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Alopecia: When to Worry and Approach a Physician

We all lose a certain amount of hair every day. It’s normal to shed between 50 to 100 strands a day because new hair will grow in its place. Alopecia (or baldness) develops when you stop growing hair in the area where it's shed. If not treated in time, hair loss can become irreversible and permanent. So, it’s crucial to know about the following red flags for alopecia so you can take appropriate steps.

Receding hairline

One of the earliest onset hallmarks of alopecia in men is a receding hairline, leading to hair loss known as frontal alopecia. Women may also experience a receding hairline, but it is not as common as in men except with traction alopecia (pulling forces on hair leading to hair loss).

A widening part

In women, a widening part is one of the first tell-tale signs of hair loss and should alert you to check with your dermatologist.

Losing more hair than usual

There's nothing to worry about if you notice some strands on your hairbrush or in a shower drain. However, situations that signal a serious underlying problem and warrant immediate attention include:

  • Large chunks of hair clogging up your shower drain.
  • Tufts of hair filling your hairbrush even after mild tugging.
  • Trails of hair on your pillow every morning when you wake up.
  • Hair coming out in handfuls when you run your fingers through or when you gently tug on them (more than three hairs coming out in one tug).

A sudden decrease in hair density and volume

A rapid hair volume and density reduction can also be an alarming sign. In this scenario, the follicles shrink more and more; yielding finer and shorter hairs that may eventually produce bald spots.

Hair fall associated with itchy scalp

Conditions like alopecia areata, scalp psoriasis, fungal scalp infections, seborrheic dermatitis, etc., can cause your scalp to itch. Scratching your scalp to alleviate the itch destroys hair follicles and promotes scarring, paving the way for scarring alopecia.

Circular patches of baldness

Alopecia areata is a condition when your immune system goes haywire and attacks your body’s hair follicles. This disease causes clumps of hair to fall out, resulting in circular bald spots.

Patchy hair loss, in which your hair falls out in patches, is a hallmark of alopecia areata. As stated above, an itchy or painful scalp often precedes this kind of hair loss. A hair strip may come off your scalp within one to two days, giving rise to a bald patch in one spot.

Developing blister-like bumps on the scalp

Sometimes, hair loss can be secondary to inflammation of hair follicles that causes you to develop pus-filled sores on your scalp. This condition – known as folliculitis decalvans – stops hair growth.

Red-scaly flakes on your scalp

Conditions like seborrheic dermatitis give rise to itchy, flaky rashes to develop over the skin of your face and scalp. While seborrheic dermatitis doesn’t usually cause hair loss, frequent scratching may make you lose plenty of hair strands.


Alopecia (or baldness) develops when you stop growing hair in the area where it's shed. If not treated in time, hair loss can become irreversible and permanent.

Key takeaways

Shedding between 50 to 100 hairs a day is normal.

Watch out for the signs and symptoms of hair loss. Do not ignore if you’re experiencing hair fall that’s out of the norm.

The earlier you seek help, the more likely you will avoid permanent baldness.

The most common red flags are a receding hairline and a widening part.

If you’re experiencing hair fall with an itchy or sore scalp, talk with your doctor to nip these symptoms and ward off further hair loss.


American Academy of Dermatology Association. Do You Have Hair Loss Or Hair Shedding?

Fabbrocini, G., Cantelli, M., Masarà, A., Annunziata, M.C., Marasca, C., and Cacciapuoti, S. (2018). Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. International Journal of Women's Dermatology.

McDonald, K.A., Shelley, A.J., Colantonio, S., and Beecker, J. (2017). Hair pull test: Evidence-based update and revision of guidelines. Journal of the American Academy of Dermatology.

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