Hair loss may be seen due to reasons such as external factors, stress, systemic connective tissue diseases like anemia and lupus, medication, hormonal and seasonal changes, nutrition problems, heavy diets, bulimia, deficiency of protein/calorie, deficiency of zinc and essential amino acid, malabsorption (intestinal and bowel problems), hypervitaminosis A, general anesthesia and mood disorders. As female type hair loss advances very slowly, fortunately, and the advance is not very severe, a complete baldness is not seen in women. By solving medical problems and problems related to stress, and with the diagnosis and treatment of the underlying disease, hair losses seen in women stop and hairs get back to their normal status in many cases.  The reason for hair loss may be surgical operations (face lifting, eye brow lifting or forehead lifting operations) and it is compulsory to fix it by hair transplantation. There is no certain answer to the question in generally what cases a hair loss reaches unacceptable limits; some women may see the hair loss and thinning as a natural process related to ageing and it does not constitute a problem.

Telogen Effluvium: This is the second most common cause for hair loss in women after the genetic type. In this clinical case, while 10% of hairs in whole scalp are usually in telogen phase, more amounts of hair follicles (around 30-50% hairs) enter into telogen phase and starts to shed. Daily amount of hair loss may be 150-700 hairs and this situation may be confused with genetic type alopecia.

“Telogen effluvium” may be seen due to reasons such as stress, systemic connective tissue diseases like anemia and lupus, medication, hormonal and seasonal changes, nutrition problems, heavy diets, bulimia, deficiency of protein/calorie, deficiency of iron, calcium, zinc and essential amino acid, malabsorption (intestinal and bowel problems), hypervitaminosis A, general anesthesia and mood disorders. When the medication is stopped, stress is gone or nutrition problem is fixed, the shedding stops and hairs grow again.

During pregnancy, 95% of hairs enter into the anagen phase, and hairs become abundant and increase in number. 3 months after the delivery, hair loss affiliated to telogen effluvium can be seen in approximately 1/3 or half of the women.

Chronic telogen effluvium is a clinical case with a difficult diagnosis, and the hair loss continues for at least 6 months. This situation that may bother women usually between ages of 30-60 may cause a daily loss of 150-700 hairs suddenly and without a certain cause. Telogen effluvium recovers by itself at 90% within 6 months and 6-7 years. It does not cause a complete baldness but it may lead to a temporary thinning in the temples, varying from person to person. In the individuals with telogen effluvium, this situation may relapse at the rate of 40%, and the hairs may shed again.

Anagen effluvium:  Chemotherapy medication may cause a more common and severe hair loss called “anagen effluvium”. In this case, hairs start to shed suddenly within a couple of days and a couple of weeks while in the anagen phase. During a day, thousands of hairs shed and approximately 80-90% of hairs may be lost. After the medication is stopped after the chemotherapy, hairs grow back. Radiation, poisoning (such as thallium and arsenic), some medication and metabolic breakdowns related to endocrine diseases may also cause anagen effluvium. In cases apart from radiation, hairs definitely recover and grow back.

Alopecia areata: It is the third most common cause in hair losses seen in women. It is a genetical oriented autoimmune disease that leaves no scar. It is seen as a local and sudden loss of hair. It is a repeating disease that can be seen everywhere in the body. Its most common type is the round or oval hair loss pattern that is seen in eyebrows and scalps in the shape of a patch. 1/3 of hairs grow back within 6 months and 1 year. There might be a definite lost at the rate of 1/3, and the hairs might not grow again. The complete loss of hairs in the scalp is called alopecia totalis; and the loss of whole hair in the body is called alopecia universalis.

In 80% of the patients, loss of hair may relapse in same areas throughout their lives. Its cause is considered to be autoimmune (the body is attacking its own hair bulbs with its own immune system as it sees them as a foreign object).  Stress and anxiety cases such as a divorce or loss of a relative are considered to be responsible but the exact reason for alopecia areata is unknown for now. The most common treatment is the steroids that are applied topically or with injection. If the alopecia state has lasted less than 1 year during the treatment, better results can be achieved; in the hair losses that last longer, the rate of treatment is lower. In approximately 90% of the cases, the hair grows by itself within 3-6 months after the shedding stops. Using minoxidil may help hairs grow back.

Traction Alopecia: In women and men who tightly tie their hair towards back, whose toppers stay at the same spot for a long time to cause weight, or who weave and stretch their hair towards back, there occurs damage in the hair bulbs depending on this tractive force and it may lead to a permanent hair loss. The hair loss is usually seen in the temples and side hairlines. 

Cicatricial alopecia : What we call cicatricial alopecia is the hair loss caused by the hair follicles being damaged due to injuries/inflammation in the skin. This sort of hair losses that are not genetic oriented can be divided into 2 categories in general:

1)Primer cicatricial alopecia: These are autoimmune diseases (cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, folliculitis decalvans, keloid acne, necrotizing acne etc.), and hair losses usually occur as a result of an immune system attack to the hair bulb. Its exact cause is unknown.

2)Secondary cicatricial alopecia: Its causes maybe physical or chemical traumas (chemical substance injuries, burnt, trauma, surgeries, bug bites, radiation etc.); hair losses due to congenital skin abnormalities (aplasia cutis congenita etc.); bacterial, viral, protozoal or fungal infections; inflammatory dermatological diseases (psoriasis, pityriasis, morphea, scleroderma, sarcoidosis etc.); medication and various cancer types. It may be the secondary cicatricial alopecia related to the individual having been tearing or pulling their own hair for a long time. In this sort of secondary hair losses, hair bulbs are completely damaged and the hair does not grow back in time. Hair transplantation is compulsory.

Trichotillomania: It is an obsessive-compulsive disorder and/or tearing off a certain area in the scalp or body as a habit. In time, as a result of pulling the hair continuously, a hair loss and shedding occur in that area. Long-lasting trichotillomania is a cicatricial alopecia that creates permanent bald areas. While its most innocent form is seen as pulling/tearing hair while watching TV or reading something, it can also be encountered as an individual tearing his/her hair in a ritualistic way in front of mirror in severe cases. The individuals mostly know that what they do is hurting themselves and regret it.