Hair Loss

What is hair loss and what causes it?
  • Hair loss (alopecia) is a condition that causes people to lose hair most commonly from their scalp but can affect any area of hair-bearing skin including eyebrows, beard, or body.
  • There are many different causes of hair loss. These are usually divided into ‘scarring’ and ‘non-scarring’ categories.
  • Non-scarring alopecias are the most common. Although there is no damage to the skin surface (resulting in a scar), there still may be permanent hair loss.
  • Non-scarring alopecias include:
    • Alopecia areata – autoimmune condition.
    • Androgenetic alopecia (male / female pattern hair loss) – this is sometimes referred to as ‘patterned hair loss’.
    • Telogen effluvium – often caused by a stressful event, following pregnancy or by medication and takes approximately 3 – 6 months to appear after the triggering event. Certain medications and recreational drugs that may be related to hair loss include those used for heart problems, high blood pressure, depression, cancer, and arthritis.
    • Hair loss caused by ringworm infection (tinea capitis)
    • Trichotillomania (hair pulling habit)
    • Nutritional deficiencies – some hair loss can be triggered by a poor diet. Like any other part of your body, hair needs a variety of nutrients including zinc, B-vitamins, iron, and protein to be healthy and grow. Sudden weight loss or chronic calorie restriction, such as in anorexia nervosa, can also cause hair loss.
    • Endocrine abnormalities (eg thyroid abnormality)

Occasional hairstyling is not a problem, but repeated strain and excessive hair styling such as hair extensions, headwear, heavy long hair, hair relaxers, glued, braids and tight ponytails can damage the follicles so that the hair does not regrow. This is a type of scarring alopecia called ‘traction alopecia’.

What is androgenetic alopecia?
  • This is a hereditary (genetic) form of hair loss that generally occurs with advancing age to some degree in most people. However, it can occur at any age.
  • A family history of androgenetic alopecia is suggestive of a family tendency toward thinned hair, but it does not predict the rate or extent to which hair loss will occur in an individual.
    • 50-60% of men will have had hair loss resulting in baldness by age 70
    • 15 – 20% of men do not have any balding even in old age
  • Hair loss in women is not as common in women and the frequency and extent of hair loss when it does occur, is not as severe as it is in men.
    • 3 – 6% of women experience alopecia before age 30
    • Up to 49% of women at at 70 have a degree of hair loss

Hair loss can be psychologically devastating for both sexes and can affect an individual’s confidence in work and social situations. One study from the Royal Australian College of General Practitioners (RACGP)* found that 52% of women were “extremely upset” by baldness, compared to 28% of men – with more than 40% of women experiencing marital problems and 64% career difficulties attributed to their hair loss.

What are the symptoms of hair loss?
  • Hair loss can be the result of stress, heredity, hormonal changes, medical conditions, or aging.   The normal hair growth cycle will lose 50 and 100 hairs from their bodies daily as part of the normal hair growth cycle. With about 100,000 hairs on your head, small hair loss is perfectly normal. 
  • If you notice that you’re losing more hair than usual with larger clumps of hair in your shower drain or thinning patches of hair or baldness. It’s better to talk with your doctor about the cause of your hair loss and treatment options.

Specific symptoms of hair loss include:

  • Generalised hair thinning and recession of the hairline on the forehead, temples, or top of the head can occur in patterned hair loss.
  •  A single patch or several scaly areas of thick, swollen, reddish skin are symptoms of scalp psoriasis. It’s a common skin disorder and won’t cause hair loss, but the harsh treatments, and often scratching can lead to temporary hair loss.
  •  Losing hair in circular or patchy bald spots on the scalp, beard, or eyebrows is usual for alopecia areata.
  • Severe medical illness, stress, or any physical or emotional shock can cause hair to loosen suddenly. This type of hair loss usually causes overall hair thinning seen in telogen effluvium, but is temporary then the hair will likely grow back after 9 to 12 months.
How can I prevent hair loss?

Some types of hair loss cannot be prevented but can be treated when it appears. However, following these tips may help you avoid preventable types of alopecia: 

  • Change hairstyles every few weeks and avoid the tension in one area of the scalp. 
  • Be gentle with your hair. Avoid tugging when combing when your hair is wet. 
  • A wide-toothed comb might help prevent pulling out hair.
  • Avoid harsh treatments or limit chemicals, such as hot rollers, curling irons, relaxers, dyes, highlights, peroxide treatments, and perms. 
  • Stop smoking. Some studies show that smoking damages the hair growth cycle and can trigger severe hair fall out. 
  • If you are having chemotherapy, ask your doctor about a cooling cap that can help you retain more of your hair. 
  •  Ask your doctor about medications and supplements you take that might cause hair loss.
What are the treatments for hair loss?

Treatment of alopecia will depend on the type and severity of the condition. Sometimes we cannot grow back the hair that has been lost, and the goal of treatment is to retain the hair that is present.

Hair growth occurs in a slow cycle and it usually takes 6 – 8 months before a measurable improvement can be seen from treatment.

  • Lifestyle Modification
    Careful hairstyling as above. Balanced healthy diet and stable weight in a healthy range.

  • Topical Treatments
    These are skin-directed creams, ointments, lotions, serums and foams. Topical treatments may be over-the-counter. Topical treatments include ingredients such as corticosteroids, minoxidil, prostaglandin analogues and calcineurin inhibitors.

  • Steroid injections
    Steroid can be injected into the scalp in some people with alopecia caused by immune system activity.

  • Oral Treatments
    For hair loss that is severe or not responding to other therapies, tablets are available and include finasteride, spironolactone, cyproterone acetate, minoxidil, prednisolone, methotrexate and cyclosporine. These all have variable side effect profiles and monitoring requirements but mostly require several months of use for full benefit to be achieved. The best oral option is determined on a case-to-case basis.

  • Platelet Rich Plasma (PRP)
    A relatively recent development in hair treatment for androgenetic alopecia is injected PRP. Blood is drawn from the individual and spun in a centrifuge to concentrate the platelets and plasma, which contain growth factors. This is then injected into the scalp skin. For best results, treatment is conducted over a number of sessions, several weeks apart.

  • Hair transplantation
    For hair loss that is severe or not responding to other therapies, surgical transplantation of hair follicles to areas of hair loss can be undertaken. This is usually performed in conjunction with oral therapy for best results. Generally, this treatment is indicated for male patients with androgenetic alopecia.

Sources

9
Bologna Dermatology 4th edn
9
Rook Dermatology Part 8, Chapter 89, Acquired Disorders of Hair

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