my hair is falling out, what should I do?

The hair loss or alopecia concern to all who suffer, but beyond the aesthetic problem, it can also be a symptom of some other disease. Shampoos, lotions, vitamin supplements are often presented as miracle solutions, but the first thing to do when we begin to notice an abnormal hair loss is to go to a specialist; that after ruling out the existence of another pathology, you can diagnose the problem and determine which is the most appropriate treatment.

fallen hair

However, we can not forget that to have a healthy hair, in addition to maintaining a balanced diet , it is advisable not to comb it when it is still wet and avoid the use of the iron and smoothing , in addition to avoiding prolonged solar exposures .

We must also emphasize that washing the hair does not cause it to fall or rot, hair can be washed daily without any problem . In fact, washing the scalp slightly can trigger problems in some people, such as the worsening of a seborrheic dermatitis.

The alopecia can be divided into two groups depending on whether or not scarring. The first ones, which are the most frequent, can be recovered; while those that leave scar, no; so the only thing that the specialist can do is stop the fall so that it does not keep moving forward.

Among the alopecias that do not leave scars the most frequent are: androgenetic alopecia, alopecia areata and telogen effluvium.

1. Androgenetic alopecia is caused by two factors: a hormonal imbalance (androgens are masculinizing hormones that are also present in women) and genetic causes (family inheritance). We can not change the latter, so the treatments have been oriented towards what can be regulated, which is the hormonal factor. Substances are also used, namely minoxidil, which help to make new hair appear and thicken the existing one. These products increase the amount of nutrients that reach the follicle because, by producing a dilation of the blood vessels, they get more blood to the area. This nutrient effect is also achieved with the infiltration of growth factors that help hair directly.

However, first of all we must perform an analytical to the patient to rule out that there are other causes that are causing the hair to fall or weaken.

2. Alopecia areata is a type of fall that occurs because the hair is attacked by our own defenses (part of the so-called autoimmune diseases). It can affect the hair of the head, but also the eyebrows, eyelashes and the rest of the body. It is recoverable even years after its inception and there are multiple treatments for it. It is important to take control of thyroid hormones, some vitamins and a review to rule out other autoimmune diseases (celiac disease, gastritis atrophic, vitiligo).

3. Telogenic effluvium is a very common cause of hair loss, it can occur due to multiple causes (low iron, low vitamins, after surgery, fever, important sun exposure …). The fall occurs three months after being exposed to the factor that triggers it, and requires an analytical study to finish the cause. With an adequate treatment the hair recovers satisfactorily. Tobacco is a factor that has been studied extensively and can also cause outbreaks of telogenic effluvium.

The scarring alopecia require a detailed study and conducting a skin biopsy to establish the exact diagnosis, although tricoscopia and helps us a lot. The treatments change a lot depending on whether one or the other. These include pillar flat lichen, chronic lupus erythematosus, decalvant folliculitis, dissecting cellulitis and erosive pustulosis . Fibrosing frontal alopecia is a special type of scarring alopecia of unknown cause that involves loss of eyebrows and the frontal line of the hair (like a diadem). It requires a diagnosis as early as possible to establish the treatment and not advance.


This problem is investigated a lot and specialists have more and more means to diagnose it, such as trichoscopy, which we usually do in the office, or the trichogram, which can be performed if there are diagnostic doubts.

The trichoscopy consists of analyzing with a dermatoscope (special magnifying glass with polarized light) the existence of certain signs that determine the type of alopecia. For example, in alopecia areata we see yellow spots (hairless follicles), black spots (broken hairs), exclamation hairs (thicker hairs at the tip instead of at the root). In the androgenetic alopecia it is seen that the hair is losing thickness due to the hormonal action. There are intermediate hairs, miniaturized and yellow dots (follicle without hair), no black spots, no hairs in exclamation. Thus, there are patterns and signs for each of the types of alopecia.

The trichogram is a technique that consists of taking a sample of approximately 20 hairs from the root, with a dry pull. Then this will be analyzed under the microscope. You can see what stage the hair is in, if there are more hairs in the growth or fall phase. If there is more than 25% in the phase of fall we will be before a telogenic effluvium. It is only done if there are doubts or to diagnose cases of hair loss in children that we will approach in the future.

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