Hair loss on the body, including the pubic area, can stem from various underlying causes. Early detection is crucial to addressing potential health risks. This article explores common reasons for pubic hair loss, providing information for different audiences, from those seeking a basic understanding to individuals looking for in-depth knowledge.
Hormonal changes can significantly impact hair growth patterns.
In women, hair loss or thinning may indicate polycystic ovary syndrome (PCOS), a condition caused by hormonal changes affecting women’s health. PCOS can lead to excessive hair growth in areas where it's not typically needed. Extra androgens, sometimes called male hormones, cause this. Your doctor can help treat your PCOS.
As a person ages, their body begins to produce fewer androgens. This may result in pubic hair loss. When the Adrenal glands do not produce enough of certain hormones, it’s called an adrenal insufficiency. If Dehydroepiandrosterone (DHEA) production from the adrenal glands is lowered, one of the symptoms could be a loss of pubic hair. DHEA deficiency can affect both men and women and, for some, may be treated with DHEA supplements.
The immune system can sometimes mistakenly attack the body's own tissues, including hair follicles.
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Patchy hair loss or failure to regrow hair can occur when the immune system attacks the body, damaging hair follicles and preventing them from developing. Affected areas may remain bald for a long time, particularly on the scalp. Hair loss can also affect the eyebrows, eyelashes, or lead to widespread body hair loss. This is considered a common type of hair loss. Alopecia areata is thought to be an autoimmune condition. This occurs when the immune system mistakenly attacks and destroys healthy hair follicles. Some people with this condition have a family history of alopecia. Alopecia areata is seen in men, women, and children. In a few people, hair loss may occur after a major life event such as an illness, pregnancy, or trauma. Hair loss is usually the only symptom. A few people may also feel a burning sensation or itching. Alopecia areata usually begins as one to several patches of hair loss about 0.4 inches (1 centimeter) to 1.6 in (4 cm). Hair loss is most often seen on the scalp. It may also occur in the beard, eyebrows, pubic hair, and arms or legs in some people. Nail pitting may also occur. Patches where hair has fallen out are smooth and round in shape. They may be peach-colored. Hairs that look like exclamation points are sometimes seen at the edges of a bald patch with a magnifying tool. If alopecia areata leads to total hair loss, it often occurs within 6 months after symptoms first start. This is called alopecia totalis when the entire scalp is involved, and alopecia universalis when the entire body is affected. Your health care provider will examine you and ask about your symptoms, focusing on areas where you have hair loss. A scalp biopsy may be done. Blood tests may also be done to check for autoimmune conditions and thyroid problems. If hair loss is not widespread, the hair may regrow in a few months without treatment. For more severe hair loss, it is not clear how much treatment can help change the course of the condition. Common treatments may include: Steroid injection under the skin surface Medicines applied to the skin Ultraviolet light therapy JAK inhibitors are a newer treatment that can target the immune response. These are medicines taken in pill form for severe cases of alopecia areata. A wig may be used to hide areas of hair loss. More information and support for people with alopecia areata and their families can be found at: National Alopecia Areata Foundation -- www.naaf.org Full recovery of hair loss is common. However, some people may have a poorer outcome, including those with: Alopecia areata that starts at a young age Widespread or complete loss of scalp or body hair Contact your provider if you are concerned about hair loss.
A type of alopecia called frontal fibrosing alopecia (FFA) can affect hair on various parts of the body. Scientists do not yet know the cause of alopecia. However, some suggest that it may be due to the immune system mistakenly attacking the hair follicles. Hormones are also likely to play a role since FFA mainly affects people over the age of 50 who are in the postmenopausal stage of their lives. Most females with FFA also experience hair loss on their scalp. Hair loss in this area typically appears along the hairline. Some women may also lose hair from other parts of their bodies, including the pubic region. There is currently no cure for FFA. However, certain anti-inflammatory medications may help to suppress the immune system and reduce inflammation of the hair follicles. These include: corticosteroids, tetracyclines, hydroxychloroquine. Certain medications can also help to promote hair growth. These include: finasteride (Proscar, Propecia), topical minoxidil (Rogaine), topical calcineurin inhibitors, such as tacrolimus (Protopic) or pimecrolimus (Elidel).
If you notice hair loss along with symptoms such as fatigue, muscle weakness, dry skin, or sudden weight gain, inform your doctor. These signs may indicate a thyroid issue. In this case, you may be prescribed medication to help stabilize thyroid function. For hair loss caused by thyroid problems, treatment may take several months. There is no need to worry excessively about thyroid medications causing hair loss, as this is very rare. However, if you happen to experience this side effect, inform your doctor as soon as possible.
Type 2 diabetes occurs when blood sugar levels exceed the body’s normal range. With diabetes, hair follicle cells may become damaged or lose their normal function. This issue often arises after being diagnosed with or showing signs of diabetes. When you have diabetes, your hair may gradually thin due to excessive hair loss or take longer to regrow. Hair loss may become more noticeable over time if blood circulation is not improved. You can consult a doctor to manage blood sugar levels and develop an appropriate treatment plan if needed.
You may have inherited issues affecting normal hair growth from birth. This theory has attracted significant attention from researchers and has been tested in various studies. If newborns show thin, sparse, or easily breakable hair, it may be linked to genetic disorders. Hair loss caused by genetics may persist and continue without stopping into adulthood. Additionally, you might face the risk of affected areas where hair either does not grow or grows very slowly. One such condition is called hypotrichosis. It’s when you’re born with sparse, thin, and fragile body hair. Your condition may stay the same. Or sometimes, you might go bald or keep losing body hair over time. Medicine may help you thicken or grow new hair.
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In Addison’s disease, the adrenal glands cannot produce enough hormones to meet the body’s needs, including cortisol and aldosterone. This is one of the reasons for body hair loss and pubic hair loss, which can lead to difficulties in women’s intimate life. When affected by this disease, you may experience constant fatigue, exhaustion, skin discoloration, and stomach problems. Talk to a doctor if you think you have Addison’s. It can be life-threatening without treatment. You can take medicine to get better. If you notice these symptoms and suspect Addison’s disease, consult a doctor immediately. While the condition can be treated with medication, ignoring it can lead to life-threatening complications.
Certain sexually transmitted infections can cause hair loss. In particular, during the later stages of syphilis, you may experience patchy hair loss. Other symptoms include fever, sore throat, or a rash that does not itch. It is crucial to use prescribed medication to treat STIs and protect your overall health. Treatment can only help reduce the effects of the disease but may not completely eliminate it from your body. Even with effective treatment, syphilis can still cause damage to the eyes, heart, and brain. To minimize the risk of contracting STIs, always remember to use condoms to prevent transmission.
Iron deficiency anemia can be a cause of hair loss. When your body lacks proper nutrition, hair roots become weak, leading to dryness, breakage, and hair loss. For this reason, doctors often check iron levels in the body as an initial step in diagnosing the cause of hair loss. Once tests confirm anemia or iron deficiency, doctors will provide tailored advice. Common solutions include increasing iron-rich foods in your diet, such as meat, beans, and leafy greens. If your body has difficulty absorbing iron, your doctor may prescribe medication or recommend suitable supplements.
Iron is just one of many essential nutrients that help keep hair strong and healthy. Your follicles depend on a variety of vitamins and minerals. If you’re not getting the right nutrients, you may notice hair loss. To maintain healthy and functional hair follicles, it is important to ensure your daily diet provides enough vitamins and minerals. Poor eating habits or difficulty absorbing nutrients can lead to prolonged hair loss. To check for nutritional deficiencies, your doctor may perform laboratory tests. They might want you to eat more protein and foods with vitamin D. You might be advised to increase your intake of protein-rich foods and vitamin D to improve your condition. However, further research is needed to determine the precise role of these nutrients in preventing hair loss. While it is important to supplement vitamins and minerals when experiencing hair loss, excess levels of certain nutrients can harm your health. Research shows too much vitamin A and selenium can cause hair loss.
Frequent exposure to life’s pressures can weaken your immune system. This is another reason hair follicles may lose their function, leading to gradual hair loss that often goes unnoticed until it becomes severe. Stress can be as harmful as autoimmune conditions. Sometimes, hair loss may stem from psychological behaviors. Research indicates that habits like pulling out hair are common in individuals with mental health disorders. If you have a mental disorder called trichotillomania, you might pull your own body hair out as a response to stress. Excessive hair-pulling can prevent regrowth in those areas, resulting in baldness.
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Inflammatory conditions can weaken hair follicles, leading to patchy hair loss. You may notice that scarred areas tend to be thicker than normal skin and undergo changes that make it very difficult for hair or body hair to grow back. These conditions can significantly impact appearance. Research shows some inflammatory disorders can cause you to lose patches of hair on other parts of your body. Studies suggest that inflammatory disorders are a common cause of hair loss. Therefore, identifying the cause and seeking early treatment is essential to give the affected area a chance for regrowth. Inflammation can destroy your follicles. That’s called cicatricial alopecia. Hair can’t grow because scar tissue gets in the way. These conditions can affect your scalp, eyebrows, and underarms.
Frequently removing hair might permanently damage the hair follicles. Hair removal methods that could lead to general pubic hair loss include: waxing, shaving, electrolysis. As a result, a person who excessively removes hair from the pubic region may experience reduced or delayed hair growth in that area.
When someone has atrophic vaginitis, the tissues of the vulva and the lining of the vagina become thin, dry, or inelastic. Women who have this condition may also develop sparse pubic hair. Other possible symptoms include: patchy skin redness, shrinkage of the vaginal tissues, small tears in the vulva, labial fusion, which is where the skin either side of the vaginal opening joins together. Estrogen replacement therapy is the primary treatment for this condition, but for people who want to avoid hormone therapy, some moisturizers, lotions, and vaginal lubricants may help to manage some of the symptoms of atrophic vaginitis. However, a person should talk to their doctor about specific treatments for pubic hair loss.
Chemotherapy medications are drugs that doctors commonly use to treat cancers. These drugs work by targeting and destroying cells that multiply rapidly, such as cancer cells. Hair cells also multiply rapidly. As a result, chemotherapy medications can cause a person’s hair to fall out. Hair loss may occur anywhere on the body, including the pubic region. Some additional side effects of chemotherapy treatment (chemo) include: nausea and vomiting, diarrhea, constipation, fatigue, mood changes, appetite changes, weight changes, anemia, easy bruising and bleeding, infection. People who experience any side effects from chemotherapy should report them to their cancer care team. A doctor may be able to prescribe medications to alleviate some of the side effects of chemo.
Radiation therapy is another type of cancer treatment that can cause hair loss. The most significant hair loss usually occurs in that is receiving treatment. People who receive radiation treatment to the pelvis may experience hair loss in the pubic region. Lower radiation doses usually cause temporary hair loss, while higher radiation doses may result in permanent hair loss. A person can ask their cancer care team about the type of hair loss they are likely to experience. Apart from localized hair loss, other early side effects of radiation therapy include skin changes, and fatigue. People who receive chemo or low-dose radiation therapy may find that their hair grows back once they finish these treatments. People who receive high-dose radiation therapy may experience permanent hair loss. People who are receiving cancer treatment may benefit from counseling or group therapy sessions. Although they will not cure hair loss, they may help people to manage the emotional effects of hair loss.
Figure 1a. An irregular patch of alopecia on the pubis with follicular hyperkeratosis and hyperpigmentation Figure 1b. The most likely diagnosis is trichotillomania (TTM). Trichotillomania is a primary psychiatric disorder with dermatological signs. The disorder causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Any hair surface can be affected. However, the most common areas affected are the scalp, eyebrows and eyelashes. The most affected scalp areas are the anterior regions and the vertex. The lower eyelid lashes are usually not involved, which helps to differentiate it from alopecia areata. The areas of hair loss are most often found on the side of the body contralateral to the dominant hand. Alopecia plaques have an artificial appearance; and are generally circular, and contain hair of various lengths, shapes and sizes. Signs of inflammation are not usually found in TTM, although in some cases, with intense scratching there may also be signs of excoriation, lichenification, erythema and postinflammatory hyperpigmentation. Most people with TTM pull their hair while in private, and generally try to hide the disorder from others. Most are consciously aware that they are pulling their hair out and may even develop elaborate rituals for doing so. Others do so unconsciously. A person may occasionally do both (pull hair consciously and unconsciously), depending on the situation and their mood. Occasionally, patients with TTM have other pathological repetitive movements, such as skin picking, cuticle or nail biting or picking, and cheek or lip biting. Trichotillomania needs to be differentiated from other causes of patchy non-scarring hair loss. Alopecia areata is the main cause of diagnostic confusion, however this presents as oval, well demarcated plaques, and the skin may feel softer than expected (Figure 2). The hair-pull test around areas of alopecia areata will render telogenic hairs. In TTM, there will be signs of recently broken and plucked hairs and the surrounding hairs may appear artificial. Figure 2. Another distinguishing factor in patients with areata alopecia is that their nails may demonstrate nail pitting (dystrophic plate changes), whereas patients with TTM have normal nails. Tinea is also a common misdiagnosis. A KOH and Woods lamp examination can rule out non-inflammatory tinea. Trichotillomania in the scalp (Figure 3) must also be differentiated from androgenetic alopecia, in which the hair loss is usually bilateral and telogen effluvium, in which it is diffuse. Well defined, unilateral alopecia plaques are more characteristic of TTM. Figure 3. Patch alopecia in the occipital area in a male aged 7 years. The hair-pull test was negative. Management depends mainly on the age of onset. In preschool aged children, where pulling or playing with the hair is a similar comfort to thumb sucking, the most effective management is to inform and advise the parents. As there is usually spontaneous resolution with increasing maturity, parents should be supportive and avoid punishing the child´s behaviour. In infants, loving care, maternal skin contact, and the availability of transitional objects (eg. As older children and teenagers may not notice their habit, it is important to carefully establish the diagnosis. In most cases, reassuring the patient that their hair is normal and will grow when they stop pulling is enough. Carefully consider the possibility of a mental health problem and refer appropriately. No medication has been approved for the treatment of TTM. Drug therapy has largely been disappointing. The prognosis mainly depends on the age of onset of the problem. In young children, the prognosis is excellent. Even in late childhood and adolescence, the prognosis is usually good.
The treatment for pubic hair loss depends on its underlying cause.
A person who experiences pubic hair loss can take steps to care for the hair they do have. This may involve: avoiding excessive hair removal, avoiding rubbing the hairs, for example when using a towel to dry the area, applying conditioners to pubic hair to reduce the risk of breakage in newly growing hairs.
If a person is uncertain why they are losing pubic hair, they should consider talking to a doctor. The doctor may examine their skin and remaining hair for signs of damage. They may also carry out tests to see if the hair loss is due to an underlying medical condition. People should talk to their doctor if they experience psychological distress as a result of hair loss. The doctor may refer the person for psychotherapy. A therapist can teach people techniques to better deal with the emotional impact of hair loss.
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