HAIR LOSS CONDITIONS
What is Hair Loss?
(AND WHAT CAN YOU DO ABOUT IT?)
Hair loss or alopecia (alopecia is a blanket term for all hair loss conditions) can be caused by an array of reasons, ranging from medical conditions, to genetics, to hormone imbalances. But whatever the cause may be, dealing with hair loss can be severely emotionally stressful and difficult time.
Getting to the root of your hair loss isn’t something to take lightly. Some hair loss conditions, whilst devastating, are cosmetic and won’t have any impact on your physical health. However, some hair loss conditions can be indicative of deeper health issues or even serious illness.
genetic hair loss
What is Androgenetic Alopecia?
Androgenetic Alopecia is more commonly known as genetic hair loss or male/female pattern baldness. It’s the most common type of progressive hair loss and affects 50% of men over the age of 50 and 50% of women over the age of 65.
What causes Androgenetic Alopecia?
It’s caused by a combination of genetics and hormones. The hormone Dihydrotestosterone (DHT) is the hormone responsible for triggering Androgenetic Alopecia in those with a genetic predisposition. DHT causes hair loss by triggering changes in the hair follicle, causing progressive shrinkage of the follicle and subsequently the hairs growing from that follicle, until the follicle shrinks completely and hair eventually stops growing.
Is Androgenetic Alopecia hereditary?
Yes, Androgenetic Alopecia is hereditary and it can be passed by the genes from either or both parents and can present in males as early as in their 30’s. Women tend to see symptoms later in life but occasionally, women may begin noticing the early signs in their 30’s or 40’s. Early onset Androgenetic Alopecia in women has been associated with with Polycystic Ovary Syndrome (PCOS) due to an excess of male hormones.
What does Androgenetic Alopecia look like?
Androgenetic Alopecia looks different in men and women. In men the usual pattern of loss is a receding hairline and hair loss from the crown or top of the head. In women, hair loss is apparent at the crown or top of the head with very little or no loss at the hairline.
Can Androgenetic Alopecia be cured?
No, unfortunately Androgenetic Alopecia cannot be cured but as it’s a progressive condition hair loss can span years, sometimes even decades before sufferers decide to address it. Early onset may result in quicker progression.
Can Androgenetic Alopecia be treated?
There are a few products for the treatment of Androgenetic Alopecia.
Medications which help to reduce levels of DHT also exist. This can potentially slow hair loss and encourage regrowth of hair. Users typically need to take the medication for 3-6 months before seeing any result and beneficial effects tend to wear off within a relatively short period after discontinuing the treatment.
Cosmetic options such as wigs, hair pieces and hair systems are great ways to disguise the progression of Androgenetic Alopecia, as well as Scalp Micropigmentation, more information on these options can be found on the Hair Loss Solutions page.
Generally chemotherapy is the treatment that is most likely to affect hair loss. Complete hair loss with other therapies is unlikely, some hormone therapies and biological therapies can cause thinning of the hair, although in most cases this is generally manageable.
Hair loss is one of the most commonly known side effects of chemotherapy. It is a common misconception that all chemotherapy drugs cause hair loss, however this is not true. Some drugs in this category don’t cause any hair loss and some cause only slight thinning.
Some chemotherapy drugs can cause hair loss though, which can include the eyebrows, eyelashes and body hair as well. It can be total (alopecia), partial (patches) or thinning. Hair loss is usually gradual and begins around 2-3 weeks after the treatment has begun.
There is a treatment that can be successful in reducing the severity of hair loss from chemotherapy called scalp cooling/the cold cap. Hair loss occurs because chemotherapy targets all rapidly dividing cells, it attacks healthy cells as well as cancer cells.
Hair follicles, the structures in the skin filled with tiny blood vessels that make hair, are some of the fastest-growing cells in the body. The patient wears the cold cap in order to reduce the temperature of the scalp, this reduces blood flow and restricts the drug’s impact on the hair follicle. The reduction in blood flow results in the hair being exposed to less of the drug which ordinarily would attack the hair follicle, resulting in a reduction in hair loss.
Scalp cooling only blocks certain chemotherapy drugs and doesn’t work for everyone. So the patient may still have hair thinning, or lose their hair completely. It’s impossible to predict whether it will work for them until they have tried it. Scalp cooling also can’t be used for all types of cancer. The patient can’t have scalp cooling if there is too high a risk that there might be cancer cells in the scalp blood vessels. This is because the cells in these blood vessels might survive the treatment.
Scalp cooling isn’t usually available for people:
- with cancers such as leukaemia and lymphoma
- with cancers that have spread to the scalp
- who are due to have radiotherapy to their scalp
Scalp Cooling also wouldn’t be suitable for patients having continuous chemotherapy through a pump or those taking chemotherapy tablets. This is because they would need to wear the cold cap 24 hours a day. The patient needs to begin Scalp Cooling for a period of time prior to starting chemotherapy. It is often described as being uncomfortable.
Trichotillomania, also referred to as “Trich” or “hair-pulling disorder,” is a mental disorder classified under Obsessive-Compulsive and Related Disorders and involves recurrent, irresistible urges to pull hair from the scalp, eyebrows, eyelids, and other areas of the body, despite repeated attempts to stop or decrease hair pulling.
Hair pulling from the face can result in complete or partial removal of the eyebrows and eyelashes, while hair pulling from the scalp can result in varying degrees of patches of hair loss. The hair pulling and subsequent hair loss results in distress for the person, and can interfere with social and occupational functioning.
For some people, the symptoms of trichotillomania are manageable, but for others, the symptoms can be completely overwhelming.
Trichotillomania is often treated using a type of CBT (Cognitive Behavioural Therapy) called habit reversal training.
Hair pulling treatment may involve:
- Keeping a diary of your hair pulling.
- Working out the triggers for your hair pulling and learning how to avoid them.
- Replacing hair pulling with another action, like squeezing a stress ball.
- Loved ones providing emotional support and encouragement.
The charity Trichotillomania Support has information on treatments and self-help advice.
What is Alopecia Areata?
Alopecia Areata is a common cause of non-scarring (does not cause scarring of the scalp) hair loss and can happen at any age. It usually presents as small circular patches or areas of hair loss on the scalp but can also appear on any part of the body where hair grows such as in the beard, eyebrows, eyelashes and even loss of areas of bodily hair. In some cases, Alopecia Areata can affect much larger areas, even the whole scalp (Alopecia Totalis) or in severe cases the whole scalp, brows, lashes and body (Alopecia Universalis).
What causes Alopecia Areata?
The cause of these conditions is inflammation, the cause of which is unknown however it is generally considered to be an autoimmune condition by many specialists which means that the body’s immune system, responsible for protecting the body from infections and disease, may be attacking the hair follicle. Alopecia Areata is not contagious, nor has any connection been made to malnutrition or vitamin deficiency. .
Does the hair grow back?
It’s impossible to predict how much hair will be lost, or if and when it will grow back. Regrowth in a typical Alopecia Areata sufferer can take months but sometimes it can take years and sometimes it does not grow back at all. Hair that does grow back sometimes grows back white at first. Those who only suffer with small patches generally experience regrowth within a year however this cannot be guaranteed. Those who suffer with Alopecia Totalis or Universalis generally do not experience total regrowth, a common opinion is that if the sufferer loses 50% or more of their density then total regrowth is unlikely.
Can Alopecia Areata be cured?
No, unfortunately Alopecia Areata, Totalis and Universalis cannot be cured. Whilst 4 out of 5 sufferers of Alopecia Areata will experience periods of regrowth, periods of hair loss can recur. If the hair lost at first is extensive, then periods of regrowth are less likely. Those with more than 50% loss of density have approximately a 10% chance of full recovery. Children suffering with the condition have a lower chance of full recovery as well as those suffering with loss of density at the hairline, front, sides or back.
Can Alopecia Areata be treated?
Whilst there are options on the market for treating Alopecia Areata, Totalis and Universalis, some are more successful than others and to date none have proven to be definitively successful. This is likely due to the lack of knowledge of the cause of the condition. These methods are available in the form of steroid creams, steroid injections, steroid tablets, UV light treatment, laser scalp treatments, minoxidil ointments and drugs and immunosuppressant drugs. Some of these methods, like most medications and treatments have some serious side effects, including (ironically) hair loss.
Scarring may not be visible on the surface of the skin as the hair follicles lay in the dermis. These conditions are relatively rare but can affect both men, women and children and can cause permanent hair loss.
What causes Cicatricial Alopecia?
There are two categories of cicatricial alopecia – primary and secondary. Primary Cicatricial Alopecia affects the hair follicles directly and Secondary Cicatricial Alopecia is caused by damage to the follicle relating to another health condition or an injury such as burns, radiation or traction.
Primary Cicatricial Alopecia’s include Lichen Planopilaris, Frontal Fibrosing Alopecia and Pseudopelade can develop quickly with little to no symptoms so the condition often goes undetected for some time. In contrast, these condition can also develop rapidly with redness, a scaly scalp, pustules and increase/decrease in pigmentation, this can also be accompanied by itching, burning and scalp pain.
Cicatricial Alopecia is thought to have a number of causes. All Cicatricial Alopecia’s present with inflammation which directly affects the hair follicle, eventually destroying it and causing permanent hair loss.
Is Cicatricial Alopecia hereditary?
No, Cicatricial Alopecia is not considered hereditary as the condition tends to affect individuals rather than groups in families. However, Central Centrifugal Cicatricial Alopecia – often referred to as Follicular Degeneration Syndrome which is most commonly found in women of African descent, sometimes does present in members of the same family.
What does Cicatricial Alopecia look like?
Cicatricial Alopecia is a collective name for many different kinds of scarring alopecia so can look different depending on the cause. Sone examples are shown here.
Can Cicatricial Alopecia be cured?
No, due to it’s scarring nature, Cicatricial Alopecia is permanent.
Can Cicatricial Alopecia be treated?
At present, there is no known effective treatment for most forms of Cicatricial Alopecia. Steroids, anti-inflammatories and tetracycline are sometimes used to treat Cicatricial Alopecia but they are not thought to be very successful.
Hair loss treatments generally provide stimulus to the hair follicle and once the hair follicle has been destroyed it will no longer respond to treatment. One exception is Central Centrifugal Cicatricial Alopecia which has been known to respond positively to minoxidil when in the early stages.
OTHER HAIR LOSS CONDITIONS...
Involutional Alopecia is the progressional thinning and loss of hair that comes with age. Unlike Androgenetic Alopecia, it is not caused by high levels of DHT shrinking the follicle. Over time, a greater number of hair follicles move into the resting phase and remaining hairs become shorter, finer and fewer in number. After Androgenetic Alopecia, ageing is the second most common type of hair loss.
Hypotrichosis is a congenital condition where there is no hair growth from the time of birth. Rather than having hair and losing it over time, people with hypotrichosis never grow any hair. This condition is thought to be caused by a genetic deviation during foetal development but is more common in males. Hypotrichosis happens during foetal development so is considered hereditary.
Babies with Hypotrichosis are born with very little, fine vellus hair or no hair at all and the hair does not continue to grow normally. Hypotrichosis is generally considered permanent but hair transplant in adulthood is an option and can be successful. There is no known successful treatment for Hypotrichosis
Folliculitis is usually caused by bacterial infection and occurs when the hair follicles become inflamed due to a blockage or damage. Follicles will likely be surrounded by a ring of inflammation and can look like acne. In the early stages, hair may still be present in the follicle, but as the condition progresses, it will fall out. In severe cases, the inflammation can permanently damage hair follicles and result in permanent hair loss.
Telogen effluvium typically occurs when hair follicles are prematurely pushed into the resting (telogen) phase of hair growth.
Telogen Effluvium usually occurs due to an acute external factor such as physical trauma, surgery, major illness or other periods of intense stress on the body. Postpartum Telogen Effluvium is also what some new mothers experience within a 3 month period after giving birth.
Traction Alopecia results from damage caused by continuous pulling, rubbing or tension applied to the hair follicle. Sufferers who wear their hair pulled up in tight ponytails, buns or braids. usually notice hair loss around the hair line.
Chignon Alopecia is a form of localised alopecia at the crown caused by wearing the hair in a chignon style for long periods of time.
Traction Alopecia can be caused by poorly applied hair extensions as well as hair replacement systems and weaves. It is caused by environmental factors so is not a hereditary condition. In most cases Traction Alopecia can be reversed by wearing the hair in a looser style or by wearing the hair down. If permanent damage is sustained to the hair follicle then the condition could be permanent.
Trichorrhexis Nodosa is identified by weak points (nodes) present along the hair shaft. The nodes cause hair to be brittle and break easily, leading to the appearance of thinning hair or patchy hair loss. The condition can be triggered by harsh styling habits such as the over use of chemicals and heat styling tools. This is often present in those who say their hair keeps breaking or won’t grow past a certain length.