Hair loss

 

 

Abnormal hair loss (alopecia) of more than 100 hairs a day is a cause of concern. Hair loss may be permanent or temporary, rapid or slow, and diffused, patterned or complete. It may be caused by genetic, environmental, or medical reasons and may or may not be treatable.

 

 

When hair loss is permanent and accompanied with inflammation, skin problems, or tissue destruction, it is called scarring hair loss. There is no such scalp tissue damage in nonscarring hair loss.

Androgenic alopecia is hair loss caused by genetic factors or family history. It is the common form of hair loss observed in both men and women where hair loss occurs in a certain pattern.

Men usually start losing their hair above the temples and form a typical M shape, while thinning of hair all over the scalp is observed in women. It is more common in men, and usually occurs after menopause in women. Androgenic alopecia is caused by androgens, particularly dihydrotestosterone.

Alopecia areata is a form of hair loss that occurs when body’s immune system starts attacking healthy hair follicles. Hair loss occurs in well-rounded patches and may affect other body parts as well, including eyebrows and eyelashes.

Alopecia areata may be caused by genetic or environmental factors or conditions such as celiac disease, vitiligo, atopy, and thyroid disorders. It affects both men and women, though is more commonly seen in males.

Telogen effluvium is a rapid, sudden, diffuse hair loss that may be triggered by a disease, stressful situation, drugs, delivery, iron deficiency, weight loss, or fever. Hair loss may be severe with 100 to 200 hairs being shed daily. It is usually seen in women.

Chronic telogen effluvium, seen in middle-aged women, is hair loss for more than 6 months accompanied with scalp pain.

Traumatic alopecia is hair loss due to pulling or use of chemicals or heat (e.g., hair straightening).

Trichotillomania is a form of hair loss that occurs due to repeated pulling and plucking of hair by the person itself. Patchy or irregular hair loss may occur without total baldness as small strands of hair remain on the scalp. It is a compulsive disorder and may require psychiatric help. It is more common in children.

Other reasons that may trigger hair loss include:

1. Poor nutrition

2. Low protein diet

3. Certain medicines

4. Family history of hair loss

5. Infections

6. Chemotherapy for cancer (anagen effluvium)

7. Autoimmune conditions such as allergic disorders, vitiligo, lupus, and rheumatoid arthritis

 

 

Abnormal hair loss occurs that may be mild (less than 100 hairs a day) or severe (100 to 200 hairs a day or more).

 

 

A detailed clinical examination along with family and medical history is required to determine the cause of hair loss. Physical exam to check pattern and extent of hair loss, inflammation or other skin issues, hirsutism or excess hair (in women) will be done.

Pull test: The patient will be asked not to wash hair for 24 hours. About 60 hairs will be pulled gently. Out of them, six or more hair must get removed to suspect for excessive hair loss.

1. Blood tests

a) Complete blood count (CBC) to check for iron deficiency

b) Thyroid stimulating hormone (TSH) for thyroid disorders

c) ANA (antinuclear antibody) test

d) RPR (rapid plasma regain) for syphilis

2. Trichogram -- hair are visualized under light microscopy

3. Scalp biopsy

 

 

The treatment will depend on the extent of hair loss, the age of the patient, and the cause of hair loss. Treatment is more effective in mild cases of hair loss, though it may take months or years. Treatment may include one or more of the following:

1. Finasteride and/or topical minoxidil for pattern alopecia in men

2. Antiandrogens such as spironolactone or topical minoxidil for pattern alopecia (androgenic alopecia) in women

3. Corticosteroid injections such as triamcinolone hexacetonide given once per month for alopecia areata

4. Medicines such as methotrexate

5. Topical immunotherapy

If treatment does not work, hair transplantation may be considered. A hair weave (synthetic hair is sewn into existing hair) or a hair piece may help.

 

 

See a doctor if you have an abnormal rate of hair loss. Untreated hair loss may cause baldness.

 

 

If hair loss is caused due to a stress factor (traumatic alopecia, telogen effluvium), full regrowth of hair may occur once the stress factor is removed. Hair loss usually requires continuous medication and may relapse once the medicine is discontinued.

 

Skalecki J. Alopecia. In: Ferri FF ed. Ferri’s Clinical Advisor 2017. Elsevier.

Bope ET, Kellerman RD. Diseases of the skin. In: Bope ET, Kellerman RD eds. Conn’s current therapy 2017. Philadelphia (PA) Elsevier Saunders Chap 14.

Diseases of Hairs And Nails. In: Goldman L, Schafer AI. Goldman-Cecil Medicine. 25th ed. chap 442.