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Hair loss

Definition


Disease: Hair loss Hair loss
Category: Dermatological diseases

Disease Definition:

Usually, baldness refers to excessive hair loss from the scalp, which could be either hereditary or caused by certain medications or an underlying medical condition. Hair loss could occur in anyone; men, women and children.

 

Although some people leave their baldness untreated, but others may cover it up with hats, scarves, makeup and hairstyles. Some people may choose medications or surgical procedures that are available. However, someone should talk to a doctor about the cause of and the best possible treatments for their hair loss before choosing any of these treatment options.
 

Work Group:


Symptoms, Causes

Symptoms:

Alopecia is the medical term for hair loss. The most common type of alopecia is pattern baldness (androgenetic alopecia), which affects approximately one-third of men and women and is usually permanent. Alopecia areata is another type of alopecia which is temporary and may involve hair loss on the scalp, as well as on other parts of the body.

 

PERMANENT HAIR LOSS:

Cicatricial (scarring) alopecia:

When inflammation damages and scars the hair follicle, this rare condition occurs, which causes permanent hair loss. In some cases, the patchy hair loss could be associated with slight pain or itching.

Male-pattern baldness:

Also known as androgenetic alopecia, this pattern baldness could begin very early, even in the teens or early 20s. This type is marked by a receding hairline at the temples as well as balding at the top of the head. Partial or complete baldness could be its end result.

Female-pattern baldness:

Also known as androgenic alopecia, women usually maintain their frontal hairline and don't experience complete baldness except in some very rare cases. Women with permanent hair loss usually have the type that is limited to thinning at the front, sides or crown.

 

TEMPORARY HAIR LOSS:

Alopecia areata:

Usually, hair loss in alopecia areata happens in small, round and smooth patches about the size of a quarter. Even though this type could cause patchy hair loss of any area that has hair such as eyelashes, eyebrows and beard, but in most cases it doesn't extend beyond a few bare patches on the scalp. This disease could progress in some rare cases, causing hair loss over the entire body. Soreness and itching may precede the hair loss. Alopecia universalis is when hair loss involves the whole body, and alopecia totalis is when hair loss includes the whole scalp.

Traction alopecia:

In case a person regularly wears certain hairstyles such as pigtails, cornrows or braids, or if they use tight rollers, bald patches could occur. Usually, hair loss occurs at the part where hair is pulled tightly or between the rows.

Telogen effluvium:

In this type, hair loss occurs suddenly. When a person with this condition combs or washes their hair, handfuls of hair may come out or it may fall out after gentle tugging. Usually, this doesn't cause bald patches but overall hair thinning.
 

Causes:

Typically, hair goes through a cycle of growth and rest. In each individual the course of each cycle varies. However, anagen, the growth phase of scalp hair, usually lasts two to three years, during which time hair grows about 1 centimeter a month. Telogen is the resting phase that usually lasts three to four months, the hair strand falls out at the end of the resting phase and a new one starts growing in its place. The growth stage starts again once a hair is shed.

 

Normally, 50 to 100 hairs are shed in a day. However, this amount of hair loss shouldn't cause noticeable thinning of the scalp hair because there are about 100,000 hairs in the scalp.

 

The gradual thinning of hair is a normal part of aging. However, when hair comes out in patches, when new hair is thinner than the hair shed, or when the rate of shedding exceeds the rate of regrowth, this hair loss could lead to baldness.

 

SPECIFIC TYPES OF HAIR LOSS AND THEIR CAUSES: 

Cicatricial (scarring) alopecia:

As mentioned before, when inflammation damages and scars the hair follicle, this type of permanent hair loss occurs, which prevents new hair from growing. This condition could accompany several skin conditions, such as lichen planus or lupus erythematosus. What exactly causes or triggers this inflammation is still not known.

Traction alopecia:

Traction alopecia is caused by excessive hairstyling or hairstyles that pull the hair too tightly. Hair usually grows back normally in case the pulling is stopped before there's scarring of the scalp and permanent damage to the root.

Androgenetic alopecia:

The time of growth shortens in male- and female-pattern baldness, and the hairs are not as thick or sturdy; this type is also called pattern baldness. The hairs become rooted more superficially with each growth cycle, and so they fall out more easily. One of the key roles in this type is heredity, meaning that a person's risk of balding is increased if there's a history of alopecia on either side of the family. The age at which someone begins to lose hair and developmental speed, pattern and extent of the baldness are also affected by heredity.

Telogen effluvium:

A change in the normal hair cycle causes this type of hair loss. When an emotional or physical shock to a person's system causes hair roots to be pushed prematurely into the resting state, this type of hair loss occurs, and the affected growing hairs from these hair roots fall out. However, the hair follicles become active again and new hair starts to grow in a month or two. Telogen effluvium is usually preceded by a physiological stress such as a high fever, metabolic disturbances, nutritional deficiencies, surgery or excessive weight loss, or it could be preceded by emotional distress, such as a death in the family. Once the condition that caused telogen effluvium corrects itself, hair usually grows back; this could take months.

Alopecia areata:

The cause of this autoimmune disease is still not known. Usually, people that develop this disease are otherwise healthy. However, a few people may have thyroid disease or other autoimmune disorders. Experts think that some people are genetically predisposed to develop this disease and that the condition is set off by a virus or something else in the environment. Someone is more likely to develop this disease in case they have a family history of alopecia areata. Generally, the hair grows back with alopecia areata; however, it may shed and then grow again a number of times. 

 

OTHER CAUSES OF HAIR LOSS:

Medications:

In some people, hair loss could be caused by certain medications that are used to treat arthritis, gout, heart problems, depression and high blood pressure. In some women, hair loss may also be caused by birth control pills.

Poor nutrition:

Hair loss may occur if someone has inadequate protein or iron in their diet or poor nourishment in other ways. Poor nutrition could be caused by crash diets, fad diets and certain illnesses, including eating disorders.

Medical treatments:

Alopecia may result if someone is undergoing chemotherapy or radiation therapy. Healthy, growing (anagen) hairs could be affected under these conditions. However, the hair usually starts to grow again after treatment has ended.

Diseases:

Hair loss may be caused by lupus or diabetes.

Hair treatments:

Hair could become damaged and break off in case the chemicals that are used for dying, tinting, bleaching, straightening or permanent waves are used incorrectly or overused. In case the hair shaft becomes damaged, overstyling and excessive brushing could also cause the hair to fall out.

Hormonal changes:

Temporary hair loss may be caused by hormonal imbalances and changes that may be due to having a baby, beginning menopause, pregnancy, an overactive or underactive thyroid gland or discontinuing birth control pills. The hair loss could be delayed by three months after a hormonal change, and it will take yet another three months for new hair to grow back. It is quite normal to have thicker, more luxuriant hair during pregnancy. However, losing more hair than normal about three months after delivery is also quite common. There may be a thinning of hair over the crown of the scalp in case a hormonal imbalance is associated with an overproduction of testosterone. Hair loss may be stopped by correcting hormonal imbalances.

Trichotillomania:

Also known as hair-pulling disorder, it is a type of mental illness in which people have an irresistible urge to pull out their hair from the scalp, eyebrows or other areas of the body. People with this disorder have patchy bald spots on their head, and they may go to great lengths to disguise it. The exact cause of trichotillomania is still not known, but it is being researched.

Scalp infection:

Hair loss may be due to infections that invade the hair and skin of the scalp, such as ringworm. Hair usually grows back once the infection is treated. An oral or topical antifungal medication can treat ringworm, which is a fungal infection.
 

Complications

Complications:

None

Treatments:

There's no cure for baldness whether it's temporary or permanent. But to help promote hair growth or hide hair loss, some treatments are available. Hair may resume growth without any treatment in some types of alopecia.

 

MEDICATION:

The cause of hair loss, extent of the loss and individual response is what the effectiveness of medications that are used to treat alopecia will depend on. Usually, in more extensive cases of hair loss, treatment is less effective.

 

These are some of the types of drugs that are used to treat alopecia:

Anthralin:

Anthralin is a synthetic and tarry substance, which is available either as a cream or as an ointment. This substance is applied to the scalp and washed off daily. Anthralin is typically prescribed to treat psoriasis, however, it could be prescribed to treat other conditions as well. In cases of alopecia areata, anthralin could stimulate new hair growth, which could take up to 12 weeks.

Corticosteroids:

Alopecia areata may be treated with injections of cortisone into the scalp. In most cases, the treatment will be repeated monthly. A person may be prescribed corticosteroid pills in case of extensive hair loss due to alopecia areata. Four weeks after the injection, new hair may be visible. Corticosteroid creams and ointments could also be used; however, injections are more effective than these ointments and creams.

Finasteride:

This is a prescription medication that is used to treat male-pattern baldness and is taken daily in the form of a pill. Most men that are using this medication experience a slowing of hair loss, and some of them show some new hair growth. This medication works by stopping the conversion of testosterone into dihydrotestosterone (DHT), which is a hormone that shrinks hair follicles and is one of the important factors in male hair loss. Diminished sex drive and sex function are some of the side effects of this medication. The benefits of finasteride stop when a person stops using it.
Because this medication poses significant danger to women of childbearing age, it is not approved for use by women. The absorption of this drug could cause some serious birth defects in male fetuses, so if a woman is pregnant, she should never handle crushed or broken tablets of finasteride. 

Minoxidil:

Alopecia areata and androgentic alopecia could be treated with this over-the-counter medication. To grow hair and prevent further loss, minoxidil is rubbed into the scalp twice a day. Minoxidil could be liquid or foam, and is available in a 2% or 5% solution. Some people may experience some hair regrowth or a slower rate of hair loss, and sometimes both.
Although the new hair resulting from minoxidil use might be thinner and shorter than previous hair, but for some people, there may be enough hair growth to hide their bald spots and have them blend with existing hair. Soon after minoxidil is discontinued, new hair stops growing. A person may be recommended discontinuing it in case they experience minimal results within six months. Irritation of the scalp is one of its side effects.

 

SURGERY:

When more conservative measures have failed, androgenetic alopecia could be treated with hair transplant and scalp reduction surgery. During the transplantation, tiny plugs of skin will be taken from the back side of the scalp, each of which contains one or several hairs. Then, these plugs will be implanted into the bald sections. Because hereditary hair loss progresses with time, several transplant sessions will be needed.

 

Scalp reduction is the process of decreasing the area of bald skin on the head. The scalp at the top part of the head may seem to have a snug fit. However, this skin could become flexible and stretched enough, so that some of it could be removed surgically, and the space is closed with hair-covered scalp after the hairless scalp is removed.
There's another scalp reduction technique called a flap, in which the hair-bearing skin is folded over an area of bald skin. In people with more extensive hair loss, scalp reduction could be combined with hair transplantation to have a more natural-looking hairline.

 

The surgical procedures that treat baldness could be painful and quite expensive. Infection and scarring are some of the possible risks. Before the quality of the new hair can be properly evaluated, it could take six or eight months.

 

A person should only consider board-certified dermatologists, plastic surgeons or cosmetic surgeons if they're interested in these procedures. Before choosing a doctor, they should also check the local and state medical boards for a record of patient complaints. The person should consult with the doctor in order to confirm the cause of their hair loss. Before proceeding with plans for surgery, the person should also review all treatment options, including nonsurgical ones.

 

WIGS AND HAIRPIECES:

In case someone doesn't respond to treatment or if they want an alternative to medical treatment, they may consider wearing a hairpiece or a wig. Quality and natural-looking hairpieces and wigs are available, which could cover both temporary and permanent hair loss.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
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Expert's opinion:

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