Hair Loss
One of the most frequently seen forms of hair loss in women is a condition called Diffuse Alopecia. It is called this because there is a diffuse or distributed shedding of hairs across the scalp. It is also known as Telogen Effluvium (CTE) or shedding.
This type of hair loss can occur at any age but is most commonly noticed post pregnancy. Its onset can be quite sudden and is often noticed by an increase in the shedding of hairs in the washing or grooming process. It frequently occurs together with a widespread decrease of hair density rather than a bald patch. The cause of this ‘increased shedding’ can be as a result of intense stress on the body's physical wellbeing, severe illness, a problem with the hormonal system or as a reaction to medication. Dieting and nutritional deficiencies can also be a contributing factor to this type of hair loss.
Generally, the shedding develops around 6-8 weeks after its initial trigger. Often the condition rectifies itself within about 6-12 months, although for some it can become a chronic problem or even be the early indication of a more long-term hair loss problem, such as Androgenic Alopecia.
Diffuse Alopecia is an occurrence related to the growth cycles of hair. Hair growth cycles alternate between the following:
- Anagen: The growth phase - which can last between 2-7 years.
- Catagen: The transition phase - which lasts around 1 week.
- Telogen: The resting phase - which can last about three months.
During the telogen phase, the hair remains in the follicle but is no longer ‘anchored’. It remains here until it is pushed out by the growth of a new hair in the anagen phase or removed by washing or grooming.
At any one time, around 85% of hairs are in anagen, around 1% in catagen and around 14% telogen. However, a sudden change on the body can trigger large numbers of hairs to enter the telogen phase at the same time. Then, about 6-12 weeks later, this large number of hairs will be shed. It is normal to shed around 50 to 100 hairs each day. Women with the condition are often considered as either imagining it, overanxious or even neurotic! Fortunately, most cases rectify themselves in time and there are ways of dealing with the condition.
Treating the condition is to initially establish the cause. This is done primarily by taking a detailed case history. Blood testing and microscopic hair analysis is also important and should be conducted in order to establish that the shed hairs are indeed in the telogen phase. Once the cause is established the treatment can commence, however, the type of treatment will differ dependent upon the cause. Nutrition, on the other hand, is always an important aid to recovery and should be used in conjunction with whatever treatment is required.
Another common type of hair loss in women is Androgenetic Alopecia. This is the most common form of hair loss generally associated with men, though some females can also be affected. The condition is also known as pattern hair loss or thinning.
The following narrative explains ‘Female Pattern’ hair thinning.
Female pattern hair thinning can affect up to 30% of women. Some experts believe this figure could even be higher. Research shows that up to 13% of women have some degree of this type of hair loss before the menopause and afterwards it becomes far more common. One piece of research suggests that over the age of 65 as many as 75% of women are affected.
It is caused by physiological changes in the hair follicle, the place where the hair is produced. In certain areas of the scalp hair follicles begin to produce hairs of a shorter growth cycle and, with each succeeding cycle, thinner hairs are produced.
Such hair loss is induced by the hormone androgen. Androgen is a male hormone that all men and women, alike, produce. Androgen circulates in the blood stream, producing a chemical called dihydrotestosterone, or DHT, by the action of an enzyme called 5-alpha reductase. People with a higher level of this enzyme make more DHT, which in excess can cause the hair follicles to gradually diminish until eventually they can no longer be seen. Androgen hormones are used to stimulate growth, primarily a characteristic of the male, in order to increase masculine hair growth, on the face, trunk and limbs. To a lesser extent, androgens are produced by the adrenal glands in both men and women. It is only a genetically predisposed female who may suffer androgenic alopecia and genetic inheritance determines that only certain follicles will be abnormally sensitive to the circulating androgens in these females.
This type of hair loss can be differentiated from the others by its typical location and progression. In men the onset is recognised by an M-shaped recession at the frontal hairline leading to oval baldness at the crown and, eventually, total balding at the front and crown region of the scalp leaving a small ‘skirt’ of hair from ear to ear. In women the loss is also restricted to the frontal and crown region, however, it appears as more of a thinning without the recession of the frontal hairline. The degree of hair loss in women seldom reaches the extent of loss seen in the male form. The onset is usually later and also less rapid.
Development usually occurs as a diffuse thinning of the hair at the frontal region often commencing alongside hormonal changes that occur during the menopause or, less frequently, after pregnancy. The progression may be gradual or intermittent and the hair may become less manageable. By their 40th year, about 25 % of women have developed some thinning and this percentage increases in the fifth decade.
Evaluation of a hair loss problem in women is very important to ensure that no coexisting hair loss is also present that may need an alternative treatment.
A full history is explored and certain blood tests may be required. This is done primarily by taking a detailed case history during the consultation. Treatment very much depends on the outcome of the consultation and/or blood test results.
This is the most common form of baldness and is seen predominately in men, though some females can also be affected. The condition is known as ‘male pattern baldness’, ‘female pattern hair thinning’ or ‘Androgenic Alopecia’.
The following narrative explains ‘Male Pattern’ hair thinning.
Male pattern baldness affects at least 50% of the adult male population, caused by physiological changes in the hair follicle, where hairs are produced. In certain areas of the scalp hair follicles begin to produce hairs of a shorter growth cycle; with each succeeding cycle, thinner hairs are produced. Such hair loss is induced by hormones, called Androgens, circulating in the blood stream. These hormones are used to stimulate growth, primarily a characteristic of the male, in order to increase masculinity. This growth includes hair growth on the face, trunk and limbs. The Testes under the direction of the Pituitary gland mainly manufacture androgens. To a lesser extent, androgens are produced by the adrenal glands in both males and females.
Androgen hormones increase hair growth on the face, trunk and limbs but slow down growth on the scalp, this helps explain why men can retain a hairy chest while still going bald on their head. It is only a genetically predisposed person who may suffer androgenic alopecia. This means the onset and progression is genetically determined.
Male hormones are at there highest level in the blood stream during the late teens and early twenties and this leads to development of the body hair in this period. From the late twenties there is a gradual decrease in the production of male hormone and by the mid-forties, they have little or no effect on the hair follicle. Therefore, if a man still has a full head of hair by the time he reaches 45, he is likely to keep it. However, some health problems, medications or nutritional deficiencies can exacerbate hair thinning. Development depends on age, presence of androgens and genetic predisposition. The onset is characterized by its M-shaped recession at the front of the hairline and oval or skullcap baldness at the crown. Exact pattern and degree of the hair loss in a particular person is unpredictable, although some indication may be found in the appearance of close family members. What happens in the case of male pattern baldness is that the male hormone slows down cell division at the root, shrinking and reducing the number of hair follicles. As the follicles become smaller, so the hairs they produce become finer with slower shorter growth periods. The growth phase is thus reduced whilst the resting phase is lengthened. In fact the early stages of the balding process are characterised by ’thinning hair’.
The initial effect is a loss of quality rather than quantity. It is later on in the process that actual loss of numbers becomes significant. The rate at which hair loss occurs in the early years will dictate the extent of which the hair loss will finally reach. Once the hair follicle is no longer able to produce a hair, it will no longer be visible. The chances of a response to treatment for this type of baldness, when it reaches this stage, are therefore highly unlikely. Studies carried out on the hereditary aspect of hair loss are not well documented but suggest that paternal inheritance is probably more a factor than the maternal side. It is also important to note that studies on male and female balding are always on going and, as such, new information is often available.
See article "Can I cure my hair loss"
This is less frequently seen than the other hair loss conditions mentioned above but it can also be the most distressing for sufferers and approximately 2% of the population develop this condition at some point in their lives. The condition is characterised as one or more patches of reversible baldness in any hair bearing area. In more severe cases this can lead to Alopecia Totalis (total scalp hair loss) or even Alopecia Universalis (complete loss of all scalp and body hair).
The areas of hair loss may appear suddenly or gradually. Most frequently, it is noticed when grooming the hair, often by the hairdresser, rather than becoming apparent due to excessive hair fall. The severity can differ greatly between cases. For example; a person may develop just one patch or several and areas of hair loss can merge to form large areas of baldness. The condition is termed an autoimmune disorder and is caused by an immune system malfunction, triggering an attack on the hair. The hair, not recognising itself as 'itself' but as it would if bacteria were entering the body. As a result of this condition inflammation of the hair follicle can also occur.
Some sufferers may notice a soreness or irritation before the onset of a bald patch; this is due to the autoimmune response. However, a majority of cases have no sensations at all. This is often how the condition can go unnoticed until the patch is of a significant size. Stubble hairs may be observed around the borders of a bald patch, these hairs, termed 'exclamation mark', can be an indicator that the condition is active or progressing. These are hairs, which have broken due to the hair shafts being weakened by the autoimmune response.
Treatment may help improve the rate of hair growth and in many cases stop or reduce hair loss altogether. The success rate is higher in individuals who begin treatment when bald patches begin than those who have suffered for years.
The tendency to develop Alopecia Areata may be inherited. However, often no known relatives have ever been affected by the condition themselves. Eczema, Asthma, and Hay Fever (termed Atopic) sufferers may be more likely to develop the condition and it is also common in people suffering Thyroid disorders. Generally, the cause of this condition is unknown, and triggers can be almost impossible to decide upon.
A full case history needs to be explored and certain blood tests may be required. This is done primarily by taking detailed information during the consultation.
Treatment very much depends on the outcome of this consultation and/or the blood test results.
These types of hair loss are the kind that will affect the condition of the scalp.
Traumatic Alopecia
This occurs when an outside agent causes physical damage or trauma to an area of the hair and scalp, resulting in a patch of hair loss at the site of the injury. A particular type or patch of hair loss may be referred to by its causing factor such as traction or, alternatively, by it is location on the scalp.
The possible causes of chemical or mechanical injury to the scalp by external factors are many. The hair may be pulled from the follicles, the shafts may be broken or if the injury penetrates the deeper layers of the scalp, the living follicles may be injured. Lack of visible follicular openings in the bald area indicates destruction of the underlying follicle and, naturally, permanent hair loss will result.
Traction Alopecia
Prolonged periods of traction may result in the hair being slowly pulled out of its follicle and the hair itself being stretched and broken, producing significant hair loss without the sufferer being aware of the cause. More frequently, sufferers are female, who are subjecting some areas of the hair to repeated stress. Braids, ‘ponytail’ hairstyles, headbands or tight rollers can all cause hair loss at the site of the tension. Afro type hair is particularly likely to develop such problems by wearing tight rows of braids or using various hair-straightening devices such as a ‘hot comb’.
Long sustained tension of sufficient force gives rise to a characteristic succession of changes that begin with redness and swelling around the follicle and proceeds to folliculitis (inflammation of the hair follicle). In early stages, there may be broken hairs in the area. Eventually there will be prolonged hair loss and finally, as scaring takes place, the hair loss will be permanent.
The most characteristic type is marginal alopecia. Symmetrical triangles of baldness develop at the edge of the scalp just in front of the ears. It can be concentrated in one or two areas that are usually the regions, which are most accessible to the sufferer and thus subjected to the greatest amount of tension. In marginal alopecia, as well as that caused by rollers and curlers, the outcome will depend upon the length of time the area has been stressed by the traction. In early stages, re-growth may be delayed from three to nine months but eventually will restore the area. However, if the follicles have been completely destroyed the hair loss will be permanent. As long as the traction continues the disorder will progress, slowly increasing the scarring in the area under tension. In most cases of traction alopecia determining the cause is all that is necessary to solve the problem. After the cause has been removed, normal re-growth usually follows, unless the follicle has been permanently damaged.
Scalp Scaling and hair loss
Some chronic scaling conditions of the scalp, such as Seborrhoeic Dermatitis, can lead to some hair loss or thinning. Generally this is due to itching, causing the sufferer to scratch the scalp. A build up of scale can also cause inflammation and soreness to the underlying skin. This type of scalp condition needs a proper care regime with the correct type of topical treatments to control the scaling. (See scalp problems)
Scarring Alopecia also termed Cicatricial Alopecia