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Possible Causes of Hair Loss

April 2025 | Brian Chicoine, MD - Medical Director, Adult Down Syndrome Center

Key Points

  • Hair loss can be caused by many conditions.

  • Alopecia areata and alopecia totalis are autoimmune conditions that are more common in people with Down syndrome compared to people without Down syndrome.

  • Hair loss associated with family genetics and with age may occur at younger ages in people with Down syndrome due to early aging.

  • Tinea capitis, a fungal infection that can cause hair loss, is probably more common in people with Down syndrome.

  • A thorough evaluation is important to determine the cause(s) of hair loss.
    Treatment varies depending on the cause.

 

Types of hair loss

Hair loss can affect the scalp or the entire body. It can be permanent or temporary and it can have one or more of many causes. 

One way to classify hair loss is focal (localized), diffuse, or patterned.

  • Focal or localized hair loss is characterized by patchy hair loss.

  • Diffuse hair loss affects hair across the whole scalp.

  • Patterned hair loss affects specific areas of the scalp (such as receding hairline and/or hair loss at the crown of the head).

These types of hair loss can be caused by a variety of conditions.

 

Focal hair loss

Alopecia areata

Alopecia areata is a patchy loss of hair that occurs suddenly but can become chronic.  It is an autoimmune disease (the body’s immune system attacks the hair follicles). Like many autoimmune conditions, it is more common in people with Down syndrome. Studies evaluating frequency are limited, but figures vary from 1.3% to 21% in people with Down syndrome compared with 0.1% to 0.2% in people without Down syndrome. One study reported an average age of onset of 7 years in people with Down syndrome.

It can be treated with steroid injections or high potency topical steroids. However, research has shown limited benefit with these steroid treatments. Janus Kinase (JAK) inhibitors are oral immunotherapy medicines that reduce inflammation and are used to treat a variety of autoimmune conditions. They have been shown to increase regrowth by more than 75% (in people without Down syndrome). JAK inhibitors have been shown to be beneficial in a small study in people with Down syndrome and additional studies are ongoing. 

As noted below, total body hair loss due to this immune abnormality is called alopecia totalis.

Additional information is provided in the Alopecia article in our Resource Library.

Tinea capitis

Tinea capitis is a fungal infection of the scalp. A patch or patches of hair loss may be found. People with Down syndrome are more susceptible to infections. A fungal culture (from a scraping of the skin) is recommended to definitively diagnose the infection. Treatment consists of an oral anti-fungal medication. Topical medications don’t penetrate the hair follicles and, therefore, are not an effective treatment.

Traction alopecia

Traction alopecia occurs from pulling on the hair such as with certain hair styling. It can also occur in a psychological condition called trichotillomania, in which the person pulls their hair out. In addition to the scalp, it may also include eyelashes and eyebrows. Treatment consists of stopping the traction. Hair will usually grow back after the traction is stopped. More information on treatment of trichotillomania, such as behavioral therapy is available in the Trichotillomania article in our Resource Library.

Trichorrhexis nodosa

Trichorrhexis nodosa is due to hair shaft weakness secondary to trauma or due to fragile hair (acquired or genetic). Traumas that can cause hair shaft weakness include excessive brushing, heat or chemical applications, and severe scalp scratching. Treatment includes stopping the trauma. This type of hair loss may benefit from correcting nutritional deficiencies. Normal hair usually grows back when the trauma is stopped.

Vitamins and minerals

There is limited research on vitamins and minerals and hair loss. Some of the available information indicates:

  • Too much vitamin A may cause hair loss.

  • Deficiencies in riboflavin, biotin, folate, and vitamin B12 are associated with hair loss.

  • Deficiencies in vitamin D, vitamin E, and zinc may contribute to alopecia areata.

  • Iron deficiency and selenium deficiency may cause hair loss. 

 

Diffuse hair loss

Anagen effluvium

Anagen effluvium is hair loss related to exposure to chemotherapy. It is usually limited to the time when someone is undergoing chemotherapy. Hair regrowth typically occurs after stopping the chemotherapy agent (medication). This would most commonly be found in people with Down syndrome who develop leukemia. Leukemia is more common in children with Down syndrome than adults with Down syndrome. Leukemia is also more common in children with Down syndrome than in children without Down syndrome. The hair growth medication minoxidil may help during the regrowth phase. Scalp cooling during chemotherapy can prevent or reduce hair loss for some people.  

Telogen effluvium

This is most often associated with stress or caused by medication side effect, thyroid disease, or nutritional deficiency. It may also be idiopathic (unknown cause). Any of these causes can contribute to hair loss in people with Down syndrome. It is usually temporary and resolves in 6-9 months after addressing the underlying cause. It can also occur postpartum (after having a baby) and after starting or stopping birth control pills.

Alopecia totalis

This is extensive or total loss of hair on the scalp and body. Please see the alopecia areata section above for more information.

 

Patterned hair loss

Androgenetic (or androgenic) hair loss

Androgenetic (or androgenic) hair loss is also called male or female pattern hair loss. Family genetics are believed to play a role (“it runs in the family”). If a person’s mother’s father is bald, there is increased risk of baldness. However, it is also found that the risk of baldness is higher if one’s own father is bald. This hair loss tends to be gradually progressive. It can occur with aging but, depending on family genetics and hormonal factors, can occur younger in some individuals. 

In women, hormonal conditions, such as polycystic ovary syndrome (PCOS) can contribute to this type of hair loss.

In people with Down syndrome, family genetics are also likely to contribute to this type of hair loss. Furthermore, it may occur at a younger age due to early aging associated with Down syndrome. 

Treatment consists of topical minoxidil. Hair transplants and injections with platelet-rich plasma are other options. Possible measures to prevent or reduce baldness include eating extra protein, vitamin supplements (see below), and coping with stress.

 

Diagnosis

History and physical exam

There are specific findings of the scalp and hair associated with the different causes of hair loss. The history and physical exam can assess for those specific findings.

The history should include a review of the medications a person is taking. Some medications that can cause hair loss include lithium, valproate, fluoxetine, warfarin, metoprolol, propranolol, retinoids, and isoniazid. Hair will usually grow back with stopping or reducing the medication. Starting or stopping oral contraceptives can cause temporary hair loss, too.

Lab tests

Lab tests may include:

  • Examining the hair under a microscope

  • Scraping/culture for fungus

  • Thyroid blood tests (TSH, T4)

  • Iron blood tests (serum iron, TIBC, ferritin)

  • Vitamin D blood test (25-OH vitamin D)

  • Blood tests to check riboflavin, biotin, folate, vitamin E, zinc, and vitamin B12 levels

  • Blood tests that assess for malnutrition (e.g., albumin levels)

  • Blood tests that assess for liver disease (e.g., liver transaminases)

  • Testing for autoimmune conditions

 

Treatment

Treatment depends on the findings from the assessment above. Treatment may include treatment for hypothyroidism, vitamin supplements, as well as the treatments described above under the different causes for hair loss.

 

Prevention

Most baldness is caused by genetics (male-pattern baldness and female-pattern baldness). This type of hair loss is not preventable.

Measures to avoid preventable types of hair loss include:

  • Gentle care of hair, avoiding excess tugging, harsh treatments, and hairstyles causing traction.

  • Reviewing medications and supplements with your doctor.

  • Protecting your hair from sunlight and other sources of ultraviolet light.

  • Quitting smoking. Some studies show an association between smoking and baldness in men.

If you're being treated with chemotherapy, ask your doctor about a cooling cap. This cap may reduce your risk of losing hair during chemotherapy.

 

Resources

Down syndrome

Alopecia

Trichotillomania

General

Hair Loss (American Academy of Dermatology Association)

Hair Loss (Mayo Clinic)

Hair Loss in Women (Mayo Clinic)

 

References

Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A. The role of vitamins and minerals in hair loss: A reviewDermatol Ther (Heidelb). 2019;9(1):51-70. doi:10.1007/s13555-018-0278-6

Dakkak M, Forde KM, Lanney H. Hair loss: Diagnosis and treatmentAm Fam Physician. 2024;110(3):243-250.

Drake L, Reyes-Hadsall S, Martinez J, Heinrich C, Huang K, Mostaghimi A. Evaluation of the safety and effectiveness of nutritional supplements for treating hair loss: A systematic reviewJAMA Dermatol. 2023;159(1):79-86. doi:10.1001/jamadermatol.2022.4867

Esbensen AJ. Health conditions associated with aging and end of life of adults with Down syndromeInt Rev Res Ment Retard. 2010;39(C):107-126. doi:10.1016/S0074-7750(10)39004-5

Lam M, Lu JD, Elhadad L, Sibbald C, Alhusayen R. Common dermatologic disorders in Down syndrome: Systematic reviewJMIR Dermatol. 2022;5(1):e33391. doi:10.2196/33391

Phillips TG, Slomiany WP, Allison R. Hair loss: Common causes and treatmentAm Fam Physician. 2017;96(6):371-378.

Rachubinski AL, Estrada BE, Norris D, Dunnick CA, Boldrick JC, Espinosa JM. Janus kinase inhibition in Down syndrome: 2 cases of therapeutic benefit for alopecia areataJAAD Case Rep. 2019;5(4):365-367. doi:10.1016/j.jdcr.2019.02.007

Rakasiwi T, Ryan C, Stein A, et al. Dermatologic conditions in Down syndrome: A multi-site retrospective review of International Classification of Diseases codesPediatr Dermatol. 2024;41(6):1047-1052. doi:10.1111/pde.15757

Ramot Y, Molho-Pessach V, Tenenbaum A, Zlotogorski A. Alopecia areata and Down syndrome: A true association or a coincidenceInt J Trichology. 2013;5(4):227-228. doi:10.4103/0974-7753.130425

Rork JF, McCormack L, Lal K, Wiss K, Belazarian L. Dermatologic conditions in Down syndrome: A single-center retrospective chart reviewPediatr Dermatol. 2020;37(5):811-816. doi:10.1111/pde.14214

Ryan C, Vellody K, Belazarian L, Rork JF. Dermatologic conditions in Down syndromePediatr Dermatol. 2021;38 Suppl 2:49-57. doi:10.1111/pde.14731

Starace M, Orlando G, Alessandrini A, Piraccini BM. Female androgenetic alopecia: An update on diagnosis and managementAm J Clin Dermatol. 2020;21(1):69-84. doi:10.1007/s40257-019-00479-x

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