The vast majority of the 85% of men [1] and 55% of women [2] who experience hair loss at some point in life do so as a result of androgenetic alopecia. However, this condition does not come on abruptly. First, it causes hair miniaturisation in specific areas of your scalp [3][4]. Then, if left untreated, it often progresses to more extensive baldness.
Soft, fine, miniaturised hairs are often a symptom of other hair loss conditions too, such as alopecia areata [5] or traction alopecia [6]. However, these conditions are often temporary. The hair follicles eventually repair themselves and start producing normal healthy hair. Keep reading this article to learn all you need to know about hair miniaturisation, such as
Hair miniaturisation is a process that involves the shrinking of the hair follicle, which leads to the production of shorter, finer strands (often about 1 cm in length) called vellus hair [3].
The hair follicle is a sheath-shaped organ within your hair anatomy that’s located inside your scalp or skin. It contains specialized cells that make your hair shafts grow [7].
The hair on your scalp comes in different sizes. Most of it is of regular length and girth, known as terminal hair. However, there are also some shorter, finer vellus hairs. These are found mainly (but not exclusively) around the hairline.
The normal ratio of terminal to vellus hair in healthy individuals is 7:1 [8]. However, sometimes a higher concentration of short, fine hair starts to grow, usually in the same part of the scalp (e.g. the frontal area or the crown). If that happens, you are likely experiencing hair miniaturisation.
If the hair follicle is affected by changes in hormonal activity or scalp inflammation, it can decrease in size, becoming unable to produce hair of normal length and thickness. The resulting miniaturised hair is more fragile. Eventually, the affected follicles stop producing new hair altogether. The growth stage of your hair growth cycle also becomes significantly shorter during this time, but the hair shedding phase remains of the same length [3]. That is when you start to see the first signs of hair thinning and balding.
The exact mechanisms through which hair becomes miniaturised in different types of alopecia are still being established. However, there is a consensus that the following factors can play a role in the process of hair miniaturisation [9][5][10]:
Here are some of the main ways your hair follicles are believed to shrink and start producing vellus hair instead of terminal hair.
Most instances of hair miniaturisation are due to androgenetic alopecia. As its name suggests, this condition is closely related to your male hormones (androgens).
The 5-alpha reductase enzyme (which occurs naturally in your body) converts some of your testosterone into a different androgen called dihydrotestosterone (DHT) [11]. When too much testosterone is converted into DHT (or if your hair is especially sensitive to it), it binds to specific androgen receptors in certain follicles. This causes the follicles to shrink, though researchers are still determining exactly why this happens.
Your hair shaft size and diameter correlate with the volume of the dermal papilla, a structure at the bottom of the hair follicle which provides it with nutrients, regulates hair growth and determines strand properties.
The dermal papilla can shrink due to a variety of factors, such as ageing, hormonal activity, or insufficient blood supply (for example, blood vessel narrowing caused by smoking). As it becomes smaller, and fewer hair-producing cells fit in the hair bulb, the strands produced also become shorter and finer [9][3]. In turn, hair miniaturisation appears to lead to further atrophy of the follicle and a decreased number of stem cells that play a role in hair production [12].
Hair miniaturisation happens quickly, over the course of a single hair growth cycle. That’s why hair loss can appear and develop within months. Research suggests this happens as a result of a disruption to the transition between different phases in the hair growth cycle (either between the growth and transition phase or the growth and shedding phase [9][3]).
When it occurs in conditions other than pattern baldness, such as alopecia areata [5] or traction alopecia [6], hair miniaturisation may be the result of damage caused to the hair follicles. This is often caused by scalp inflammation (in alopecia areata) or mechanical damage produced by excessive tension on the follicles (in traction alopecia).
In many cases, hair miniaturisation is visible to the naked eye; you’ll notice that some of the hair on certain parts of your head (usually the hairline, temples and crown) has suddenly become significantly shorter and finer than the hair on the surrounding areas.
It’s normal to have some vellus hairs, but when you develop a high number of miniaturised hair in certain spots, it’s possible you’re experiencing a type of alopecia.
If you want to be sure, you can pull out a few hairs from different parts of your head, stretch them out fully and measure them against one another. If there are substantial differences in length and diameter, you may be experiencing hair miniaturisation [13].
Most frequently, hair miniaturisation occurs in areas of the scalp affected by androgenetic alopecia. Be on the lookout for this if you notice any of the following tell-tale signs of this type of hair loss.
Male pattern baldness often starts in the frontal area of the scalp, then makes its way to the crown if left untreated. Here are its most common signs:
Women who experience female pattern baldness may notice their frontal area is spared, but they have significant hair thinning through the mid-scalp:
Several types of alopecia can result in hair miniaturisation. Here are some of the most common.
The condition responsible for the vast majority of hair miniaturisation cases is androgenetic alopecia (male pattern baldness and female pattern baldness). As DHT binds to specific androgen receptors in your hair follicles, they shrink and produce miniaturised hairs [9].
If this process isn’t curbed quickly, the follicles eventually become unable to produce hair. When this happens to many follicles in the same area, hair thinning develops, leading to increasingly large bald spots.
Miniaturised hairs have been observed in chronic forms of alopecia areata (and sometimes in repeated episodes) [5][14][8]. This shrinkage occurs as your white blood cells attack your hair follicles. The ratio of vellus to normal-sized hair in areas affected by chronic alopecia areata becomes 1:1, compared to 1:7 in people with healthy hair [8].
However, unlike androgenetic alopecia, where hair miniaturisation will become permanent without treatment, in alopecia areata it is usually temporary. The hair follicles often spontaneously heal and revert back to their normal size after the flare-up has ended.
Excessive use of tight hairstyles, such as braids or ponytails can cause hair loss. This temporary condition is called traction alopecia and it is caused by mechanical damage to your hair follicles. This damage can result in hair miniaturisation in the affected areas [8]. However, in most cases, traction alopecia is temporary and resolves itself without treatment 3-4 months after you stop applying tension to your follicles.
Not all hair miniaturisation can be prevented. However, there are things you can do to improve your hair follicle health and reduce the risk of developing conditions that result in hair thinning and miniaturisation:
Normally, the people most predisposed to hair miniaturisation are the ones who are most likely to develop androgenetic alopecia. This includes men and women over the age of 50, with a family history of pattern hair loss.
However, people with autoimmune conditions that affect the hair follicles (alopecia areata, or forms of lupus that cause hair loss [10]) and those who wear excessively tight hairstyles for long periods are also at an increased risk.
A hair doctor can easily determine whether you are experiencing hair miniaturisation by performing trichology diagnostic tests, such as a trichoscopy. However, hair miniaturisation is not a diagnosis in itself, but a symptom that can occur in several types of alopecia.
If the reason your hair is falling out isn’t immediately obvious, your trichologist can also order hair loss blood tests or a scalp biopsy. The results will help provide you with an accurate diagnosis, so you can get the best possible treatment for your hair thinning.
In many cases, hair miniaturisation is reversible, as long as it is addressed in a timely fashion and you haven’t yet reached the point of developing dead hair follicles. Here are some of the most effective hair miniaturisation treatments that may stimulate your follicles for hair growth.
This treatment is effective against a variety of hair loss conditions. That is because Minoxidil works by dilating the small blood vessels in your scalp, allowing more oxygen and nutrients to reach your hair follicles. This helps your hair follicles regenerate, as they receive more resources to grow and produce healthy, full-sized hair.
Finasteride is the most frequently prescribed treatment for male pattern baldness. It works by inhibiting the activity of 5-alpha reductase, the enzyme which converts some of your testosterone into DHT.
Finasteride helps lower the DHT levels in your blood (or, when topical Finasteride is used, in your scalp). This can curb existing hair miniaturisation and allow mildly damaged hair follicles to heal and revert to their original size.
While Finasteride may also be effective in female pattern hair loss, it is generally not recommended for premenopausal women, as it can cause foetal malformations and hormonal imbalances.
If your hair miniaturisation is caused by an autoimmune condition such as chronic alopecia areata, steroid creams for hair loss may be prescribed to reverse it. While acute alopecia areata normally resolves on its own within a year of onset, chronic forms can last for years if left untreated. If your alopecia is more advanced or resistant to treatment, intralesional steroid injections may be used to reverse your hair loss.
In many cases, corticosteroids will reduce scalp inflammation, helping your hair follicles gradually revert to their normal size and produce healthy hair once more. However, there are also situations where the alopecia is resistant to treatment (especially more severe forms, such as alopecia totalis or ophiasis alopecia).
This treatment has proven itself effective in curbing and reversing hair miniaturisation in conditions such as androgenetic alopecia, alopecia areata and advanced traction alopecia. PRP hair treatment involves drawing a small amount of blood from your arm and separating the platelet-rich plasma from other blood fractions. The PRP is then injected into the areas affected by hair miniaturisation.
The abundant growth factors in platelet-rich plasma help your hair follicles heal and revert back to their normal size, producing healthy hair once more.
While not yet FDA-approved, studies performed on the use of stem cell hair treatment in curbing and reversing androgenetic alopecia and alopecia areata show some promising results. This treatment usually involves extracting stem cells from some of your own tissue (e.g. from body fat or hair follicles), multiplying and processing them and injecting them into the areas of your scalp with hair miniaturisation. These versatile cells will help your hair follicles heal and regenerate and resume terminal hair production.
Patient before and 8 months after his FUE hair transplant performed at the Wimpole Clinic
While hair restoration surgery cannot reverse hair miniaturisation, it can restore hair growth in thinning areas. If you are experiencing androgenetic alopecia, a hair transplant is the closest thing we have today to a cure for baldness. That is because it involves harvesting healthy, normal-sized hair follicles from the back and sides of your head and implanting them in the areas with miniaturised hair.
Since the transplanted follicles are less sensitive to DHT, as they become attached in their new locations they will produce healthy, terminal hair. And since this newly grown hair won’t be affected by miniaturisation, your hair transplant results will be permanent.
If you’re worried that your hair is affected by miniaturisation, book a consultation today with one of our experienced trichologists. They will carefully check your hair for signs of miniaturisation and run all the necessary tests to diagnose your alopecia quickly and accurately. Then, after careful consideration of your condition, medical history, lifestyle and preferences, they will recommend a hair growth plan tailored specifically to your needs.
Should your hair follicle miniaturisation be too advanced to reverse with non-surgical hair restoration treatment, a hair transplant may be your best option. At the Wimpole Clinic, we have a 97-100% hair restoration success rate for both FUT and FUE procedures.
Find out more about hair miniaturisation by reading the answers to these frequently asked questions.
No. While this temporary condition manifests with diffuse hair thinning, telogen effluvium does not cause hair miniaturisation. When experiencing this stress-induced type of alopecia, a greater proportion of your hair than normal is forced out of the growth stage of your hair growth cycle and into the shedding stage. That is why your hair may appear so thin you can see your scalp.
But while more of your hair is falling out, it is not getting shorter or decreasing in diameter [19]. In fact, the absence of excessive miniaturised hair can help trichologists diagnose chronic telogen effluvium.
Yes, hair miniaturisation is a common feature of female pattern baldness [20][21] and it can also occur in other conditions that affect both genders (e.g. traction alopecia and alopecia areata).
However, when it comes to androgenetic alopecia, it is less common for women’s hair follicles to stop producing hair completely, leaving extensive bald spots, as happens in men. That is because the female hormonal profile involves a different balance between oestrogens and androgens.
That largely depends on the condition that is causing it. Milder forms of alopecia areata or traction alopecia can resolve themselves without treatment. In these cases, the miniaturised hairs revert to terminal size within a few months to a year.
However, in conditions such as androgenetic alopecia, hair miniaturisation does not resolve itself spontaneously, but progresses if left untreated. If it advances past a certain point, the hair follicle “dies” – it becomes unable to produce any more hair.
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