I Can See My Scalp through My Hair: What To Do?

visible scalp black hair
Written by
Morgan German
Medically approved by
Ahmad Chaudhry M.D.

You're confused and frustrated that you can see your own scalp. You're wondering what's going on and how can you regain a fuller head of hair.

In this article, we'll go over the possible reasons why you have a visible scalp area, and what can you do to fix it.

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What's a normal hair growth cycle?

i can see my scalp through my hair

In order to understand what's going on, first we need to understand how hair grows and falls.

The normal human hair growth cycle is composed of three major stages that include anagen, catagen, and telogen phases. These phases are characterized by varying durations, hair morphology, and hair physiology. Each of these three hair growth cycle phases is described below.

Anagen (Growth) Phase

Anagen or growth phase of the human hair growth cycle lasts for approximately two to six years. The duration is determined by the type of hair and is proportional to the length of hair. therefore, scalp hair is known for having a longer anagen phase of the hair growth cycle. At any given time, approximately 85-90% of the total existing hair is in the anagen phase. 

In the anagen phase of the hair growth cycle, both melanocytes and hair follicle cells undergo rapid proliferation and demonstrate greater metabolic activity as compared to other stages of the hair growth cycle. Melanocytes synthesize greater quantities of melanin pigment. As the cells divide the dermal papilla of the hair follicle thickens further. The extracellular matrix also expands and the hair shaft increases in length.

Catagen (Transitional) Phase 

Catagen or transitional phase of the hair growth cycle highlights the process of follicular regression during this phase. The proliferation of both hair follicle cells and melanocytes ceases resulting in reduced synthesis of melanin. As the cell division halts, the hair follicles regress towards the surface of the scalp that will eventually fall off in the following phases of the hair growth cycle. 

During this stage, the root bulb shrinks around the hair roots and gives rise to a club-like structure. Therefore, hair during this phase is commonly referred to as club hair. The root bulb is not the hair follicle but the keratin proteins that form the structure of the hair strands. The total duration of the catagen phase is approximately 2-3 weeks after which the hair follicles progress to the telogen phase of the hair cycle. 

Telogen (Resting) Phase 

The telogen or resting phase is the last stage of the normal hair growth cycle, after which the hair follicles enter into a new hair growth cycle. The hair follicle becomes dormant and there is no sign of the proliferation of melanocytes and hair follicular cells. However, the hair strands remain attached to the dormant follicles. The duration of the telogen phase is variable, however, scalp hair resides in the telogen phase for almost a year. 

At any given time, approximately 10-15% of the total body hair is present in this phase. Hair may be shed during this phase either by the growth of underlying anagen hair or due to hair manipulation activities such as washing or brushing of hair. 

The exogen phase is an extension of the telogen phase of the hair cycle. During the exogen phase, the hair shaft and hair follicle are completely separated and you experience hair fall off the scalp.

What are some common causes of hair loss?

see scalp through hair, in clinic

Let's jump right into the potential reasons.

Hair loss is a common occurrence in both children and adults, however, older adults tend to suffer from hair loss, thinning hair, or alopecia more frequently than other age groups.

This condition of thinner hair not only affects the social well-being of an individual but also has significant negative consequences on psychological health.

Following are some of the most common causes of hair loss:

Androgenetic Alopecia

Androgenetic alopecia is the most prevalent form of hair loss in both male and female populations, however, men are predominantly affected by this disorder. Many individuals have a genetic susceptibility to androgenetic alopecia and may also have a family history of this disorder.

In men, hair loss occurs at the vertex and frontal regions of the scalp while hair at the temporal and occipital regions may become thinner as the person grows older. On the contrary, frontal scalp hair is usually spared in females and they tend to experience diffuse thinning hair, particularly in the lateral regions of the scalp. Thyroid disorders, malnutrition, and iron deficiency anemia may also mimic androgenic alopecia. 

Alopecia Areata

Alopecia areata is characterized by immune-mediated destruction of the hair follicles. This acute form of hair loss manifests as patchy hair loss. In other words, you'll see a bald patch or a bald spot on your head. The diagnosis of alopecia areata is usually made clinically.

The three different patterns of hair loss in alopecia areata are as follows.

  1. Patchy alopecia is characterized by circumscribed patterns of hair loss.
  2. Alopecia totalis is characterized by total loss of scalp hair. 
  3. Alopecia universalis is characterized by total loss of body hair. 

Tinea Capitis

Tinea capitis is referred to as a dermatophyte infection of the scalp. The most common pathogen responsible for tinea capitis is Trichophyton tonsurans. Transmission of this fungal infection occurs via direct contact or shedding of the fungal particles by the asymptomatic carriers. Clinical manifestations of tinea capitis include patchy alopecia that may involve the entire scalp, pruritis, and adenopathy. 

Telogen Effluvium

This is a non-scarring and non-inflammatory form of alopecia characterized by the rapid progression of excessive hair follicles into the telogen phase of the hair growth cycle. This hair eventually falls off a few months after the onset of the stressful event. 

Triggering factors of telogen effluvium include systemic chronic conditions, surgery, pregnancy, and childbirth. Malnutrition, endocrine disorders, and febrile conditions. Certain medications also serve as triggering factors for telogen effluvium. These medications include antithyroid drugs, anticonvulsants, anticoagulants, retinoids, and beta-blockers.

Patients suffering from telogen effluvium are often asymptomatic. The clinical features of telogen effluvium include uniform hair thinning, excessive balding while brushing or washing, erythema, inflammation, scaling, and altered distribution of the thin hair. Telogen effluvium is only temporary hair loss. It's a self-limiting disorder and resolves a certain time after the elimination of the triggering factor.

Trichotillomania

Trichotillomania is a behavioral disorder characterized by conscious or unconscious pulling, twisting, and/or twirling of one's hair. The mean age of onset of this disorder is approximately 13 years. The classic clinical presentation of trichotillomania is frontoparietal patches of alopecia with uneven hair. Complications of this disorder include skin damage, infections, and permanent scarring of the scalp. 

Trichorrhexis Nodosa

This condition is characterized by loss of hair secondary to trauma or due to abnormal morphology and increased fragility of the hair. Traumatic events may include heat application, trichotillomania, excessive brushing, tight hairstyles, excessive scratching of the scalp, harsh hair treatments, and excessive contact of hair with salt water. Trichorrhexis nodosa primarily involves the proximal hair shaft.

Genetic causes of fragile hair and trichorrhexis nodosa include Menkes disease, keratinization defects, argininosuccinic aciduria, trichorrhexis invaginata, and intussusception of the hair fiber. Hypothyroidism may also cause trichorrhexis nodosa.

Anagen Effluvium

This condition is referred to as excessive hair loss during the anagen phase of the hair cycle owing to the impaired metabolism of the hair follicle. Anagen effluvium is significantly associated with chemotherapeutic medications. Other toxins and inflammatory conditions may also give rise to anagen effluvium. This condition is reversible upon withdrawal of the offending agent and rarely progresses to permanent alopecia.

what scalp skin and hair biologically look like

This is what your scalp and hair looks like

The psychological impacts of hair loss

Although alopecia may not have a significant negative impact on the physical health of an individual, it may lead to some serious psychological consequences. Alopecia is a psychologically deteriorating event in an individual's life. People suffering from hair loss and receding hairline may experience higher levels of depression and anxiety (DermNetNZ).

Psychological effects of alopecia result in work-related, social, and personal problems in an individual's life. Alopecia patients suffer from greater psychological distress and may even question their identity at some point. These patients also develop social phobias and paranoid disorders. Personal and social psychological consequences of alopecia include poorer body image, quality of life, and self-esteem.

 

Pharmacologic hair loss treatments

Pharmacologic treatments of hair loss include finasteride and minoxidil. Both the pharmacologic formulations are approved by the FDA.

Minoxidil

Minoxidil was initially developed as an anti-hypertensive medication and then later developed as a topical formulation for the treatment of androgenetic alopecia. Minoxidil promotes vasodilation by stimulating potassium channels. This facilitates enhanced cellular proliferation and cellular DNA synthesis. 

Hair follicles contain sulfotransferase, the enzyme responsible for the conversion of minoxidil into minoxidil sulfate. Minoxidil sulfate is responsible for the therapeutic effects of minoxidil. Minoxidil sulfate shortens the telogen phase and promotes the progression of hair follicles into the anagen phase of the hair cycle. Minoxidil stimulates the activity of beta-catenin which leads to increased follicle proliferation and differentiation.

Finasteride

Finasteride is widely used for the treatment of androgenetic alopecia and benign prostate hyperplasia. Finasteride suppresses the activity of types II and III 5-alpha reductase, thus, reducing both serum and localized levels of dihydrotestosterone. Increased levels of DHT in androgenetic alopecia patients disrupt the normal growth cycle and promote excessive hair thinning.

What's the difference between the two?

Non-pharmacologic hair growth and hair loss treatments

Non-pharmacologic solutions for hair growth include the following:

Diet

Diet plays a crucial role in the growth and maintenance of your thin hair. An adequate and persistent supply of vitamins and minerals is important for the normal progression of the hair growth cycle.

Vitamin and mineral deficiencies not only elicit hair loss but may also exacerbate pre-existing conditions that include androgenetic alopecia and telogen effluvium. 

Vitamin D and other minerals play a crucial role in male pattern baldness and female pattern hair loss treatment. Vitamin D supplementation is known for the improvement of hair growth in individuals suffering from androgenetic alopecia, alopecia areata, and telogen effluvium.

Iron, zinc, vitamin B12, folate, and selenium also play a crucial role in the treatment of hair loss disorders such as female pattern baldness and male pattern hair loss.

These micronutrients are important for the normal hair growth cycle at both cellular and molecular levels. These vitamins and minerals regulate the turnover of cells and matrix in the rapidly proliferating hair follicular cells.

The addition of sufficient and high-quality macronutrients in a diet such as proteins also aids in the sufficient absorption of these micronutrients. For instance, vitamin C and amino acids promote iron absorption. 

Dietary supplementation, therefore plays a significant role in the treatment and management of hair loss disorders. Nutritional therapies can greatly enhance growth in cases where hair thinning and loss occurred due to any nutritional deficiency. L-cysteine and thiamine supplementation is known for the treatment of telogen effluvium.

Herbal treatment

Herbal solutions are also useful for the treatment of hair loss disorders. These are effective alternatives if you want to avoid the adverse effects of medical treatments.

Herbal preparations may comprise of ginger, Chinese red ginseng, palmetto, stinging nettle, pumpkin, turmeric and ashwagandha.

Hair transplant

Surgical treatment of hair loss includes hair transplantation. The two most prevalent techniques of hair transplantation are follicular unit extension (FUE) and follicular unit transplantation (FUT).

FUT involves the cutting of skin from the posterior region of the scalp. Before this, donor site hair is trimmed up to 2 mm. Hair follicles from this strip are re-inserted into the bald areas of the scalp. Noticeable results appear a few months after the surgical procedure.

FUE is a relatively longer hair transplant procedure in which hair follicles are removed from the scalp and then re-inserted into the skin. This procedure does not involve cutting skin before the procedure.

Hair products

Some products are capable of combating thinning hair by fostering healthier cells for healthy hair and thick hair. You'd want to choose products that are highly reviewed, have trustworthy scientific evidence, and most importantly, are safe to use.

Finding effective results are difficult, especially when there are so many options to choose from. That's why, we at Scandinavian Biolabs always strive to make sure you can trust our effectiveness. Our products work and that's that - and we have a guarantee to back our confidence in our Hair Growth Routine.

Hair Growth Routine For Men

Cosmetic treatments

Hair extensions and scalp micropigmentation are beneficial in cases where it's a permanent medical condition and/or hereditary hair loss.

What can you do?

Here are some tips you can take to encourage hair growth to hide your scalp:

Be calm

Stress causes hair loss to worsens. That's the last thing you'd want to happen.

Consider

Consider what your options are - do you want to do it at home, with surgery or with drugs.

If you do consider at home solutions, we recommend you to do your research and pick solutions that are safe and effective.

Our Hair Growth Routine are exactly that. We use naturally-derived ingredients combined vigorous testing and researching to give you a solution that's GUARANTEED to work. That's it, no gimmicks.

Learn more about our Money-Back Guarantee

Consult

We always advise you to consult with a health practitioner who can assess your situation and give you accurate medical advices.

Conclusion

A variety of internal and external factors are responsible for causing female hair loss and male pattern hair loss. These factors are potentially reversible such as nutrient deficiencies, physiologic stresses, and endocrine disturbances. 

Different forms of hair loss include traction alopecia, alopecia areata, telogen effluvium, anagen effluvium, and trichotillomania. Hair loss disorders can be treated both by pharmacological and non-pharmacological therapeutic modalities.

References 

  1. https://www.ncbi.nlm.nih.gov/books/NBK499948/ 
  2. https://www.sciencedirect.com/topics/medicine-and-dentistry/hair-growth
  3. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6380979/ 
  4. https://www.aafp.org/afp/2017/0915/p371.html 
  5. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC1261195/ 
  6. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6691938/
  7. https://www.ncbi.nlm.nih.gov/books/NBK513329/  
  8. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8647708/ 
  9. https://pubmed.ncbi.nlm.nih.gov/31680216/ 
  10. https://www.ncbi.nlm.nih.gov/books/NBK547740/ 
  11. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5418894/