Hair Loss and Hair Thinning (Alopecia) – Assessment by a Dermatologist
A specialist in dermatology identifies the cause of hair loss in women, men and children and develops an appropriate treatment plan.
Hair loss (alopecia) is a common symptom with many possible causes – from hereditary hair loss and alopecia areata to hair loss following illness, stress or childbirth. At Charlottenlund Privathospital, hair loss is assessed by Susanne Birkballe, specialist in dermatology, using examination of the scalp with a dermatoscope, blood tests and, if necessary, a small tissue sample from the scalp. Treatment can be started at the same appointment, and follow-up is arranged as needed. Both children and adults can be examined.
What is hair loss?
Hair loss means losing more hair than normal or experiencing thinning and reduced hair density. Each hair grows for several years, enters a resting phase and then falls out so that a new hair can grow. It is therefore normal to lose some hair every day. Hair loss occurs when this balance changes – either because more hairs enter the resting phase at the same time, because the hair follicles shrink, or because the immune system attacks them.
Doctors distinguish between three main types: patchy hair loss, where clearly defined areas become bald; diffuse hair loss, where the hair becomes thinner across the entire scalp; and scarring hair loss, where the hair follicles are destroyed. The pattern of hair loss provides the first indication of the possible cause.
Patchy hair loss
Round or oval bald patches
Seen with alopecia areata
Can be caused by scalp ringworm, especially in children
Can be caused by pulling on the hair from tight hairstyles
Thinning across the scalp
Widening part or thinning hair on the crown
Seen with hereditary hair loss in women and men
Can occur a few months after illness, childbirth or stress
May be linked to nutritional deficiencies or thyroid problems
Source: Birch et al., British Journal of Dermatology 2001
What can cause hair loss?
The most common cause is hereditary hair loss (androgenetic alopecia), where the hair follicles gradually shrink and produce thinner hairs. In men, this typically appears as a receding hairline and thinning at the crown. In women, the hairline is usually preserved, while the hair becomes thinner on top and the parting becomes wider.
Alopecia areata is an autoimmune condition in which the immune system attacks the hair follicles. Around 2% of the population develops the condition at some point in their lifetime, and it can begin at any age, including childhood. The hair often grows back, but the condition can recur.
With telogen effluvium, diffuse hair loss develops several months after a physical or psychological stressor such as high fever, surgery, childbirth, major weight loss or prolonged stress. The hair loss usually stops on its own once the underlying cause has resolved.
Other causes include nutritional deficiencies, thyroid disorders, side effects of medication, fungal infection of the scalp and skin conditions such as psoriasis and eczema affecting the scalp. More rarely, hair loss is caused by an inflammatory condition that leads to scarring, for example lupus.
When should you see a doctor about hair loss?
You should seek medical advice if the hair loss starts suddenly or becomes progressively worse, if bald patches develop, or if the scalp is itchy, sore, flaky or red. You should also seek medical advice if the skin of the scalp becomes shiny and smooth, as this may be a sign of scarring hair loss, where early treatment is important to preserve the hair follicles.
Hair loss in children should always be assessed. The same applies if hair loss occurs together with other symptoms such as fatigue, changes in weight or irregular menstrual periods.
How is hair loss assessed by a dermatologist?
The assessment begins with a consultation about when the hair loss started, how it has developed, and whether there has been recent illness, childbirth, new medication or a family history of hair loss. The scalp, hair and nails are then examined.
The scalp is examined with a dermatoscope, which magnifies the hair shafts and the openings of the hair follicles. The examination can show whether the hairs are thinner, broken or missing, and whether the hair follicles are preserved. This helps distinguish between different types of hair loss.
Blood tests are taken to identify possible causes such as nutritional deficiencies or thyroid disease. If the diagnosis is unclear, or if scarring hair loss is suspected, a small tissue sample (biopsy) is taken from the scalp under local anaesthesia. Results are typically available within 5–10 working days.
The course usually consists of one appointment and, if necessary, one or two follow-up visits. The assessment is carried out by Susanne Birkballe, specialist in dermatology.
How is hair loss treated?
Treatment depends on the underlying cause. For hereditary hair loss and alopecia areata, topical treatment or tablets may be started, with the specialist determining the most suitable option based on the type and extent of the hair loss. Because hair grows slowly, it usually takes several months before the effect can be assessed, so a follow-up appointment is arranged.
With telogen effluvium, treatment focuses on identifying and removing the triggering cause, after which the hair usually grows back. If blood tests identify a deficiency, the need for supplementation is assessed. Fungal infections of the scalp and skin conditions such as psoriasis and eczema are treated specifically according to the diagnosis.
Treatments that are only provided in a hospital setting, for example for very extensive alopecia areata, are arranged following referral.
What can women do about hair loss?
In women, several causes are often present at the same time – for example hereditary thinning combined with hair loss after childbirth, during menopause or due to nutritional deficiencies. For this reason, it is useful to investigate the full picture before spending time and money on shampoos or supplements.
Assessment by a dermatologist can clarify which factors are contributing to the hair loss and whether treatment, follow-up blood tests or simply time for the hair to grow back is needed.
Can children experience hair loss?
Yes. In children, hair loss is often caused by alopecia areata, fungal infection of the scalp or the child pulling out their own hair. The dermatologist sees children of all ages, and a child with hair loss should be examined so that, for example, a fungal infection can be treated and prevented from spreading.
Referral and payment
Many private health insurance policies cover assessment by a dermatologist, but insurers typically require a referral from the patient’s GP and prior approval. Self-paying patients do not need a referral. Prices are available in the price list. Consultations take place at the main hospital in Charlottenlund.
Frequently asked questions
Why am I suddenly losing a lot of hair?
Sudden hair loss across the scalp is often due to telogen effluvium, which occurs a few months after, for example, a high fever, surgery, childbirth or stress. Bald patches may be alopecia areata. A dermatologist can determine the cause.
What can hair loss be a sign of?
Hair loss can be hereditary, but it can also be a sign of nutritional deficiencies, thyroid disease, medication side effects, an autoimmune disease or a scalp condition. That is why it is important to investigate the cause when it is not obvious.
Can vitamin and mineral deficiencies cause hair loss?
Yes, nutritional deficiencies can contribute to hair loss. Blood tests can show whether there is a deficiency, and the dermatologist will assess whether supplements are appropriate based on the results.
Does hair grow back after alopecia areata?
Hair often grows back, but the condition can recur. Treatment can be started, and progress monitored at follow-up appointments.
Do you need a referral to see a dermatologist for hair loss?
If you are paying privately, you do not need a referral. If you are using health insurance, the insurer will typically require a referral from your GP and prior authorisation.
Can children lose their hair?
Yes. In children, hair loss is often caused by alopecia areata, scalp ringworm or hair pulling. The dermatologist sees children of all ages.
Read also
Hair loss may be associated with other conditions affecting the skin and the body:
→ Dermatologist and dermatology – Overview of skin conditions → Psoriasis – Also affecting the scalp → Eczema – Eczema affecting the scalp and body → Connective tissue diseases – Lupus and other autoimmune conditions