Different Types of Hair Loss: How to Tell Them Apart

Hair loss is not one diagnosis. A hairline that has gradually moved backwards, sudden shedding from the whole scalp and eyebrows and a smooth circular bald patch may all be described as “hair loss”, but they can have very different causes and should not be treated in the same way.

Judging your hair loss purely on how much hair you find in the shower/sink or on your pillow in the morning doesn't tell you everything.

Is the hair shedding, thinning or snapping?

These can sound like the same thing, but they are not and they can point to different things.

Shedding is finding more hair coming out in the shower, on your pillow in a hairbrush etc.

Thinning is when follicles continue producing hair, but the individual strands become progressively finer, shorter and less visible. Snapping means the hair shaft is breaking rather than the entire hair being shed from the root. Heat, bleaching, chemical treatments, tight hairstyles and repeated friction can leave shorter broken hairs of noticeably different lengths. 

Where is the hair loss happening?

Is your hair loss mainly at the temples, behind the hairline, at the crown, along the parting or across the whole scalp? Is there one clearly defined patch, several patches or a general reduction in density? Is it affecting your beard, eyebrows, eyelashes or other body hair? 

How quickly did it happen?

Was your hair loss gradual over several years, or did the change seem to happen over days/weeks. It can be difficult to judge purely from memory, looking at older photographs in similar lighting can help you judge it better. Also take a note of if the hair seems to still be progressing or has remained stable.

Does the scalp look and feel normal?

Look at the skin as well as the hair. Does the scalp appear unchanged, or is there redness, scaling, crusting, pustules, swelling, discharge or a change in colour or texture? Are any areas unusually smooth or shiny, and can you still see the small openings where the hairs emerge?

Pattern hair loss usually develops slowly over months to years. In men, the first sign may be that the corners of the hairline have moved backwards, the hair behind the hairline feels less dense or more scalp is visible through the crown. It can happen so gradually that you only notice it when comparing photographs taken several years apart.

This type of hair loss is caused by dihydrotestosterone, usually shortened to DHT, affects genetically susceptible follicles on the scalp. Instead of suddenly dying or releasing all their hairs at once, those follicles begin producing hairs that are progressively finer, shorter and lighter in colour. Eventually, some become so small that they are barely visible.

This is why pattern hair loss does not always produce handfuls of hair in the shower. You may still be growing hair in the affected area, but each strand provides less coverage than the one it replaced.

What does male pattern hair loss look like?

Male pattern hair loss commonly affects the:

1. Temples and corners of the frontal hairline
2. Hair immediately behind the hairline
3. Top of the scalp
4. Crown or vertex

The hairline and crown do not always thin at the same speed. Some men retain a strong hairline but develop a noticeable patch at the crown, while others experience recession for years before the crown changes.

Hair around the back and sides of the scalp is usually more resistant to DHT and tends to be preserved. This creates the recognisable pattern rather than an equal loss of density from everywhere. The scalp itself should normally look healthy, without significant redness, scaling, pain or scarring

Does it only come from your mother’s side?

No. The idea that baldness can only be inherited from your mother’s father is an old wives tale. Male pattern hair loss is influenced by many genes and can be inherited from either or both parents. A strong family history may make the diagnosis more likely, but having a father with a full head of hair does not rule it out, and having several bald relatives does not tell you exactly when or how far your own hair loss will progress.

What does female pattern hair loss look like?

Women more commonly notice a widening of the central parting and reduced density across the top of the scalp. The frontal hairline is often retained rather than receding in the same way it commonly does in men.

The underlying process is similar to men, affected follicles produce progressively finer and shorter hairs. However, new hair loss in a woman may need further assessment, particularly when it is accompanied by irregular periods, increased facial hair or acne, as these can sometimes point towards an underlying hormonal condition.

Pattern hair loss is the type for which treatments such as finasteride and minoxidil are mainly used.

Telogen effluvium causes increased shedding from across the scalp rather than thinning concentrated at the temples, hairline or crown. You may notice handfuls of hair when washing, much more in your brush or a reduction in the thickness of your ponytail.

The scalp usually looks healthy, without a smooth bald patch, scarring or significant inflammation. Although the parting may appear wider, telogen effluvium generally causes an overall loss of volume rather than one completely bare area.

Why does telogen effluvium happen?

Most scalp hairs are actively growing, while a smaller number are resting and preparing to fall out. In telogen effluvium, an illness or major physical change causes more hairs than usual to enter the resting stage together. They are not shed immediately, which is why hair loss commonly begins around two to three months after the trigger.

Possible triggers include:

1. Illness, particularly with a high temperature
2. Surgery, serious injury or childbirth
3. Rapid weight loss, crash dieting or nutritional restriction
4. A major stressful event
5. Starting certain medicines
6. Stopping hormonal treatment, such as the contraceptive pill
7. Iron deficiency or a thyroid condition

No trigger is identified in around one-third of cases. Persistent shedding should not automatically be blamed on stress, particularly when there may be signs of iron deficiency, thyroid disease or inadequate nutrition.

How is it different from pattern hair loss?

Telogen effluvium releases an increased number of otherwise normal hairs. Pattern hair loss gradually causes susceptible follicles to produce finer and shorter hairs.

The two can occur together. Someone with mild pattern thinning may develop telogen effluvium after an illness, operation or rapid weight loss, making the previously subtle loss at the crown or parting suddenly much more noticeable. This does not necessarily mean their pattern hair loss has rapidly worsened or that an existing treatment has stopped working.

How long does telogen effluvium last?

The heavy shedding phase commonly lasts around three to six months. New hairs then begin growing, but it can take several more months for them to become long enough to restore the previous volume.

Telogen effluvium is described as chronic when it continues for longer than six months. This does not automatically mean permanent hair loss, but it may indicate that the trigger remains present, an underlying cause has been missed or another type of hair loss is occurring alongside it.

Do you need a hair-loss treatment?

Acute telogen effluvium normally improves once the trigger has resolved. The priority is recovering from the original illness, returning to a nutritionally adequate diet or treating a confirmed deficiency where one is found.

Taking iron, biotin or general hair supplements without knowing that you are deficient is not the same as treating the cause. Finasteride and dutasteride treat DHT-driven pattern hair loss, not telogen effluvium. Minoxidil may sometimes be considered where pattern hair loss is also present, but sudden unexplained shedding should not automatically be treated by adding another hair-loss product.

When should you get it checked?

Speak to your GP if the shedding continues for several months, there is no plausible trigger or you also have symptoms such as fatigue, unexplained weight changes or changes to your periods. Blood tests may be needed to look for causes such as iron deficiency or thyroid problems.

Alopecia areata usually looks very different from pattern hair loss. Instead of the hairline gradually moving backwards or the crown becoming less dense, one or more clearly defined bald patches can appear over a relatively short period.

The classic presentation is a smooth, round or oval patch, often compared to the size and shape of a coin. The skin within it usually looks normal and is not obviously scaly, scarred or inflamed. It most commonly affects the scalp, but patches can also develop in the beard, eyebrows, eyelashes or elsewhere on the body.

What causes alopecia areata?

Alopecia areata is an autoimmune condition. Inflammation caused by the immune system interferes with the affected follicles and stops them producing hair normally.

It is described as non-scarring hair loss, which means the follicles have not necessarily been permanently destroyed and may be capable of growing hair again. It is not contagious, and there is no evidence that it is caused by poor hair care or a particular food. Although people often associate an episode with stress or a recent illness, no clear trigger can be identified in many cases.

What should you look for?

The patch itself may be the only obvious sign, but there are some additional clues:

1. Short, tapered “exclamation mark” hairs may be visible around the edge of an actively expanding patch.
2. A few white or grey hairs may remain within the area.
3. Regrowth may initially appear as fine, pale or white hair.
4. Small pits or a roughened surface can sometimes develop on the nails.
5. Some people notice mild itching, tingling or burning around the area before or after the hair is lost.

They may be difficult to recognise without examining the scalp closely or using a dermatoscope. Alopecia areata is therefore normally diagnosed after an assessment rather than from a photograph alone.

Is a round patch at the crown alopecia areata?

This on its own does not tell if you do or do not have alopecia areata as male pattern hair loss commonly affects the crown and can create a roughly circular area of thinning.

The important difference is that pattern hair loss usually leaves hairs within the area. They may be finer, shorter and provide less coverage, but the crown does not normally become completely smooth and bare all at once.

Alopecia areata more often produces a clearly bordered patch in which most or all visible hair has disappeared. It may also appear somewhere that would be unusual for male pattern hair loss, such as the side of the scalp, the back of the head or within the beard.

Could a smooth patch be something else?

A scaly or inflamed patch containing broken hairs may suggest a fungal scalp infection such as tinea capitis, particularly in a child. An unusually shaped area containing hairs of many different lengths may be caused by repeated hair pulling or breakage. Smooth, shiny skin where the normal follicle openings have disappeared raises more concern about a scarring form of hair loss.

This is why “patchy hair loss” should not be treated as a diagnosis in itself. The appearance of the skin and the hairs remaining around the patch can change what needs to happen next.

Will the hair grow back?

Hair can regrow because alopecia areata does not usually destroy the follicle permanently. In limited cases, spontaneous regrowth is common. The British Association of Dermatologists estimates that around four out of five affected people may achieve complete regrowth within one year without treatment, although the likelihood is lower when a large proportion of the hair has been lost from the beginning.

However, regrowth does not necessarily mean the condition has gone permanently. New patches can appear later, and it is not possible to predict with certainty how an individual case will progress. Extensive loss involving the whole scalp, known as alopecia totalis, or the scalp and body, known as alopecia universalis, is less likely to recover completely than one or two small patches.

How is alopecia areata treated?

Small areas may sometimes be monitored because the hair can regrow without treatment. Where treatment is appropriate, options may include corticosteroid scalp preparations or steroid injections into smaller patches. More extensive or persistent alopecia areata may need specialist dermatology treatment.

Finasteride and dutasteride reduce DHT and are intended for suitable cases of male pattern hair loss. They do not address the autoimmune inflammation responsible for alopecia areata.

Topical minoxidil is sometimes used alongside other alopecia areata treatments or where early regrowth has already begun, but the evidence for it working well on its own is limited.

For severe alopecia areata, newer medicines called Janus kinase—or JAK—inhibitors are also being studied and used within specialist care. Two large phase 3 trials involving 1,399 adults and adolescents with at least 50% scalp hair loss tested the oral JAK inhibitor upadacitinib. After 24 weeks, around 45% of those taking 15mg and 54–55% taking 30mg had regained enough hair to leave no more than 20% of the scalp without hair, compared with 1.5–3.4% of those receiving placebo. Improvements were also reported in eyebrow and eyelash growth.

These results apply to severe alopecia areata, rather than someone with one small, recently developed patch. Upadacitinib is a systemic immunomodulating medicine with important safety considerations and would be managed through specialist dermatology care, not as an ordinary online hair-loss treatment. ^[1]

Not every area of reduced density is caused by pattern hair loss or excessive shedding. Hair can also be repeatedly pulled from the follicle, snap partway along the shaft or be removed through a hair-pulling behaviour.

The location of the thinning and the lengths of the remaining hairs can help distinguish between them.

Traction alopecia: when hairstyles pull on the follicles

Traction alopecia is caused by repeated tension from styles such as tight ponytails, buns, braids, cornrows, weaves, extensions or heavy locs.

Thinning often develops where the pulling is greatest, particularly around the temples, frontal hairline or above the ears. Some shorter hairs may remain along the edge because they were not caught in the style, producing what is known as the "fringe sign".

Persistent tightness, soreness, itching, headaches or bumps around the affected area suggest that the follicles are under too much strain. Hair does not need to be pulled out immediately; repeated tension can gradually cause thinning over months or years.

Early traction alopecia may recover when the pulling is stopped. However, longstanding traction can scar and permanently destroy the follicles, leaving smooth or shiny skin where the normal follicle openings are no longer visible.

Reducing the risk means loosening tight styles, taking breaks from extensions and weaves, reducing their weight and avoiding repeated pulling in the same direction. Minoxidil may sometimes be considered after the tension has been removed, but it cannot compensate for a style that continues to pull on the follicles. Finasteride and dutasteride do not treat traction alopecia.

Hair breakage: when the strand snaps

Hair breakage occurs when the shaft becomes damaged and snaps rather than being shed from the follicle. Common causes include bleaching, chemical relaxing, excessive heat, rough brushing, tight hair ties, friction and extensions.

Possible signs include:

1. Numerous short hairs of different lengths
2. Frayed or split ends
3. Short pieces of hair rather than complete shed hairs
4. Breakage concentrated where bleach, heat, bands or extensions are used
5. Reduced fullness through the lengths of the hair

This differs from telogen effluvium, where complete hairs are shed from across the scalp, and pattern hair loss, where follicles gradually produce finer and shorter strands.

A broken hair cannot be repaired or reattached by a shampoo, supplement or hair-loss medicine. Products may reduce friction or improve how the hair feels, but the damaged section must grow out or be cut away. The main treatment is reducing the source of damage and handling new growth more gently.

Hair pulling disorder: irregular patches with hairs of different lengths

Repeated hair pulling can also cause patchy loss. This is known as trichotillomania, or hair pulling disorder.

Some people experience a strong urge to pull, while others do it almost automatically when concentrating, watching television or feeling stressed. It can affect the scalp, eyebrows, eyelashes, beard or other body hair.

Unlike the smooth, clearly defined patch often seen with alopecia areata, hair pulling usually leaves an irregular area containing hairs of noticeably different lengths. Some have been pulled out completely, while others have broken or remained untouched.

Hair pulling is not simply a bad habit that someone can always stop through willpower. A GP can help rule out other causes and arrange support. Treatment often involves cognitive behavioural therapy, including habit reversal training to identify triggers and replace the pulling with another action.

These features are clues rather than a diagnosis, and more than one problem can occur at the same time. Seek an assessment if the cause is unclear, the area continues to expand, the scalp becomes painful or inflamed, or the skin appears smooth and shiny.

In male or female pattern hair loss, the scalp itself usually looks and feels normal. The hairs gradually become finer, but there should not be marked redness, crusting, pustules, pain or burning.

An itchy or flaky scalp does not automatically mean permanent damage. Dandruff, seborrhoeic dermatitis, psoriasis, eczema and reactions to hair products can all cause redness and scale. However, when these changes occur alongside patchy or progressive hair loss particularly when the redness and scale surround individual hairs the cause should be assessed rather than assumed to be ordinary pattern thinning.

Why does a smooth or shiny scalp matter?

In non-scarring conditions such as pattern hair loss, telogen effluvium and alopecia areata, the follicles usually remain within the skin and may still be capable of producing hair.

In scarring alopecia, inflammation damages and eventually destroys the follicles. The normal follicle openings can disappear, leaving the skin pale, smooth or shiny. Once a follicle has been replaced by scar tissue, minoxidil or another hair-growth treatment cannot bring it back.

This can be difficult to judge at home, and a dermatologist may use a dermatoscope to look for missing follicle openings, redness or scale around individual hairs.

What warning signs should you look for?

Seek an assessment for hair loss accompanied by:

1. Persistent pain, burning or intense itching
2. Redness or scale around individual hairs
3. Pustules, crusting, oozing or bleeding
4. Several hairs emerging together in tufts
5. Smooth or shiny skin with few visible follicle openings
6. Loss of the eyebrows alongside a receding frontal hairline
7. A painful, soft or swollen area of scalp
8. Scaly patches containing numerous broken hairs

Some scarring conditions cause little pain or inflammation, so the absence of discomfort does not completely rule them out.

What can cause scarring hair loss?

Scarring alopecia is an umbrella term covering several inflammatory conditions.

Lichen planopilaris can cause patchy loss with itching, pain or burning. Redness and scale may be most noticeable around hairs at the edge of the patch, while established areas can appear smooth and shiny.

Frontal fibrosing alopecia causes the frontal hairline to recede in a band and may also affect the eyebrows. Unlike ordinary pattern recession, hair cannot regrow once the affected follicles have been destroyed.

Other scarring conditions may begin at the crown or cause pustules, crusting and irregular areas of inflammation. The important distinction at home is not identifying the exact condition, but recognising when the scalp and follicles appear to be affected rather than the hair simply becoming thinner.

Could it be a scalp infection?

A fungal infection called tinea capitis, or scalp ringworm, can cause itching, scaling, broken hairs and patchy hair loss. It is most common in children but can also affect adults.

More inflamed infections may produce pustules, yellow crusting or a painful, boggy swelling known as a kerion. Tinea capitis usually requires prescription oral antifungal treatment because shampoo alone does not reliably clear infection from within the hair follicles.

A scaly bald patch should therefore not automatically be labelled alopecia areata. Alopecia areata usually leaves smooth, relatively normal-looking skin, whereas scale and broken hairs increase the suspicion of infection or another scalp condition.

Does dandruff cause hair loss?

Ordinary dandruff does not usually destroy the follicles. More severe inflammation and repeated scratching may contribute to temporary breakage or shedding, but dandruff should not normally produce smooth, shiny areas where the follicle openings have disappeared.

It is also possible to have dandruff or psoriasis alongside pattern hair loss. Treating the scalp may reduce itching and flaking, but it will not necessarily reverse unrelated recession at the temples or thinning at the crown.

Will finasteride or minoxidil help?

Finasteride and dutasteride treat DHT-driven pattern hair loss. They do not treat fungal infections or the inflammation responsible for scarring alopecia.

Minoxidil may support growth from follicles that are still functioning and is sometimes included in a wider specialist treatment plan. It cannot restore a follicle that has already been destroyed or control the inflammation causing further damage.

When should you seek medical advice?

Arrange a GP assessment if hair loss is accompanied by pain, burning, redness, persistent scale, pustules, crusting or changes in the texture of the scalp. A receding frontal hairline with eyebrow loss, a swollen patch or an area becoming smooth and shiny should also be checked.

Chemotherapy-related hair loss often begins within two or three weeks of treatment, much sooner than telogen effluvium.

Many chemotherapy medicines target rapidly dividing cells. This helps destroy cancer cells but can also affect the cells producing actively growing hairs, causing the strands to weaken, break or fall out. This is called anagen effluvium because it affects hairs during their active growth stage.

Does all chemotherapy cause hair loss?

No. Some medicines cause extensive hair loss, others cause partial thinning, and some cause little noticeable change. The risk depends on the particular medicines, doses and individual response.

Depending on the treatment, the eyebrows, eyelashes and other body hair may also be affected. Radiotherapy can cause hair loss too, but usually only in the area being treated.

Will the hair grow back?

For most people, chemotherapy-related hair loss is temporary. Growth usually resumes after treatment, although it may take several months to become noticeable and longer for the previous length and density to return.

The first regrowth may initially be finer, curlier, straighter or a different colour. Permanent or incomplete regrowth can occur but is uncommon and is more likely with high doses of certain medicines. The oncology team can give the most useful prediction because they know the exact treatment being used.

Can scalp cooling help?

Scalp cooling, often called a cold cap, may reduce hair loss during some chemotherapy treatments by reducing the amount of medicine reaching the follicles.

It does not work for everyone and is not suitable for every cancer or chemotherapy regimen, so it should be discussed with the oncology team before treatment begins.

Finasteride and dutasteride cannot prevent chemotherapy-related hair loss because DHT is not the cause. Minoxidil should not be started during cancer treatment without agreement from the oncology team.

Yes. The categories in this guide are useful, but they are not mutually exclusive. Hair loss can be multifactorial, meaning two or more processes may be affecting the scalp at the same time.

The most common example is gradual pattern hair loss followed by a sudden episode of telogen effluvium.

Someone may have been slowly losing density at the temples or crown for several years without paying much attention to it. They then have an illness, operation, period of rapid weight loss or another major trigger. Around three months later, hair begins shedding from all over the scalp.

The sudden loss of volume can expose the underlying crown thinning and make it look as though the pattern hair loss has rapidly worsened. The British Association of Dermatologists specifically notes that telogen effluvium and male or female pattern hair loss can appear at around the same time, and that the sudden shedding may lead to an earlier diagnosis of pattern hair loss that was already developing.

A gradually receding hairline or thinning crown with an otherwise healthy scalp may be suitable for assessment through a pharmacy prescribing service. However, sudden shedding, completely bald patches or changes to the scalp may have causes that finasteride, dutasteride or minoxidil will not treat.

Arrange a GP appointment if:

1. The hair loss appeared suddenly or worsened quickly
2. Hair is being lost from across the scalp without an obvious cause
3. You have developed one or more completely bald patches
4. Your eyebrows, eyelashes, beard or body hair are also affected
5. Shedding has continued for several months
6. The hair loss is occurring in a child
7. You also have fatigue, unexplained weight changes, heavy or irregular periods, or recently followed a restrictive diet
8. The change is causing significant distress

A GP may be able to identify the pattern by examining your scalp and asking when and where the loss began. Where diffuse shedding is unexplained, blood tests may be considered for causes such as iron deficiency or thyroid problems.

Seek advice more promptly if the scalp has changed

Pain, burning, redness, swelling, persistent scale, pustules, crusting or smooth, shiny skin can suggest infection or scarring hair loss. Early assessment matters because inflamed follicles may be saved, but follicles that have been permanently destroyed cannot regrow.

A painful or boggy scaly patch, particularly in a child, may be caused by a fungal scalp infection and usually requires prescription treatment rather than shampoo alone.

When might you need a dermatologist?

A GP may refer you to dermatology if the diagnosis is unclear, scarring alopecia is suspected, alopecia areata is extensive or progressing quickly, or inflammation continues despite treatment. A dermatologist can examine the follicles more closely and, where necessary, take scalp samples or a small biopsy.