Trichology: what your hair can reveal about your health

Trichology studies and treats diseases of the hair and scalp. Hair is not just an aesthetic concern: it often represents a true indicator of the body’s overall state of health. Behind sudden hair loss, progressive thinning, or a reduction in hair density, there may be many different underlying causes, ranging from hormonal imbalances and stress to inflammatory or autoimmune diseases.

Dr. Alberto Valentino, a surgeon from Turin specialising in dermatology and venereology, explores the importance and role of trichology, namely «a small branch of dermatology that deals with the study and diagnosis, as well as the treatment, of diseases affecting both the hair and the scalp, emphasising that, the role of the trichologist is not limited to assessing the quality or quantity of hair loss, but also to understanding why it is happening».

The role of trichology

The condition may be temporary, progressive, inflammatory, autoimmune, or scarring in nature. During a trichological examination, «various pieces of information are collected – Valentino explains – We begin with the patient’s medical history, including any family history of specific conditions, medications being taken, previous illnesses, stress, weight changes or nutritional deficiencies, pregnancies or menopause in women, as well as lifestyle and even cosmetic habits. We also assess the timeline and progression of the hair loss».

This is followed by direct observation through trichoscopy, «which is nothing more than epiluminescence dermoscopy applied to the scalp. It allows us to observe the follicle, as well as the hair, at different magnifications, assessing both hair shaft diameter and follicular density, as well as the possible presence of inflammation or other dermoscopic findings such as scaling, miniaturisation, or signs of scarring alopecia», says the doctor.

The main causes of hair loss

Among the most common conditions, Valentino identifies: «androgenetic alopecia in both men and women, Telogen Effluvium, alopecia areata, and scalp disorders such as seborrheic dermatitis, psoriasis above all, as well as folliculitis and other forms of scarring alopecia».

These conditions can arise from a wide variety of causes that affect the delicate balance of the hair follicle. «Stress, fever, surgery, hospitalisation, or rapid weight loss, nutritional deficiencies, thyroid disorders, or other conditions can push many follicles simultaneously into the shedding phase, whereas they are normally much more asynchronous – Valentino explains – This process is called Telogen Effluvium and patients usually report sudden, diffuse hair loss, noticing large amounts of hair on their pillow or in the sink while washing their hair».

Stress is one of the possible triggering factors, but as Dr. Valentino reminds us, «it should not be used as a generic explanation for everything». The underlying cause may instead be a genetic predisposition, as in androgenetic alopecia, or «iron, vitamin D or zinc deficiencies, thyroid disorders, or other conditions that need to be investigated».

Lifestyle also influences hair loss. «Strict diets with insufficient protein intake or iron deficiency, as well as unbalanced eating habits, affect both hair quality and the health of the follicle itself. In addition, if a person has irregular sleep patterns, smokes, experiences chronic stress, or uses harsh cosmetic products, bleaching treatments, or repeated chemical procedures, all of this can make the hair more fragile and prone to breakage».

The most common disorders

Androgenetic alopecia presents differently in men and women. «In men, it begins after puberty and, sooner or later depending on the individual, typically appears with a receding hairline or thinning in the frontotemporal area and crown, which are the most commonly, and earliest, affected regions – Valentino points out – In women, on the other hand, thinning generally occurs in the central region of the scalp, while the frontal hairline is preserved».

Alongside this condition, the already mentioned Telogen Effluvium presents as «diffuse hair loss that more frequently affects young adults and women, often associated with stress, nutritional deficiencies, the postpartum period, hormonal changes, or weight loss – the doctor explains – We also see inflammatory scalp diseases such as seborrheic dermatitis and psoriasis, as well as irritant or allergic dermatitis caused, for example, by hair dyes or other cosmetic products, which usually cause severe itching, burning, scaling that patients perceive as dandruff, redness, and a sore scalp. Together, these symptoms can further worsen the perception of hair loss».

As for alopecia areata, we are talking about «a well-known autoimmune disease that causes patchy hair loss. It develops suddenly and has a very significant psychological impact».

Among the most concerning and difficult conditions to manage, Dr. Valentino highlights scarring alopecia. «In these cases, the hair follicle is progressively destroyed by an inflammatory process that leads to fibrosis. If not diagnosed in time, they can result in permanent hair loss. Therefore, prompt intervention is essential. One positive aspect is that today many patients seek medical advice for preventive reasons, noticing reduced density, thinning hair, finer strands, or loss of volume. The earlier we intervene, the better the chances of preserving the patient’s follicular reserve».

Increasingly personalised therapies

In recent years, trichology has made important advances, but the principle on which treatment is based remains the same: everything starts with a correct diagnosis. There is no universally effective therapy, because every patient has different causes, clinical characteristics, and needs.

From established treatments, available in both topical and oral formulations, always following careful evaluation of the patient’s clinical condition and any contraindications, to a more modern and personalised approach with tailored dosages, «compounded formulations or combined protocols, together with photographic and video-dermoscopic follow-up» are used to assess treatment effectiveness and motivate the patient.

Among regenerative medicine techniques, «PRP, or platelet-rich plasma, involves drawing the patient’s blood, centrifuging it, and reinjecting a fraction rich in growth factors into the scalp to stimulate the hair follicle and its activity, with the aim of improving hair quality in selected patients».

In recent years, exosomes, stem cells, low-level laser therapy, and other technologies have also attracted attention, although Dr. Valentino recommends caution. «Regenerative medicine can be useful but almost never replaces standard therapies. It generally works best as a supportive treatment. The real innovation lies in combining early diagnosis with objective monitoring through photographic techniques and personalised therapies, while avoiding unrealistic promises».

Beyond the aesthetic issue

People who begin to lose their hair often experience a change in their body image and may feel they are losing control over their appearance, with repercussions on their quality of life.

«In clinical practice, we very often see patients who are concerned not only about the hair loss itself, but who are also visibly distressed from a psychological point of view. Some begin avoiding photographs, changing their hairstyle to conceal thinning hair or a receding hairline, wearing hats constantly, or avoiding social situations that might highlight the problem and make them feel uncomfortable around others. Others – Valentino continues – develop truly obsessive behaviour. They constantly examine themselves in the mirror, repeatedly photograph their scalp and compare the images with older ones. Some even go so far as to keep the hairs they lose during washing or find on their pillow».

Treating hair often means helping a person regain peace of mind, self-confidence, and trust in themselves, especially in an era dominated by social media, where constant comparison with often unrealistic beauty standards can amplify feelings of discomfort.