Causes of hair loss are varied, and of course treatments are specific to the type of hair loss. Six major types of hair loss and treatment are discussed in the following sections.
Alopecia Areata
Androgenetic AlopeciaAnagen Effluvium
(hair loss due to chemicals or radiation)
Self induced hair loss
Telogen Effluvium
(sudden or severe stress related hair loss)
Scarring Alopecia
Other types of hair loss
1.Syphilitic Alopecia.
2.Scleroderma
3.Tinea Capitis
Alopecia Areata
Alopecia Areata is thought to be an auto-immune disease of the hair, initially appearing as a rounded bare patch about an inch across. Alopecia Areata affects both men and women equally and is often experienced first in childhood. According to a survey taken in America one person in every hundred is likely to experience Alopecia Areata at sometime in their life. Many people affected with Alopecia Areata will only have one experience of hair loss with regrowth occurring afterwards, however it is estimated that in approximately 20% of cases in the UK hair loss recurs or becomes permanent.
There are three types of Alopecia Areata which are named according to their severity.
Alopecia Areata is mild patchy hair loss on the scalp
Alopecia Totalis is the loss of all scalp hair
Alopecia Universalis is the loss of scalp and all body hair
Researchers believe that Alopecia Areata is an auto-immune disease, this means that the body’s immune system acts as if the hair follicles are foreign and attacks them. White blood cells called T-lymphocytes attack the hair follicle which causes the hair to stop growing and enter into the telogen (resting) phase, then about 3 months later, when the resting phase is over the hair will then fall out. Only when T-lymphocytes stop attacking the hair follicle will new hair grow.
Androgenetic Alopecia
Male Pattern Baldness / Female Pattern Baldness
Androgenetic Alopecia accounts for 95% of all hair loss. It can affect both men and women although men experience a much greater degree of loss. In women Androgenetic Alopecia appears as diffuse hair loss occurring over most of the scalp. In men however the pattern of loss usually starts with a receding hairline which then advances to thin the top of the head.
Causes of Androgenetic Alopecia
In 400 BC Hippocrates observed that eunuchs did not become bald. Later Aristotle noticed this also. In the 1940s Dr James Hamilton concluded that genetic predisposition in the present of the male hormone androgen where the factors that caused the development of Androgenetic Alopecia.
However it is now known that it is more specifically the male hormone dihydrotestosterone (DHT) which is converted from the enzyme testosterone by the enzymes 5 alpha reductase which contributes to Androgenetic Alopecia in those who are genetically predisposed. It is interesting to note that individuals with a deficiency in 5 alpha reductase do not develop Androgenetic Alopecia. This is because the body is unable to convert testosterone into dihydrotestosterone.
When Androgenetic Alopecia occurs large active hair follicles in specific areas begin to change to smaller less active ones that shrink slightly with each new growth cycle. The enzyme 5 alpha reductase is thought to be the major cause of this. Under the action of the enzyme the male hormone testosterone become dihydrotestosterone. This causes the hair shafts to narrow producing progressively finer hairs with each new growth cycle until eventually the hairs become transparent and stop emerging. If an individual has androgenetic alopecia the overall levels of testosterone may be normal however the activity of 5 alpha reductase is greater than normal which results in increased amounts of dihydrotestosterone in the hair follicle.
Anagen Effluvium
Cancer Treatment Hair Loss
Anagen Effluvium is the sudden hair loss which occurs as a result of chemicals or radiation, such as the hair loss that results during certain types of Chemotherapy or Radiation Treatment.
In Anagen Effluvium the hair does not enter a resting stage as is does with Telogen Effluvium. The hair loss is usually sudden occurring 1 to 3 weeks after expose to the chemicals or radiation has occurred. Cancer treatments such as Chemotherapy and Radiation Treatments are the most common causes of Anagen Effluvium. However exposure to toxic chemicals such as Thallium and Arsenic may also produce a sudden loss of hair.
Chemotherapy is used in the treatment of cancer to destroy the cancer cells which divide rapidly within the body. One side effect of this cancer treatment however is that it can also stop the growth of the hair and may cause the shedding of hair. In some cases up to 90% of the hair may be affected and often the remaining 10% was already in the resting phase before the treatment was started. Some hair follicles do not shed the hair but produce a narrower weaker hair which breaks off easily.
Anagen Effluvium caused by Chemotherapy is only a temporary condition and in most cases hair growth will return to normal once treatment is finished. Many people even claim that their hair grows back healthier and thicker than before. Sometimes when the hair grows back the texture can be different. Some people who have had curly hair have claimed that their hair has grown back straight, and sometimes even the colour can become different.
There is a wide range of drugs used in Chemotherapy and not all of these drugs cause hairloss. The drugs which are most likely to cause hair loss are listed as follows:
Amsacrine
Cisplatinum
Cytosine Arabinoside
Cyclophosphamide (Cytoxan)
Doxorubicin (Adriamycin)
Epirubicin
Etoposide (Taxol)
Ifosfamide
Vincristine (Oncovin)
The following drugs are less likely to cause hair loss:
Actinomycin
Bleomycins
Daunorubicin
Methotrexate
Carboplatin
Mitomycine C
Vinblastine
When hair loss occurs as a side effect of Chemotherapy it normally occurs very suddenly. Often the hair falls out in large clumps and in many cases it occurs overnight. Patients receiving Chemotherapy may wake to find large clumps of hair on their pillows. Many Doctors and nurses recommend that the patient cut the hair very short before the hair loss is expected. Some patients may even choose to shave their heads in order to avoid shedding clumps of hair. It seems than many people seem to prefer the look of a totally bald head rather than a patchy looking scalp.
If a patient is able to plan for the hair loss due to Chemotherapy or Radiation Therapy, then the patient may choose to find a wig before the treatment starts. If a wig is obtained before the treatment starts then it can be worn form the time before the hair loss occurs through to the stage where the hair grows back. There is a wide range of wigs available ranging from human hair to synthetic hair and wigs with a vacuum-fitted base to ready to wear wigs. Scarves and hats are also a good option for those who wish to disguise the hair loss.
There are a large number of choices that can be made when dealing with sudden hair loss cause by Chemotherapy or Radiation Treatment. Everyone is different and will deal with this hair loss according to their needs.
The important thing to remember is that this hair loss is not permanent and once treatment is stopped the hair follicles will recover and the hair will grow back.
Self Induced Hairloss
Some damage to the hair is self inflicted sometimes consciously or unconsciously the two main types of self induced hairloss are Trichotillomania and Traction Alopecia.
Trichotillomania
Trichotillomania is self induced hairloss which results from the continuous pulling or plucking of the hair. It occurs most commonly among young children, adolescents and women and effects twice as many females as males. The hair is often pulled out in distinct patches on the scalp however some individuals also pull out eyebrows and eyelashes.
The treatment for Trichotillomania often involves counselling or psychiatric help, however in some cases an antidepressant may be prescribed.
Traction Alopecia
Traction Alopecia is usually caused by continuous and excessive pulling on the hair due to various types of hairstyling. Ponytails, buns, braiding and cornrows often result in a continuous pulling on the hair. This traction gradually results in hairloss. If this type of traction and hairloss continues for an excessively long period of time then the hairloss may become permanent. Generally however a change in hairstyle that reduces the traction on the hair and hair follicle is all that is required in the treatment of Traction Alopecia.
Telogen Effluvium
Sudden stress relate hairs loss which appears as thinning throughout the whole scalp
Telogen Effluvium occurs when sudden or severe stress causes an increase in the shedding of the hair. In Telogen effluvium a sudden or stressful event can cause the hair follicles to prematurely stop growing and enter into a resting phase. The hair will then stay in the resting phase for about 3 months after which time a large amount of hair will be shed. Often the person involved will have recovered from the event before the hair loss occurs. In most cases the hair loss is temporary and the hair soon recovers. However in some cases the hair loss continues until the underlying cause is fixed. Telogen Effluvium appears to affect more women than men because more of the precipitating event such as childbirth are experienced by women.
Temporary hair loss can be caused by:
Child Birth
Pregnancy Termination’s
Starting or Stopping Birth Control Pills
Dieting Drug
Therapy
Severe Emotional Stress
Hair loss after Child Birth
It is quite common for some women to experience some hair loss approximately 3 months after childbirth. This hair loss is triggered by the sudden changes in hormone levels.
Some statistics suggest a 20% of mothers lose hair during childbirth and others suggest a figure closer to 45%. Fortunately in most cases the hair will return to normal 9-12 month after the child’s birth.
Many woman notice that their hair is thicker and healthier during pregnancy, this is due to the increased levels of hormones oestrogen and progesterone which cause more hairs than normal to remain in the growth phase. When the child is born however many of the hair follicles that had delayed entering the resting phase suddenly enter the resting phase due to the rapid drop in hormone levels. As a result of this these hairs are then shed about 3 months after the birth.
Hair loss resulting from Pregnancy Termination’s
Similar to the way in which sudden hair loss can occur after childbirth sudden hair loss can also occur after and abortion or miscarriage which the hair loss is triggered by sudden changes in hormone levels. Hair that has remained in the growth phase due to increased hormone levels will suddenly enter the resting phase and will be shed approximately 3 months after the event.
Hair loss resulting form taking the Birth Control Pill
Birth control pills affect the hormone levels within the body and these hormone levels can affect hair growth. In some cases hair thinning may occur due to the male hormones present is some types of contraceptive pills, this type of hair loss is similar to pattern baldness or Androgenetic Alopecia. However discontinuation of The Pill can result in hair loss similar to that which occurs after child birth due to the drop in hormone levels.
Surgery
The shock involved in a major operation can result in sudden hair loss. Also after micrograft and minigraft surgery where follicles are transplanted on the scalp Telogen Effluvium almost always occurs. Due to the shock of surgery the hair follicles will fall out within about 3 months after which time new hairs will grow from the transplanted follicles.
Prescribed Drugs that can cause hair loss
Some drugs have been reported as causing hair loss in some individuals. While not everyone will experience hair loss some drugs are more likely to cause hair loss than others.
He following is list of some drugs that have been reported to have a side effect of hair loss:
Alloppurinol ( for the treatment of Gout)
Heparin ( blood thinner)
Coumarin (blood thinner)
Clofibrate (Cholesterol lowering drug)
Gemfibrozil (Cholesterol lowering drug)
The above drugs are only a few of the drugs that have been reported as contributing towards hair loss. If you suspect that prescription drugs that you are taking are causing hair loss you should discuss this with your doctor.
Hair loss caused by severe emotional stress
Some people experience Telogen Effluvium or sudden diffuse hair loss after a traumatic event such as the death of a family member or someone close, an accident, abuse or any other severely traumatic event. These events may trigger hair follicles to enter the resting phase prematurely in which case an increase in the amount of hair shed will be noticed about 3 months after the event, as the hair makes a transition from the
The above types to sudden hair loss are usually temporary an in most cases hair will grow back normally soon after it has fallen out. However in some cases where diffuse and sudden hair loss occurs the hair loss may continue until the underlying cause is treated. Types of sudden diffuse hair loss that continues until the cause is treated are as follows:
Thyroid Gland Malfunction
Diabetes
Anaemia
Systemic Lupus Erythematosis
Hair loss that is cause by the above underlying causes will usually continue until the underlying cause is treated.
Thyroid Gland Malfunction
Generally the first test a doctor or specialist is likely to carry out on a patient who is experiencing hair loss is a thyroid function test, as a thyroid problem may result in hair loss, Two types of thyroid problems can occur and either of these problems can result in hair loss. These conditions are Hypothyroidism and Hyperthyroidism
Hypothyroidism --- Underproduction of Thyroxin
Hypothyroidism occurs when the thyroid gland produces too little thyroid hormone (thyroxin) to meet the bodies needs.
Hyperthyroidism --- Overproduction of Thyroxin
Hyperthyroidism – Overproduction of Thyroxin Hyperthyroidism occurs when the thyroid gland produces too much Thyroxin hormone to meet the bodies needs. People with other auto-immune disease are especially vunerable to hyperthyroidism. Hair loss may occur from either hypothyroidism or hyper thyroidism. In some cases hair loss is minimal, however some individuals experience severe hair loss. Fortunately hair loss is usually reversible with proper treatment. If you suspect that you have a problem with your thyroid function then you should visit your doctor.
Diabetes
Diabetes occurs when the body is unable to metabolise carbohydrates correctly. Untreated diabetes can result in hair loss.
Systemic Lupus Erythematosus
This condition is an auto-immune disease which causes inflammation of multiple organ systems. The main signs of the disease are fever skin eruptions on the face and neck area, hands and arms. About half of the people with lupus will have hair loss. Systemic Lupus Eerythematosus mainly effects women between the ages of 20 and 50. It is thought that genetic makeup plays a major role in the development of the disease.
Scarring Alopecia
When inflammation of the hair follicles occurs due to infection it can lead to Scarring Alopecia. It is easy to identify a case of severe Scarring Alopecia because there will be rough patches on the surface of the scalp made up of small blood vessels and connective tissue. Scarring Alopecia can have many causes some of these causes and different types of Scarring Alopecia are discussed below.
Scarring Alopecia caused by Discoid Lupus Erythematosus
Discoid Lupus Erythematosus is a diffuse connective tissue disease which can result in hair loss on the scalp. In Discoid Lupus Erythematosis lesions occur a round scaling papules 5 to 10 mm across with follicular plugging. There may or may not be scaling. Eventually the skin becomes smooth atrophic and scarred. Lupus is a photosensitive disease therefore exposure to sunlight should be minimised. Topical cortocosteroid ointments such as Triamcinolone Acetonide may be helpful in the treatment of small lesions. Also anti malarial drugs such as hydroxychloroquine are useful in the management of Discoid Lupus Erythematosis.
Lichen Planus
Lichen Planus is a rather uncommon skin disease that effects about 1% of the population. Lichen Planus is a inflammatory disease that strikes primarily the skin and mucous membranes. It usually starts as an itchy patch on the front of the wrists and forearms. the sides of the legs and ankles and lower back. In rare cases, when Lichen Planus can effect the scalp and other hairy areas this is called Lichen Planopilaris. It appears on the scalp as raised reddish-purple areas that look like lichen on a rock, or as an area of Alopecia with follicle plugging which usually clears up. Steroid lotions are used to relieve itchiness, antimalarial drugs may reduce inflammation.
Pseudopelade of Brocq
Pseudopelade of Brocq is a rare Scarring Alopecia which has no potential for regrowth. It usually affects middle aged people.
Aplasia Cutis Congenita
Aplasia Cutis Congenita is a rare disorder that often results as a small blistered atrophied area usually in the midline of the scalp and present from birth. In most cases the problem heals itself however in larger areas it may be associated with underlying developmental disorders.
Congenital Atrichia
Congenital Atrichia occurs when a baby is born without hair follicles in certain areas. This can be quite common and usually only occurs in a few spots which are easy to cover.
Other types of Hair loss
Syphilitic Alopecia
Syphilitic Alopecia is usually a manifestation or secondary syphilis. The hairloss that occurs is patchy and often described as moth eaten. Diagnosis is made by either blood test or microscopic examination and penicillin is often used to treat the condition.
Scleroderma
Sclerodema is a disease that causes fibrosis (hardening and tightening) of the skin. The hardening is caused by excessive collagen production, which causes hardening of the skin and when it appears on the scalp interferes with the normal functioning of the hair follicles and growth of the hair. The manifestation of Scleroderma can range from mild localised Scleroderma where just a few patches may appear on the skin or it can be severe and effect the internal organs as well. This type of Scleroderma is known as Systematic Scleroderma. Sclerodema is much more common in women with the onset usually occurring between the ages of 40-60.
Tinea Capitis
Tinea Capitis is another name for ringworm, which appears on the scalp. Tinea Capitis is highly contagious and may spread throughout an entire family, school or kindergarten. It can also be passed from animals to humans as well as between people. The main symptoms or signs of Tinea Capitis is scaling and redness in a round or uneven area of stubbled hairloss. This is where the Tinea is digesting the keratin of the hair. These patches of hairloss slowly expand as the Tinea spreads. The most commonly used treatment for ringworm is an anti fungal agent which is taken once a day for a period of between four and twelve weeks. Nizoral Shampoo (Ketaconazole 2%) may occasionally be prescribed in addition to oral treatment to reduce the surface scaling.
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