Hair loss, in today’s society, affects a large number of people. That said, not everyone suffers from the same ‘type’ of hair loss. It manifests in various forms, each with a varying degree of severity. The general medical term for hair loss is Alopecia. Alopecia stems from a number of factors; these can range from genetics to environmental, or even psychological influences. Some more specific forms of hair loss include: androgenetic alopecia, telogen effluvium, alopecia areata, ringworm and scarring alopecia. Hair loss can even occur as a result of cosmetic overprocessing.
This article takes androgenetic alopecia – hair loss in its most common form – as its focus. However, it will also discuss some other predominant forms of hair loss identified by dermatologists over the years. Dermatologically, enormous breakthroughs have been made with hair loss over the last few years, yet research into hair biology and hair diseases is still limited. Such research must increase in the future if dermatologists are to continue to make advances.
Telogen Effluvium (TE) is one of the most common forms of hair loss. Surprisingly little research has been done with regard to this condition. The word ‘effluvium’ means ‘outflow’. TE affects different phases of the hair growth cycle. TE occurs when the number of growing hair follicles changes. When the number of follicles producing hair falls significantly during the resting, or ‘telogen’ phase, the amount of dormant telogen stage follicles will concomitantly increase, resulting in TE.
TE can develop in any number of ways. Environmental forces are a common factor, causing TE by “shocking” the growing hair follicles into a resting state for a while, resulting in an increase in hair shedding. This causes the hair to thin. Removing the subject from exposure to the environmental force easily reverses any hair loss incurred. The follicles are then able to return to their growing state and start producing new hair fibres resulting in a full head of hair within a year.
The thinning of hair on the top of the scalp usually characterizes the condition. Hairline recession is rare. It is not often that an individual suffering from TE will lose all of there hair, although severe cases can see hair loss from their eyebrows and from their pubic region. Because the hair follicles are not permanently damaged, most of the time TE hair loss is relatively easy to reverse by the use of medication.
The manner in which one treats TE depends on its causation and severity. If it manifests through stress, treatment can be simple; taking natural supplements, or undertaking activities for stress control, like a diet plan or an exercise program (running and yoga). If no particular cause can be identified, hair loss medications like Minoxidil might be prescribed.
Anagen Effluvium (AE) develops rapidly in comparison to TE. Under normal conditions, hair fibre grows at up to 0.4mm a day, which requires certain rates of cell proliferation. Cytostatic cancer drugs and various toxins and poisons inhibit such rapid cell growth, thereby curbing hair fibre production. As a result, AE is most commonly found in individuals with such poisons contained in their bloodstream.
It’s onset involves hair fibres beginning to fall out. These fibres have a tapered root end, and are called dystrophic Anagen hairs. Some patients receiving cancer treatment use cold therapy – a cap with ice packs and cold water, placed on the patient’s head – which shocks hair follicles into suspended animation prior to the drug’s action taking place and hence minimizing damage. Some patients do not use cold therapy due to the discomfort it entails. Their decision is further justified in that the recovery period for AE is quite rapid. New hair can grow within a month, although it may be permanently changed, texturally or in colour. Because the follicles are effectively frozen in time, they can continue to grow once the poison causing the anagen effluvium has been removed.
Alopecia Areata (AA) is the third most common form of hair loss. Around 2% of people will experience it within their lifetime, a condition affecting men, women and children. Like the aforementioned forms of hair loss, the research that has been completed on this condition is insufficient. What has been established thus far is that AA stems from an inappropriately activated immune system. This causes the immune system to mistakenly attack hair follicles, regarding them as a threat to the body. Alopecia Areata describes partial hair loss on the scalp. Alopecia Totalis is the terminology used for hair loss that has spread over the entire scalp, while Alopecia Universalis is used for hair loss affecting an individual’s eyebrows, lashes, beard and pubic hair. If just limited to the beard area, hair loss is called Alopecia Barbae.
AA appears as clearly defined, circular bald patches on the scalp. Fortunately, AA is unlike other autoimmune diseases as hair follicles are not completely destroyed, and regrow once inflammation subsides. Sadly, around 30% of individuals experience the condition permanently or semi-permanently. This can result in the affected area growing as time passes. Traditionally regarded as a stress-induced condition, dermatologists now believe that AA is much more complicated. Genetics, hormones, allergies, viruses and toxins have revealed themselves to be factors in this affliction.
Most commonly AA treatment involves corticosteroids, applied to bald patches. Extreme cases might call for systemic corticosteroids (ingested orally or otherwise), “pulse therapy” or specialized treatments that involve the application of sensitizing chemicals to the skin, designed to encourage hair growth. For some unfortunate individuals, though, all treatments prove ineffective, meaning the only solution may be hair grafts or wigs.
Scarring alopecia is also known as cicatricial alopecia. This is a broad term, and incorporates: dissecting cellulitis, eosinophilic pustular folliculitis, follicular degeneration syndrome (previously called “hot comb” alopecia), folliculitis decalvans, lichen planopilaris, and pseudopelade of Brocq, amongst other conditions. Scarring alopecia might also represent a facet of a much more generalized condition such as chronic lupus erythematosus.
There are numerous forms of scarring alopecia. They all permanently destroy hair follicles, producing enduring hair loss. These forms may first present as small patches of hair loss, the extent of this loss increasing with time. The spread might also involve severe itching, burning, and pain. If a dermatologist suspects scarring alopecia, they will conduct a skin biopsy to confirm the diagnosis. On confirmation, the patient is generally treated with corticosteroids and by injections into the affected area. Extreme cases can require the use of antimalarial and isotretinoin drugs.
If an individual cannot grow hair, their condition is called Hypotrichosis. ‘Alopecia’ describes hair loss; ‘hypotrichosis’ describes a situation where hair loss cannot occur due to an absence of hair to lose in the first place. Hypotrichosis is caused by genetic aberrations or defects of embryonic development, and so sufferers are often born with the disease. There are hundreds of different varieties of hypotrichosis, all lacking treatment options. A few forms of hypotrichosis include:
A baby may be born with a patch of skin that is like an open wound or an ulcer. This is a developmental defect from the womb. This defect often occurs at the rear of the scalp. If the defect is small, the skin will scab over and the baby will be left with a scar. If the congenital aplasia is large, an operation may be required.
Triangular alopecia (alopecia triangularis) affects a triangular patch of skin and hair above the temples. Hair follicles are unable to grow in the affected area. Treatment might involve the implantation of hair follicles taken from elsewhere on the body.
Individuals with Congenital Atrichia (CA) are born with a full head of hair but lose this hair as a child. This loss is permanent. It can be caused by a single gene defect, even though the child’s parents do not manifest the condition physically. CA occurs as a result of the hair follicles entering their first resting state (telogen phase) in early childhood. The telogen phase means the dermal papilla cells remain deep in the skin, and are thus unable to communicate with the epithelial cells. This communication line is essential for the growth of hair. This means the anagen growth phase cannot commence, and therefore, no future hair growth will occur.
Seborrheic dermatitis is a skin condition that may also lead to temporary hair loss if it affects the scalp. Dermatitis causes the skin to appear oily and inflamed, can be itchy and can be painful to the touch. Seborrheic dermatitis occurs when the sebaceous glands at the base of the hair follicles start producing an unusually large amount of rich sebum. This excess of rich sebum triggers the proliferation of skin flora. Dermatitis often correlates with the fluctuation of hormones, such as occurs during puberty. Other causes of Seborrheic dermatitis include Parkinson’s disease, head injury, stroke and stress. Deficiencies of essential nutrients and chronic fatigue can exacerbate the condition should it already exist.
Although it predominantly affects the skin, if hair follicles are close to the inflammatory cells they can be adversely affected, as the skin becomes a difficult environment for their growth. Medicated shampoos may be effective in treating seborrheic dermatitis. The inflammation may also be treated using a corticosteroid cream. While the condition may vanish quickly, a preventative treatment is advisable.
Loose Anagen Syndrome
A self-descriptive condition, loose anagen syndrome is the growth of ‘weak’ hair that is loose and easily pulled from the follicle. Loose anagen syndrome is often found in young children (more commonly in blonde haired children) and the rear of the head is often more susceptible. The condition occurs when the root sheaths that protect the hair shaft in the skin are underdeveloped. Because the sheaths are not fully formed there is insufficient adhesion between the hair shaft and the root sheath, meaning the hair is easily pulled out. For example, when sleeping, the friction between the pillow and one’s hair can cause substantial hair loss. Even remaining hair may not grow particularly long. This means the hair fibre is poorly anchored in the follicle. There is no known effective treatment for loose anagen syndrome.
Traction alopecia occurs when an individual wears a tight hat, has a cornrow hair style, braids the hair or pulls the hair into a tight pony tail/ bun. The pulling action puts the hair under undue pressure, meaning hair loss occurs. The condition leaves clear bald patches or sparse, thin coverage. If causative actions continue for a long time and the same hair is repeatedly pulled out, then the hair follicles may stop growing hair permanently due to the damage they have incurred.
Overprocessing and Cuticle Stripping
The most common cause of hair loss and damage by far is overprocessing. Examples include perming, bleaching, straightening and hair dyeing, which all involve harsh chemicals that significantly compromise the integrity of hair fibre. For such treatments to work, the cuticle must be opened up so that other active ingredients can reach the hair cortex and rearrange the chemical bonds in the hair structure. If the chemicals are extremely caustic, or are used too frequently the cuticle can be permanently damaged, leading to hair loss or an appearance of dull, “dry” and frizzy hair, which often ‘breaks’ in time.
Some physical techniques which also badly damage hair include aggressive brushing, back combing, and other grooming techniques, causing breakage by exerting high levels of strain on the hair. To ‘fix’ the damage caused by any of these techniques, the best approach is to cut off as much damaged hair as possible and to be gentle until new, undamaged hair grows. There are cosmetic treatments to help “glue” damaged hair back together, yet these have limitations in that they only work for a short period and have to be reapplied regularly. Patience, in this case, is the best cure.