Diffuse Alopecia – Causes, Treatment and Complications

Hair shedding and hair loss are common across ages and genders. However, it is a matter of concern if you are losing excessive hair. Diffuse hair loss or diffuse alopecia is a common cause of hair loss among women.

Alopecia is a medical term for hair loss. It can be localized (hair loss in patches) or diffused (hair thinning and loss all over the scalp). This condition can be quite distressing. Multiple factors are responsible for diffuse hair loss, and treatment is often directed towards controlling the underlying factors. In this article, we have discussed the causes, symptoms, and treatment options for managing diffuse alopecia. Read on.

What Is Diffuse Hair Loss?

Diffuse hair loss or diffuse alopecia affects the entire scalp (1). The scalp hair grows in cycles:

• Anagen (active hair growth stage that may last 2- 8 years)
• Catagen (involution stage that may last 4-6 weeks)
• Telogen (the resting stage that may last 2-3 months)

The exogen phase is when the hair finally falls out, marking the end of the telogen phase.

Each hair follicle may undergo 10-30 cycles during its lifetime. Diffuse hair shedding or diffuse alopecia occurs when any phase of the hair growth cycle is disrupted (1).

Multiple factors may disrupt the hair cycle and cause diffuse hair loss. Let’s take a look.

What Causes Diffuse Hair Loss?

1. Telogen Effluvium

This is the most common cause of diffuse hair loss. Telogen effluvium is a temporary hair loss that may last for several months. Fever, a major surgery, childbirth, psychological stress, nutritional deficiency – anything can trigger telogen effluvium and cause hair loss. Other factors like low serum ferritin levels caused by iron deficiency and thyroid disorders may also trigger telogen effluvium(2), (1).

2. Anagen Effluvium

Diffuse hair loss may also be caused by Anagen effluvium – loss of hair during its growth phase. Anagen hair loss is often triggered by (1):

• Chemotherapy Or Radiation Therapy: It can be seen a week or two after treatment. It affects 80 to 90% of the body, including the eyebrows and eyelashes.
• Heavy Metal Poisoning: Selenium, colchicine, and thalium poisoning may also trigger anagen effluvium.
• Alopecia Areata: This autoimmune condition may cause hair loss in patches(focal alopecia), complete hair loss on the scalp (alopecia totalis), or complete scalp and body hair loss (alopecia totalis).

3. Stress (Physiological And Emotional)

Physiological stress, such as trauma, childbirth, injury, illness, and major surgery, may cause telogen effluvium. However, it is reversible. Emotional stress may cause some hair loss, but the relationship between emotional stress and chronic diffuse hair loss is controversial, and more studies are needed to arrive at a conclusion (1).

4. Medical Conditions

Medical conditions like hyperthyroidism, hypothyroidism may trigger telogen effluvium. However, the hair grows back once the condition is managed. Other medical issues like chronic renal failure, lymphoproliferative disorder, lupus, psoriasis, seborrheic dermatitis, and allergic contact dermatitis may also cause telogen effluvium and diffuse hair loss (1).

There are specific ways to identify diffuse hair loss. Here are the signs and symptoms to look for.

What Are The Signs Of Diffuse Hair Loss?

Diffuse hair loss can affect anyone. You may experience:

• Excessive Shedding: Losing 50-150 strands of hair is normal. However, if you are experiencing hair loss in clumps, consult a doctor immediately.

• Hairline Recession: Hair thinning in the central part of the scalp, widening of the hair parting, and hair loss from the frontal part (female pattern hair loss) without any apparent cause are signs of diffuse hair loss triggered by telogen effluvium (2).

If you notice these signs and symptoms, consult a doctor immediately for a proper diagnosis. They may run a few tests to confirm diffuse hair loss and the underlying reason.

How Is Diffuse Hair Loss Diagnosed?

1. History and Examination

The doctor may conduct:

• Scalp Examination: The scalp is assessed for the degree of hair loss and the pattern. The doctor may check for signs of scarring, scaling, redness, or inflammation.
• Hair Shaft Examination: The doctor may check the length, strength, and diameter of the hair shafts.
• Trichoscopy: The doctor may examine the scalp using a trichoscope for a more in-depth analysis.
• Ultrasonogram (USG): The doctor may conduct an USG to check for polycystic ovary syndrome (PCOS).

2. Blood Test

The following tests may be required:

• Complete Blood Count And Ferritin: To identify iron deficiency and anemia.
• Thyroid Function Tests: To determine hyperthyroid or hypothyroid.
• Serum Zinc Level Tests: To check for zinc deficiency.
• Renal and liver function tests: To determine kidney and liver functions as these issues may also cause hair loss.
• Antinuclear Antibodies (ANA) Test: To determine any autoimmune condition.
• Hormonal Evaluation: This would include prolactin, free androgen index, hormone-binding globulin for women suspected of having hyperandrogenism.

3. Hair Pull Test

The dermatologist may grab a small section of hair that may have about 40-50 strands from different parts of the scalp and gently tug. If six or more strands fall out of each section, it may indicate active hair loss. This test is often done to determine alopecia areata, telogen, and anagen effluvium.

4. Trichogram

This is conducted to analyze the hair. The dermatologist may pluck 25 or 50 hair strands from different parts of the scalp and examine them under a microscope to determine the number of anagen and telogen hairs.

• If more than 80% of the hairs are in the anagen phase and less than 20% are in the telogen phase, your hair loss is normal.
• If 25% of hairs are in the telogen phase, you have telogen effluvium.

5. Scalp Biopsy

It is also called “punch” biopsy. The dermatologist uses a sharp pencil-like device to puncture the scalp and remove tissue for examination. This test is often done to diagnose scarring and cicatricial alopecia.

Once the reason for diffuse hair loss is diagnosed, the doctor may suggest the following treatment options.

What Are The Treatment Options For Diffuse Hair Loss?

1. Topical Minoxidil

Applying 2% and 5% minoxidil (Rogaine) on the scalp may promote hair growth. This is a common treatment option for hair loss caused by telogen effluvium (3).

2. Supplements

Doctors may recommend biotin, amino acids, proteins, and zinc supplements for acute telogen effluvium, chronic diffuse hair loss, and chronic repetitive telogen effluvium (4).

3. Steroids And Other Medications

Oral finasteride and anti-androgens like spironolactone are also used off-label for treating androgenetic alopecia (5). If there are any other underlying issues, like dandruff and scalp infection, the doctor may suggest medicated shampoos and topical solutions for treating them.

4. Scalp Cooling

If chemotherapy or radiation therapy has triggered diffuse alopecia, it could be managed with scalp cooling (6).

Other than these, you have also to take care of nutritional deficiencies (if any). Follow a  balanced diet and take vitamin supplements suggested by your doctor. Telogen effluvium and diffuse hair loss triggered by physiological stress go away once the stress factor is eliminated. You may also try home remedies to take care of your scalp and hair at home.

Treating Diffuse Alopecia At Home

Besides taking care of the hair and following the doctor’s prescription, you may also follow home remedies to prevent hair loss and manage the underlying causes of hair loss (like stress).

• Onion Juice: You can rub fresh onion juice on the affected area. This home remedy is said to promote hair growth (7).
• Aromatherapy: Essential oils help calm your mind and reduce stress levels. This may also help minimize hair fall (8).
• Garlic Gel: Evidence suggests that applying garlic gel and topical betamethasone on bald patches promote hair growth (9).
• Saw Palmetto: This popular herbal remedy is said to reverse hair loss.  You can apply saw palmetto extract on the affected area (10).
• Caffeine Extract: A study found that caffeine may stimulate hair growth (11).

Certain factors may increase the risk factor of developing diffuse alopecia. Let’s take a look at them.

What Are The Risk Factors Of Diffuse Alopecia?

You may develop any form of alopecia if you have:

• A family history of the condition
• Other autoimmune conditions like vitiligo and discoid lupus erythematosus
• Thyroid issues
• A history of atopy (genetic tendency to develop allergic diseases)

Pregnancy, childbirth, surgeries, and physiological stress may also increase your chances of developing telogen effluvium and diffuse alopecia.

Conclusion

Multiple factors can cause diffuse hair loss. It may be reversed once the underlying factor is gone, or you can undergo treatment for it. If you are experiencing diffuse alopecia, do not panic. Talk to your doctor, find out the underlying cause(s), and then undergo treatment. Also, do not forget to take care of your overall health and follow a good hair care routine to care for your scalp and hair.

Frequently Asked Questions

Why does telogen hair loss occur?

Anything can trigger telogen hair loss, including stress, injuries, surgeries, nutritional deficiency, and thyroid disorders.

What are the causes of anagen hair loss?

Anagen hair loss may result from any scalp infection, side effect of any medication, autoimmune condition, or due to radiation therapy or chemotherapy.

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Ramona Sinha

Ramona is an associate editor at StyleCraze. Prior to that, she authored over 200 articles on skin and hair care.... more

Dr. Shruti Chavan

( MBBS, Dermatologist)

Dr. Shruti Chavan is a consulting dermatologist at Dr.Sheth's Skin and Hair Clinic since 6 years. She is a co-committee... more