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<h2>Are you experiencing thinning hair, hair loss, or baldness? 
</h2>
Hair loss, thinning hair, and baldness can be temporary or chronic problems that cause anxiety and loss of confidence in people of all genders and ages because hair is like something that helps enhance your appearance. When facing hair loss, thinning hair, or baldness, everyone starts looking for various solutions to fix the problem.
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<h2>What are the causes of thinning hair, hair loss, and baldness?</h2>
<ol>
<li>Ethnicity, gender, and age</li>
<li>Pathogens that directly affect the hair or indirectly cause abnormal hair loss due to infections in other organs</li>
<li>Chemicals such as drugs, toxins contaminated in food and water</li>
<li>Systemic diseases such as kidney failure, hyperthyroidism</li>
<li>Severe and sudden emotional distress or shock</li>
<li>Diet usually does not affect hair loss except in cases of malnutrition</li>
<li>Cancer treatment with chemotherapy</li>
<li>Hormonal imbalance</li>
<li>Rapid weight loss</li>
</ol>
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<h2>How do you know if hair loss is abnormal? 
</h2>
Hair shedding is normal, but if more than 100 hairs fall out per day for several consecutive days, it indicates excessive hair loss.
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<h2>Hair loss and thinning conditions are divided into groups: 
</h2>
1. Localized hair loss is divided into 2 groups: 
Patchy hair loss without scarring on the scalp, commonly found, includes
1.1 Fungal patchy hair loss Common in children. Hair falls out in clusters. The skin in the affected area has scales or crusts, sometimes with redness. 
Treatment Oral medication is required because topical treatment cannot completely eliminate the fungus.
1.2 Patchy hair loss from hair pulling (trichotillomania) Common in children under stress who pull their own hair when they have no outlet. When pulling the hair, it does not come out easily like fungal hair loss. 
Treatment Requires understanding of the disease pathogenesis and patient issues. Psychiatric consultation may be needed. Additionally, steroid cream combined with antihistamines can improve symptoms.
1.3 Patchy hair loss from alopecia areata Patients have an immune system disorder where white blood cells attack hair follicles, causing hair follicles to stop functioning. Hair disappears in patches, and the skin in the bald area is smooth without stubble or broken hairs or bumps on the skin. This condition differs from the two above. Usually, one or multiple patches of hair loss are found. In severe cases, hair loss occurs all over the scalp, and in the most severe cases, all body hair falls out like a leafless tree. 
Treatment Consultation with a doctor is recommended because treatment requires long-term use of topical or oral steroids.
1.4 Patchy hair loss with scarring on the scalp Caused by various reasons such as scalp abscesses, severe inflammatory fungal scalp infections, burns, scalds, or discoid lupus erythematosus on the scalp. Most patients have severely damaged hair follicles that cannot regenerate new hair, and fibrosis occurs in the dermis. 
Treatment Consult a doctor for accurate diagnosis before treatment.
2. Generalized hair loss commonly found includes
2.1 Telogen effluvium Patients in this group have hair on the scalp that shifts from the growth phase to the resting phase, causing excessive hair shedding. Causes include various infections such as typhoid fever, malaria, prolonged fever from colds, various drugs such as vitamin A derivatives like Etretinate, Acitretin. It is also seen in women postpartum, severe stress, or shock. Hair loss gradually improves within 1-2 months after the cause passes.
2.2 Generalized hair loss from secondary syphilis infection Hair falls out in patches all over the scalp resembling moth-eaten areas. Definitive diagnosis requires blood tests.
2.3 Genetic and hormonal hair thinning Patients experience gradual changes in hair follicles from thick to thin hair. In men, hair thins significantly in the central scalp area. In women, hair thins in the central scalp area as well but does not result in complete baldness like men.
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<h2>There are several treatments for this type of hair thinning as follows:</h2>
Hair growth medications
<ol>
<li>Minoxidil is available in topical and oral forms. Oral use is not suitable for women because it causes abnormal hair growth on the body, mustache, and beard. Women should use only the topical form.</li>
<li>Finasteride 1 mg/day requires continuous use for at least 1 year. After achieving results, medication must continue because stopping will cause hair to thin again. (This drug is ineffective in postmenopausal women.)</li>
<li>Spironolactone is a diuretic used to lower blood pressure and has anti-androgen effects that prevent hair follicles from shrinking. Use requires monitoring blood pressure and electrolyte levels to prevent side effects.</li>
</ol>
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Assoc. Prof. Dr. Puan Sutthipinittham
Dermatology Clinic, Phyathai 2 Hospital

Hair shedding is normal, but if more than 100 hairs fall out per day continuously for several days, it indicates excessive hair loss beyond the normal.

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