Have you ever wondered why you are losing your hair? Have you looked at your pillow and combs and it seems your hair is no longer on your head. This week, healthplus takes a look at the topic of hair loss and how it can be treated.
Alopecia is the general medical term for hair loss. There are many types of hair loss with different symptoms and causes.
Some of the more common types of hair loss are described below, including:
- male- and female-pattern baldness
- alopecia areata
- scarring alopecia
- anagen effluvium
- telogen effluvium
Male- and female-pattern baldness
Male-pattern baldness is the most common type of hair loss, affecting around half of all men by 50 years of age. It usually starts around the late twenties or early thirties and most men have some degree of hair loss by their late thirties.
It generally follows a pattern of a receding hairline, followed by thinning of the hair on the crown and temples, leaving a horseshoe shape around the back and sides of the head. Sometimes it can progress to complete baldness, although this is uncommon.
Male-pattern baldness is hereditary, which means it runs in families. It’s thought to be caused by oversensitive hair follicles, linked to having too much of a certain male hormone.
As well as affecting men, it can sometimes affect women (female-pattern baldness). During female-pattern baldness, hair usually only thins on top of the head.
It’s not clear if female-pattern baldness is hereditary and the causes are less well understood. However, it tends to be more noticeable in women who have been through the menopause (when a woman’s periods stop at around age 52), perhaps because they have fewer female hormones.
Commonly with African women, they tend to experience hair loss from the front hair line due to excessive hair manipulation and pulling from braiding and weaving of their hair, sometimes also from over processed hair (relaxed).
Alopecia areata
Alopecia areata causes patches of baldness about the size of a large coin. They usually appear on the scalp but can occur anywhere on the body. It can occur at any age, but mostly affects teenagers and young adults.
In most cases of alopecia areata, hair will grow back in a few months. At first, hair may grow back fine and white, but over time it should thicken and regain its normal colour. Some people go on to develop a more severe form of hair loss, such as:
- alopecia totalis (no scalp hair)
- alopecia universalis (no hair on the scalp and body)
Alopecia areata is caused by a problem with the immune system (the body’s natural defence against infection and illness). It’s more common among people with other autoimmune conditions, such as an overactive thyroid (hyperthyroidism), diabetes or Down’s syndrome.
It’s also believed some people’s genes make them more susceptible to alopecia areata, as one in five people with the condition have a family history of the condition.
Alopecia areata can occur at any age, although it’s more common in people aged 15-29. It affects one or two people in every 1,000.
You are more likely to have permanent hair loss if you:
- Have a family history of the condition.
- Have the condition at a young age (before puberty) or for longer than 1 year.
- Have another autoimmune disease.
- Are prone to allergies (atopy).
- Have extensive hair loss.
- Have abnormal color, shape, texture, or thickness of the fingernails or toenails.
How is it treated?
Because hair usually grows back within a year, you may decide not to treat alopecia areata.
If you choose not to treat the condition and wait for your hair to grow back, you may wish to:
- Wear hairpieces. Hairpieces are made from human or synthetic hair that is implanted into a nylon netting. Hairpieces may be attached to the scalp with glue, metal clips, or tape.
But hair weaving, which involves sewing or braiding pieces (WEAVE-ON) of longer hair into existing hair, is not recommended because it may cause permanent hair loss.
- Use certain hair care products and styling techniques. Hair care products or perms may make hair appear thicker. Dyes may be used to color the scalp. But continual use of perms or dyes may result in more hair loss.
The most common treatment for patchy hair loss is many injections of corticosteroids into the scalp, about 1 cm (0.4 in.) apart, every 4 to 6 weeks-speak to your doctor about this.
Children and some adults may be treated with topical corticosteroids that are applied to the affected skin.
Minoxidil (Rogaine) may be used along with topical corticosteroids.
Contact immunotherapy triggers an allergic reaction on the scalp that may help hair to grow.
A medicine is “painted” on the scalp once a week. This irritates the skin and makes it red and scaly. Hair growth may appear within 3 months of beginning treatment. Side effects of contact immunotherapy include a severe rash (contact dermatitis) and swollen lymph nodes, especially in the neck.
Psoralen with ultraviolet a light (PUVA) therapy may also be used to treat alopecia areata.
PUVA usually is reserved for people who have large areas of skin affected by the disorder or who cannot use other treatments.
For PUVA, a medicine called a psoralen is used to make the skin more sensitive to ultraviolet A (UVA) light. Then the skin is exposed to UVA light.
Scarring alopecia
Scarring alopecia, also known as cicatricial alopecia, is usually caused by complications of another condition. In this type of alopecia, the hair follicle (the small hole in your skin that an individual hair grows out of) is completely destroyed. This means your hair won’t grow back.
Depending on the condition, the skin where the hair has fallen out is likely to be affected in some way.
Conditions which can cause scarring alopecia include:
- scleroderma – a condition affecting the body’s connective (supporting) tissues, resulting in hard, puffy and itchy skin
- lichen planus – an itchy rash affecting many areas of the body
- discoid lupus – a mild form of lupus affecting the skin, causing scaly marks and hair loss
- folliculitis decalvans – a rare form of alopecia that most commonly affects men, causing baldness and scarring of the affected areas
- frontal fibrosing alopecia – a type of alopecia that affects post-menopausal women where the hair follicles are damaged, and the hair falls out and is unable to grow back
Scarring alopecia occurs in both males and females, but is less common in children than adults. It accounts for about 7% of hair loss cases.
Treatment Options for scarring alopecia
Scarring alopecia can involve a lot of damage and permanent hair loss. For this reason treatment of scarring alopecia should be quite aggressive.
Early visit to a dermatologist (doctor that treats skin diseases) is the best option you have. NEVER GO TO A CHEMIST OR VISIT A DOCTOR WHO IS NOT SPECIALISED IN DERMATOLOGY.
The nature of treatment varies depending on the particular diagnosis. Scarring alopecias that involve mostly lymphocyte inflammation of hair follicles, such as lichen planopilaris and pseudopelade, are generally treated with corticosteroids in topical creams and by injection into the affected skin. In addition, antimalarial and isotretinoin drugs may be used.
For scarring alopecias with inflammation of mostly neutrophils or a mixture of cells, the typical treatment involves antibiotics and isotretinoin.
More experimentally, drugs like methotrexate, tacrolimus, cyclosporin, and even thalidomide have been used to treat some forms.
Once a scarring alopecia has reached the burnt-out stage and there has been no more hair loss for a few years, bald areas can be either surgically removed if they are not too big or the bald patches can be transplanted with hair follicles taken from unaffected areas.
Anagen effluvium
Anagen effluvium is widespread hair loss that can affect your scalp, face and body.
One of the most common causes of this type of hair loss is the cancer treatment chemotherapy. In some cases, other cancer treatments – including immunotherapy and radiotherapy – may also cause hair loss.
The hair loss is usually noticeable within a few weeks of starting treatment. However, not all chemotherapy drugs cause hair loss and sometimes the hair loss is so small it’s hardly noticeable.
It may be possible to reduce hair loss from chemotherapy by wearing a special cap that keeps the scalp cool. However, scalp cooling is not always effective and not widely available.
In most cases, hair loss in anagen effluvium is temporary. Your hair should start to grow back a few months after chemotherapy has stopped.
Telogen effluvium
Telogen effluvium (TE) is probably the second most common form of hair loss dermatologists see.
It is a poorly defined condition; very little research has been done to understand TE.
In essence though, TE happens when there is a change in the number of hair follicles growing hair. If the number of hair follicles producing hair drops significantly for any reason during the resting, or telogen phase, there will be a significant increase in dormant, telogen stage hair follicles. The result is shedding, or TE hair loss.
Telogen effluvium is a type of alopecia where there is widespread thinning of the hair, rather than specific bald patches. Your hair may feel thinner, but you’re unlikely to lose it all and your other body hair isn’t usually affected.
Telogen effluvium can be caused by your body reacting to:
- hormonal changes, such as those that take place when a woman is pregnant
- intense emotional stress
- intense physical stress, such as childbirth
- a short-term illness, such as a severe infection or an operation
- a long-term illness, such as cancer or liver disease
- changes in your diet, such as crash dieting
- some medications, such as anticoagulants (medicines that reduce the ability of your blood to clot) or beta-blockers (used to treat a number of conditions, such as high blood pressure)
In most cases of telogen effluvium, your hair will stop falling out and start to grow back within six months.
Treatments for Telogen Effluvium
How TE is treated depends on what has activated it or caused it. For short-term TE that can be linked to a trigger like surgery, the best response is to sit tight and wait for the follicles to recover of their own accord.
For persistent TE, if the causal factor can be isolated or identified, then the best method is to remove it. For example, if stress is the problem, stress reduction is the long-term answer. If a dietary deficiency appears on a blood test, then supplements can work. A deficiency in thyroid hormones can be treated with hormone supplements.
However, often a specific causal factor cannot be identified. If this is the case, there are few treatment options.
Most dermatologists resort to prescribing minoxidil, a direct hair growth stimulator. Minoxidil can work well for some individuals with TE, but if the underlying cause is still present, then minoxidil must be continued to block redevelopment of TE. With removal of the trigger, minoxidil use can be stopped.
In conclusion, hair loss is seen and experienced by all and sometimes it’s seasonal in some countries. For example some afro-Caribbean experience hair loss more in the winter than any other time in the year.
My advice will be in you notice a worrisome trend in hair loss visit a dermatologist as it may be a symptoms of an underlying disease you may not know you have. And for women constantly putting pressure on their hairline by excessive braiding, platting, over-processing you should remember to take care of your hair by checking the hair products you are using and avoid those not suitable for you and using wigs at interval to allow your hair to grow.
Eat healthily-loads of fruits and vegetables, and protein and if possible use vitamin supplements if yo are deficient on any e.g. Iron, vitamin A.
See you next week.