hair loss than the telogen effluvium that sometimes accompanies the surgery itself (or any surgery for that matter). This has been termed 'breast implant illness.' Whether or not hair loss occurs as a long term consequence in a small proportion of women who have undergone breast augmentation continues to be studied. It's an area of research that we follow closely given how often these scenarios arise in our clinic.
Patient Handout on Breast Implant Illness
Link to Video Discussion - Breast Implant Illness
7. Celiac Disease
Celiac disease is a disease of the small bowel. It’s a chronic immune mediated bowel disorder in which ingestion of the protein gluten leads to changes in the small intestine (i.e. villous atrophy) in genetically susceptible individuals. Celiac disease is an increasingly common condition in the population and 1 to 1.5 % of people are affected. Females are two times more likely to be affected than males. The diagnosis is definitively confirmed by a biopsy of the small bowel. Many patients with celiac disease have a variety of hair loss issues. Telogen effluvium from micronutrient deficiency and iron deficiency is common. Other autoimmune diseases may be present in patients with celiac disease that can cause hair loss as well.
Patient Handout on Celiac Disease
7B. Churg Strauss Syndrome (also called eosinophilic granulomatosis with polyangiitis (EGPA))
Handout on Churg Strauss Syndrome (CSS)
8. Central centrifugal cicatricial alopecia (CCCA)
This is a common type of hair loss condition that mainly affects black women. CCCA usually starts in the mid-to-late 30s. Affected women may have no symptoms or or may notice itching or burning in the central region of the scalp (i.e. the crown). Hair loss then slowly progresses outwards from the central scalp over time leading to permanent hair loss.
9. Chemotherapy Induced Hair Loss
Patients undergoing chemotherapy commonly experience hair loss. Temporary hair loss occurs with over 60 % of chemotherapy drugs. However, permanent hair loss is much less common. Certain drugs have been reported to have an increased chance of causing permanent chemotherapy induced hair loss (or PCIA). These include: TAXANES (docetaxel, paclitaxel) used to treat breast cancer, BUSULFAN used to treat acute myelogenous leukaemia, CISPLATIN used to treat lung cancer and other cancers, ETOPOSIDE used to treat many cancers, CYCLOPHOSPHAMIDE, and THIOTEPA.
Patient Handout on Permanent Chemotherapy Induced Hair Loss
10. Chronic telogen effluvium
Chronic telogen effluvium or 'CTE' is one of a number of hair shedding problems known as “hair shedding” conditions. Those affected by CTE notice increased amounts of hair being lost daily. The amount of hair loss varies greatly from day to day. Some days, over 400 hairs may be lost, whereas on other days, 30-40 hairs will be shed. Those affected by CTE will mention excessive hair in their brush, hair falling on clothes, clogged shower drains and plugged vacuums. Some individuals have scalp symptoms such as tingling or pain (medical term: trichodynia).
Patient Handout on Chronic Telogen Effluvium
Patient Handout on the 5 Day Hair Collection
11. Cicatricial Alopecia
Cicatricial Alopecia (also known as scarring alopecia) is a specific type of hair loss that causes permanent hair loss. There are many different types of scarring alopecia including lichen planopilaris, frontal fibrosing alopecia, folliculitis decalvans and central centrifugal cicatricial alopecia.
Top 25 Frequently Asked Questions about Scarring Alopecia
12. Congential adrenal hyperplasia (CAH) - Late onset type
Late onset on non-classic congenital adrenal hyperplasia is an uncommon genetic disorder that is frequently due to mutations in the 21-hydroxylase gene leading to reduced levels of the 21 hydroxylase enzyme. The clinical features of late onset CAH in post pubertal adults may be difficult to differentiate from those of the polycystic ovary syndrome (PCOS). They include irregular periods, acne, hirsutism, and infertility.
Patient Handout on Late Onset CAH
Congenital Adrenal Hyperplasia - Table Comparing Changes with PCOS
13. Discoid lupus erythematosus (DLE)
Discoid lupus of the scalp or “DLE” is a form of hair loss condition that often leads to with permanent scarring. Individuals with DLE may first notice itchy pimples in the scalp that then proceed to resolve with permanent scarring. Most individuals who have scalp DLE do not have systemic lupus erythematosus (a more serious type of disease that can affected several organs in the body. Although the vast majority of patients are healthy, approximately 5 % of DLE patients ultimately develop SLE.
Patient Handout on Discoid Lupus
14. Dissecting Cellulitis (DSC)
This is an uncommon form of scarring hair loss condition that mainly affects black & hispanic men aged 20-40. Individuals affected by DSC notice pustules and soft boggy nodules on the scalp that drain blood and pus. Hair loss then occurs in the area. Many individuals with DSC also develop boil-like lesion in the armpit or groin (known medically by the name hidradenitis suppurativa) and some patients develop very bad acne-like lesions.
Patient Handout on Dissecting Cellulitis
15. Drugs Causing Hair Loss
Many drugs cause cause hair shedding. Some of the more common drugs causing hair shedding include (with percentages): Acitretin 10-75 %, Cidofovir 22 %, Danazol Up to 17 %, Heparin > 10 %, α-IFN 1-10 %, Β-IFN 4 %, PEG IFN 22 %, Lefleunomide 10 %, Levobunolol 1-10 %, Lithium 10-19 %, Moexipril 1-10 %, Ramipril 1-10 %, Terbinafine 1-10 %, Timolol 1-10 %, Valproic acid 1-10 %, Warfarin 1-10 %.
16. Epidermal Nevi (Verrucous Epidermal Nevi)
An epidermal nevus is a type of growth which represents an overgrowth of cells of the epidermis. Most of these are present at birth, but can also develop in early childhood. Epidermal nevi of the scalp are uncommon but do occur and may cause hair loss in the affected area. Treatment is not necessary in most cases, but the option for complete surgical excision, or destruction via cryotherapy, or laser exists.
Patient Handout on Epidermal Nevi
17. Erosive Pustular Dermatosis (EPDS)
EPDS is a relatively uncommon condition and is more likely to affect individuals 50 years of age and over. The cause of EPDS is unknown but it is thought that injury plays an important role in pathogenesis. Patients with a history of extensive ultraviolet radiation skin damage or those with a history of other means of scalp injury seem to be more likely to develop this condition. Individuals affected with EPDS often develop crusted erosions on the scalp some of which may have pus. The crusts can often be lifted from the scalp to expose the erosions that give the condition its name.
18. Eyebrow hair loss
There are several reasons for eyebrow hair loss including: endocrinological problems (including thyroid problems), autoimmune related issues (such as alopecia areata), malignancies, infections, traumatic causes/injury (including over plucking or trichotillomania), genetic diseases, aging and a variety of skin diseases.
19. Eyelash hair loss
Loss of the eyelashes may occur for a number of reasons. Expert consultation is advised for those affected by eyelash loss. Common reasons include: use of cosmetic products, autoimmune conditions such as alopecia areata or frontal fibrosing alopecia, trichotillomania, scarring alopecia, traumatic injury, infections, burns.
20. Familial Hypercholesterolemia
Familial hyercholesterolemia does not cause hair loss but has very important health implications. Familial hypercholesterolemia (“FH” for short) affects about 1 in every 250 people worldwide. About 150,000 Canadians have this condition and most simply never get diagnosed. In fact, it is estimated that only about 10 % of patients with FH ever get diagnosed. For patients who are ultimately proven to have FH, the risk of cardiovascular disease is about 20 times above the general population.
Patient Handout on Familial Hypercholesterolemia
21. Female Hair Thinning
Female pattern thinning (also called female patten hair loss or female androgenetic alopecia) is a common type of hereditary hair thinning in women. By age 50, about 35 % of women have this form of hair loss. Although hair density may become quite thin, women do not become completely 'bald' like men. Hair thinning starts as early as the teenage years, but usually in the twenties and thirties and is usually fully expressed by the age of 40.
Patient Handout on Androgenetic Alopecia in Women
22. Fibrosing Alopecia in a Pattern Distribution (FAPD)
Fibrosing Alopecia in a Pattern Distribution (FAPD) is a unique type of scarring alopecia that has features of both androgenetic alopecia and lichen planopiliaris. It appears that the immune system in patents with FAPD is targeting miniaturizing hair follicles.
Patient Handout on Fibrosing Alopecia in a Pattern Distribution (FAPD)
23. Folliculitis decalvans
This is a commonly misdiagnosed hair loss disorder that leads to permanent scarring hair loss. Both men and women are affected. Hair loss starts in the top and middle of the scalp with pimple-like eruptions, pustules and sometimes even bleeding. This leads to progressive hair loss. Affected patients may have significant itching, burning and pain.
Patient Handout on Folliculitis Decalvans
24. Follicular mucinosis
Follicular mucinosis (sometimes referred to as ‘alopecia mucinosa’) can occur at any age and sometimes leads to permanent hair loss. Individuals affected by Follicular mucinosis must be closely followed by their physicians as rarely it can be associated with a malignancy (such as mycosis fungoides, Hodgkin’s lymphoma, etc). If a cancer is going to occur at all, it generally occurs within the first 5 years after diagnosis but can occur later. Therefore, close follow up is necessary.
Patient Handout on Follicular Mucinosis
25. Frontal fibrosing alopecia (FFA)
FFA a type of scarring hair loss condition that affects women. The frontal hairline, sides of the scalp and sometimes the eyebrows, eyelashes and body hair may be affected. The hair loss in the bald areas is generally permanent. Females between 47-63 years of age are most likely to develop FFA. Caucasian women seem to be the most affected group. Many patients with FFA are asymptomatic but rarely there is burning, pain and tenderness in the affected areas scalp. Most patents come to notice loss of hair in the frontal hairline or sides or loss of the eyebrows.
Patient Handout on Frontal Fibrosing Alopecia
25b. Granulomatosis with Polyangiitis (formerly known as Wegener’s granulomatosis)
26. Hair Breakage
Hair breakage occurs for several reasons, including overuse of chemicals & overuse of heat. Some genetic conditions and autoimmune disorders may also lead to hair fragility.
27. Hair Shedding Problem (Telogen Effluvium or "TE")
A number of conditions can cause increased daily hair shedding, including: , thyroid problems, low iron levels, dieting, prescription based drugs, major stress, illness, high fever, labour and delivery (i.e. post partum TE). Shedding will continue provided the 'trigger' that caused the initial shedding is still present. Once the trigger is removed (for example the thyroid levels are restored in someone with thyroid abnormalities), the shedding stops in 4-8 months.
Patient Handout on Telogen Effluvium
28. Hashimoto’s Thyroiditis
Hashimoto’s Disease affected about 1-5 % of the population. It affects women more commonly than men and individuals are often 35-60 years of age. Patients have a painless enlarged goiter and may develop hypothyroidism. Elevated anti-thyroid peroxidase (anti-TPO) antibodies are common in Hashimoto’s disease.
Patient Handout on Hashimoto’s Disease
29. Hemochromatosis
Ferritin levels are commonly ordered as part of a standard work up for many patients with hair loss. Although low ferritin levels are commonly thought to be associated with hair loss, one must not simply skim over the lab results too quickly if the ferritin levels return back showing that the patient has extremely high ferritin. Although there are many, many causes of elevated ferritin, it is important for all hair specialists to immediately recognize the possibility that a patient with elevated ferritin might have a diagnosis of hemochromatosis. Consideration must be given to the possibility of hemochromatosis in all patients with both of the following two criteria: a) an elevated transferrin saturation above 0.45 (45 %) and b) an elevated ferritin level above 200 ng/mL in women and 300 ng/mL in men
Patient Handout - Hemochromatosis
30. Hyperprolactinemia (Elevated Prolactin Levels)
Prolactin is a hormone produced by the pituitary gland in the brain. Elevated prolactin levels are sometimes found in blood test results, especially among women 25-40 who are undergoing screening tests for possible underlying hormonal abnormalities. There are a wide variety of causes of elevated prolactin, some of which require no further work up and testing and some of which require further testing.
Patient Handout - Considerations for Patients Undergoing Prolactin Testing
Physician Training Guide - Approach to Elevated Prolactin for Hair Specialists
31. Hypervitaminosis D (Elevated Vitamin D Levels)
Elevated vitamin D does not cause hair loss. Nevertheless it is a phenomenon for all specialists to be aware in the age of exuberant do it yourself supplementation plans among the general public
Physician Training Guide - Approach to Elevated (Toxic) Vitamin D Levels
31. Hypophosphatasia
Hypophosphatasia is not a condition associated with hair loss. However, it is a condition that may be encountered in routine blood tests and it is important to recognize the condition
Patient Handout - Hypophosphatasia
32. Lichen planopilaris (LPP)
Lichen planopilaris a type of scarring hair loss condition. The hair loss in the bald areas is permanent. It is one of the most common causes of scarring alopecia. Adults of all ethnic backgrounds. Females are two times more likely than males to get LPP (but both are affected). The cause remains unknown. Stress may contribute to worsening of itching burning or pain for some people but does not appear to be a cause.
Patient Handout on Lichen Planopilaris
33. Male Pattern Balding (MPB)
Male pattern balding, also called male androgenetic alopecia is common. By age 50, about half of men will have significant amounts genetic hair loss. The condition is inherited from both mother and father's side of the family (contrary to the misconception that it is only mother’s side). Males with MPB experience hair loss in the temples and the crown which slowly expands to involve the entire frontal, mid-scalp and top of the scalp in some men. The back of the scalp (occipital area) is usually not involved as this area tends to be quite resistant to balding.
Patient Handout on Androgenetic Alopecia in Men (Male balding)
34. Mast Cell Activation Syndrome (MCAS)
Mast cell activation disorders are among the great “mimickers” of many conditions in medicine. It often takes many years to reach the correct diagnosis simply because these disorders resemble other conditions so closely. For many people with mast cell activation syndrome, hair loss is not a primary concern. However, there are some patients where MCAS is associated with hair loss.
Patient Handout on Mast Cell Activation Syndrome
35. Morgellons Disease
The key features of Morgellons are the presence of skin lesions with filaments that lie under, are embedded in, or project from skin. These filaments can be many colors including white, black, or brightly coloured. The typical patient has concerns that fibers of glass/other material are coming out of the skin. They may resemble cotton. Patients may have burning, itching, stinging of the skin and sensations of something crawling. They may have fatigue, difficulty concentrating and difficulties with sleep. It remains open to some debate as to whether this condition is a true somatic or psychiatric condition.
Patient Handout on Morgellons Disease
36. Non-Classical congential adrenal hyperplasia (CAH)
Late onset on non-classic congenital adrenal hyperplasia is an uncommon genetic disorder that is frequently due to mutations in the 21-hydroxylase gene leading to reduced levels of the 21 hydroxylase enzyme. The clinical features of late onset CAH in post pubertal adults may be difficult to differentiate from those of the polycystic ovary syndrome (PCOS). They include irregular periods, acne, hirtuitism, and infertility.
Patient Handout on Non-classical CAH
37. Pityriasis amiantacea
Pityriasis amiantacea is a scalp condition that can lead to hair loss. For some patients, the hair loss is temporary whereas for others it may be permanent. All patients with pityriasis amiantacea, have thick scale that surrounds hair follicles. The scale sometimes looks like “shingles” on a roof. When hairs are removed from the scalp, the scales come off with the hairs.
Patient Handout on Pityriasis Amiantacea
38. Prolactin Elevations on Blood Tests (also known as hyperprolactinemia)
Prolactin is a hormone produced by the pituitary gland in the brain. Elevated prolactin levels are sometimes found in blood test results, especially among women 25-40 who are undergoing screening tests for possible underlying hormonal abnormalities. There are a wide variety of causes of elevated prolactin, some of which require no further work up and testing and some of which require further testing.
Patient Handout - Considerations for Patients Undergoing Prolactin Testing
Physician Training Guide - Approach to Elevated Prolactin for Hair Specialists
39. Pseudopelade of Brocq (PPB)
Pseudopelade of Brocq a type of scarring hair loss condition and causes permanent hair loss. Both males and females can develop pseudopelade, although it is 3 times more common in females. Several features lead to this diagnosis, including areas of scarring, rarely pinky-red colour around the hair follicles, depression of the skin (called atrophy), and findings on the biopsy showed very little inflammation, loss of the fat glands and scarring.
Patient Handout on Pseudopelade of Brocq
40. Scarring Alopecia
Scarring Alopecia (also known as cicatricial alopecia) is a specific type of hair loss that causes permanent hair loss. There are many different types of scarring alopecia including lichen planopilaris, frontal fibrosing alopecia, folliculitis decalvans and central centrifugal cicatricial alopecia.
Top 25 Frequently Asked Questions about Scarring Alopecia
41. Seborrheic dermatitis (SD)
SD a common condition which affects up to 3 % of individuals. It causes redness, scaling and flaking in the scalp and sometimes also in the eyebrows, forehead and nose area as well. ‘Dandruff’ is a very mild variant with lots of flaking but not a great deal of redness. SD can be worsened by diet, emotional stress and the winter months. Malessezia globosa is a yeast and the cause of seborrheic dermatitis.
Patient Handout on Seborrheic Dermatitis
Download our Fluconazole Handout for Seborrheic Dermatitis
42. Telogen Effluvium
Telogen effluvium refers to hair shedding from a variety of so-called 'triggers.' Well recognized triggers include stressful life events, low iron, thyroid dysfunction, nutritional issues, dieting and certain medications. Shedding occurs about 2-3 months after a trigger. Telogen effluvium is different from chronic telogen effluvium.
Patient Handout on Telogen Effluvium
Patient Handout on Chronic Telogen Effluvium
Patient Handout on the 5 Day Hair Collection
43. Tinea capitis
Tinea capitis refers to a scalp fungal infection, typically occurring in children age 3-10. Tinea capitis is common in young children and is caused by a group of fungi known as dermatophytes. The most common dermatophyte in North America is known as Trichophyton tonsurans. Brushes and combs help spread the condition. This condition starts off as a red bump which then spreads. The scalp then becomes progressively scaly. The hair in the area may be lost. With certain types of fungal infections of the scalp, the scalp may be very soft or “boggy” and the individual may feel unwell. In rare cases, the lymph nodes ("glands") may also be enlarged.
Tinea Capitis: 25 Key Points (Handout for Practitioners)
Patient Handout on Tinea Capitis
44. Traction Alopecia
Traction alopecia refers to a form of hair loss due to repeated stress on hair follicles. Females develop traction hair loss from ponytails, extensions or use of braids, weaves, cornrows or extensions. Men can develop traction alopecia as well.
45. Trichotillomania (TTM)
About 4 % of the world will develop trichotillomania at some point in their lives. TTM can occur in children and adults. A proportion of patients will have underlying depression, anxiety and obsessive compulsive disorder. Treatment of trichotillomania centers around understanding the psychological issues that lead to the pulling. Cognitive behavioural therapy can be effective for many individuals with trichotillomania.
46. Trichobezoar
Trichobezoar refers to the collection of hair in the lumen and the stomach. It is due to trichotillomania (hair pulling) and/or trichophagia (eating of hair). The hair is generally the patient’s own hair but rarely can be another person’s hair (such as sibling).
Download Patient Handout on Trichobezoar
47. Wegener’s Granulomatosis (renamed now as Granulomatosis with Polyangiitis
