Hair shedding vs hair loss: how to tell the difference

Most people notice hair in the same places: the shower drain, the hairbrush, the pillow. It is natural to worry. But hair that falls out and hair that stops growing back are two different things. Telling them apart is the first step to knowing if you need help.

Some hair fall is normal and healthy

Every hair grows for years, rests for a few months, then falls out so a new hair can take its place. A healthy scalp has about 80,000 to 120,000 hairs. At any time, about 85–90% of them are growing and the rest are resting or falling. Because of this constant change, the American Academy of Dermatology (AAD) says losing 50 to 100 hairs a day is normal.

You may see more hair on wash days, simply because loose hairs collect between washes. Long hair can also look like more, because each strand is easier to see.

When more hair starts to fall

Sometimes lots of hair roots go into the resting stage together and fall at once. Doctors call this sudden shedding telogen effluvium. It usually follows a shock to the body — a high fever, an illness, having a baby, surgery, losing weight fast, a very stressful time or a new medicine. The hair fall usually starts about 3 months later, but it can be anywhere from 1 to 6 months.

The hair usually falls evenly from all over the scalp, and the roots can still grow hair. Once the cause has passed, the AAD says hair tends to look full again within about 6 to 9 months. Hair fall that goes on for more than 6 months is called chronic. It needs a closer look.

What hair loss looks like

Hair loss is different: something stops hair from growing back as it was. In pattern hair loss (androgenetic alopecia), each hair grows for a shorter time, and the roots slowly get smaller (miniaturisation). They grow shorter, finer hairs. It is very common. In a study of 1,005 men aged 30 to 50 in India, 58% had some pattern hair loss. Because it is slow, people often notice it in photos before they see it in the mirror.

• A hairline that is moving back, mostly at the temples
• A wider parting, or more scalp showing at the crown
• A ponytail that feels thinner than before
• Round or oval patches with little or no hair
• Hairs that break easily, instead of falling out from the root

Pattern hair loss, patchy hair loss, scarring hair loss and breakage all have different causes and need different care. Some people have more than one. In scarring types, scar tissue replaces the hair roots — and a scarred root can never grow hair again. That is the best reason not to “wait and see” when something looks unusual.

How a doctor tells them apart

A skin doctor (dermatologist) puts your story together with a close look at your scalp. A close-up scalp check called trichoscopy looks at the hair and scalp at about 20 to 160 times bigger. It shows the hair openings, the skin around them and how thick each hair is. It can help tell scarring from non-scarring hair loss, and early pattern hair loss from hair fall. It can also be repeated to track progress.

Simple things to note at home

• When did you first notice the change? Did anything happen in the months before?
• Does the hair fall out with a small white bulb at the root, or snap along its length?
• Is the change all over the scalp, or in one area?
• Does anyone in your close family have similar thinning?
• Any other changes — itching, flakes, redness, tiredness or recent weight change?

Write these down and take a few clear scalp photos. That gives a doctor much more to work with than memory alone.

When to see a doctor

• Hair fall that is still heavy after about 6 months, or keeps coming back
• Bald patches that appear quickly
• A scalp that hurts, burns, itches a lot, or is red or scaly
• Hair loss along with other signs, such as unusual tiredness, weight change or irregular periods
• Thinning that is clearly getting worse, or is affecting how you feel every day

The next step

Not sure if it is hair fall or thinning? Start with the guided 3D scalp scan. Your report tells you, in plain words, if treatment looks suitable, if a doctor should look first, or if treatment is unlikely to help. If you go ahead, Dr. Tyagi checks everything before your video consultation. He suggests treatment only if it can help you.