Why has my hair stopped growing?

Understanding Hair Loss: Causes and Management

Hair loss can be caused by various medical conditions, with alopecia areata being one of the most common non-scarring causes. Your hair may have stopped growing due to conditions such as alopecia areata, telogen effluvium, androgenetic alopecia, or other medical conditions that require proper diagnosis and treatment. 1

Common Causes of Hair Loss

Alopecia Areata

• An autoimmune condition affecting the hair follicle
• Typically presents as patches of hair loss on the scalp
• May progress to total scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis)
• Characteristic features include:
  • Exclamation mark hairs (broken hairs that taper at the base)
  • Regular round yellow dots visible on dermoscopy
  • Normal-appearing skin in the areas of hair loss 1

Telogen Effluvium

• Sudden onset hair loss often triggered by:
  • Physical stress (surgery, illness)
  • Emotional stress
  • Hormonal changes
  • Medications
• Usually resolves once the triggering factor is removed 2, 3

Androgenetic Alopecia

• Pattern hair loss affecting both men and women
• Men: temporal-frontal recession
• Women: central thinning
• Progressive thinning over time 2

Other Potential Causes

• Trichotillomania (compulsive hair pulling)
• Traction alopecia (from tight hairstyles)
• Tinea capitis (fungal infection)
• Anagen effluvium (often from chemotherapy)
• Nutritional deficiencies
• Systemic diseases 1, 4

Diagnostic Approach

1. Clinical Examination:

   • Pattern of hair loss (patchy, diffuse, or patterned)
   • Presence of scalp inflammation or scarring
   • Examination of hair shafts for breakage or structural abnormalities 1

2. Dermoscopy:

   • Can aid diagnosis by revealing:
     • Yellow dots in alopecia areata
     • Exclamation mark hairs
     • Cadaverized hairs (fractured before emergence) 1

3. Additional Testing (when diagnosis is uncertain):

   • Fungal culture (for suspected tinea capitis)
   • Skin biopsy (particularly for scarring alopecias)
   • Serology for lupus or syphilis if clinically indicated 1

4. Laboratory Testing:

   • Not routinely recommended for alopecia areata
   • Iron studies are not recommended as routine testing for alopecia areata 1

Management Options

For Alopecia Areata:

• Limited patchy hair loss:
  • Intralesional corticosteroids (strength of recommendation B) 1
  • Topical corticosteroids (strength of recommendation C) 1
  • Spontaneous remission occurs in up to 80% of patients with limited patchy hair loss of short duration (<1 year) 1

For Androgenetic Alopecia:

• Topical minoxidil 5% (FDA-approved for men and women)
• Finasteride (for men only)
• Platelet-rich plasma therapy 5

For Telogen Effluvium:

• Identify and remove the triggering factor
• Reassurance that hair will typically regrow once the cause is addressed 3

Important Considerations

• Psychological Impact: Hair loss can have significant psychological effects, including anxiety and depression. Support and counseling may be beneficial 1, 2

• Prognosis: For alopecia areata, disease severity at presentation is the strongest predictor of long-term outcome:

  • 68% recovery rate for those with <25% initial hair loss
  • 32% recovery rate for those with 25-50% initial hair loss
  • Only 8% recovery rate for those with >50% initial hair loss 1

• Treatment Expectations: Many treatments can induce hair growth but may not alter the underlying disease course. Some conditions like extensive alopecia areata can be resistant to treatment 1

• Monitoring: Regular follow-up is important to assess treatment response and adjust management as needed

When to Seek Medical Attention

You should consult a healthcare provider for proper diagnosis and treatment options, especially if:

• Hair loss is sudden or severe
• You notice scalp inflammation or scarring
• You experience other symptoms alongside hair loss
• Hair loss is causing significant psychological distress 2

Remember that proper diagnosis is essential for appropriate treatment, and many causes of hair loss can be effectively managed with the right approach.