Alopecia
What are causes of hair loss?
There are many causes of scalp hair loss, and they do differ in men and women. This article will cover the common ones. Studies show that losing up to 100-150 hairs per day is normal. Human hair naturally grows in three phases: anagen, catagen, and telogen.
- Anagen is the active or growing phase.
- Catagen is a fairly short phase of the natural hair cycle during which hairs begin to break down.
- Telogen is the resting phase.
The hairs that are shed daily are often in the resting or late phase in the hair cycle. Normally, about 10% of the scalp hairs are in the resting or telogen phase at any time. These hairs are not growing and are getting prepared for cyclic shedding.
- stress,
- nutritional changes,
- hormonal changes like those in pregnancy, puberty, and menopause may cause a reversible hair loss.
- several health conditions, including thyroid disease and iron deficiency anemia, can cause hair loss.
- cancer treatments and immune suppression medications including chemotherapy, hair loss is a very common side effect.
How is hair loss classified?
Patchy hair loss
Some conditions produce small areas of hair loss, while others affect large areas of the scalp. Common causes of patchy hair loss are
- alopecia areata (small circular or coin size patches of scalp baldness that usually grow back within months),
- traction alopecia (thinning from tight braids or ponytails),
- trichotillomania (the habit of twisting or pulling hair out),
- and tinea capitis (fungal infection).
What is alopecia areata?
A common condition, alopecia areata usually starts as a single quarter-sized circle of perfectly smooth baldness. Alopecia patches usually regrow in three to six months without treatment. Sometimes, hair grows back in white. In another variant, alopecia can produce two or three bald patches. When these grow back, they may be replaced by others. The most extensive form is called alopecia totalis, in which the entire scalp goes bald. It’s important to emphasize that patients who have localized hair loss generally don’t go on to lose hair all over the scalp. Alopecia can affect hair on other parts of the body, too — for example, the beard or eyebrow.
Alopecia areata is generally considered an autoimmune condition, in which the body attacks itself (in this case its own hair follicles). Most alopecia patients, however, do not have systemic problems and need no medical tests. While alopecia areata has frequently been blamed on “stress,” in fact, it may be the other way around; that is, having alopecia may cause stress.
What is traction alopecia?
This is a small or localized hair loss area caused by repetitive or persistent pulling or force on hair roots. Tight braids and ponytails can pull hard enough on hairs to make them fall out. If this happens, it’s best to choose hairstyles that put less pressure on hair roots. The sooner this is done the better to avoid permanent damage.
What is trichotillomania?
This refers to the habit of someone voluntarily pulling at their own hairs or twisting them, sometimes without realizing it. The scalp and eyelashes are often affected. Unlike alopecia areata patches, which are perfectly smooth, hair patches in trichotillomania show broken-off hairs. Treatment is often entirely behavioral: You have to notice that you’re doing it and then consciously stop. Severe or resistant cases may require stress counseling with a therapist or psychologist or medical treatment with a psychiatrist. Several antidepressant or anxiety medications have been shown to potentially help with this condition.
What is tinea capitis?
Tinea is the medical word for fungal infection, and capitis means head. Tinea capitis is fungal infection of the scalp that for the most part affects school-age children. Tinea capitis is more common in black African or African-American scalps. This condition is rare in healthy adults. Bald spots usually show broken-off hairs.
What is generalized (diffuse) hair loss?
This is an overall hair thinning without specific bald spots or patterns. While this type of hair loss may not be noticeable to others, often the individual will feel their hair is not as thick or full as it previously was. Common conditions in this category are
- telogen effluvium (rapid shedding after childbirth, fever, or sudden weight loss);
- androgenetic or androgenic hair loss (“male-pattern baldness,” “female-pattern baldness”).
What is telogen effluvium?
Under normal conditions, scalp hairs live for about three years (the anagen, or growing, phase); they then enter the telogen, or resting, phase. During the three-month telogen period, the hair root shrivels up into a small white “club,” then the hair falls out. It is therefore normal to lose about 100 hairs every day, more of them on days when shampooing loosens the hairs that are ready to fall out. The hairs are then replaced by the body.
Sometimes people worried about losing their hair start noticing hairs on their pillow or in the sink, not realizing that they’ve always been there. A close look at these will usually reveal the white club at the end, showing that these hairs were already dead. Normally, about 10% of scalp hairs are in the telogen phase.
There are several circumstances that produce a “shock to the system” that alters the hair growth rhythm. As a result, as much as 30%-40% of the hairs can cycle into telogen. Three months later, hairs come out in a massive shedding (effluvium), especially near the front of the scalp. These include
- childbirth,
- high fever,
- sudden weight loss (crash dieting),
- surgery,
- severe illness,
- and severe stress or loss (death in family, announcing change in sexual preference “coming out of the closet,” divorce, etc.).
What is androgenetic or androgenic alopecia (“male-pattern baldness,” “female-pattern baldness”)?
This type of alopecia is often attributed to genetic predisposition and family history. Traditionally, this was originally described only in men, but we now know it is seen in both men and women. The hair loss in men is often faster, earlier onset, and more extensive.
Doctors refer to common baldness as “androgenetic alopecia” or “androgenic alopecia,” which implies that a combination of hormones and heredity (genetics) is needed to develop the condition. The exact cause of this pattern is unknown. (The male hormones involved are present in both men and women.)
Male-pattern baldness
Even men who never “go bald” thin out somewhat over the years. Unlike those with reversible telogen shedding, those with common male-pattern hair loss don’t notice much hair coming out; they just see that it’s not there anymore. Adolescent boys notice some receding near the temples as their hairlines change from the straight-across boys’ pattern to the more “M-shaped” pattern of adult men. This normal development does not mean they are losing hair.
Some “myths” about male-pattern baldness
- You inherit baldness through your mother’s male relatives. Actually, baldness can come from either side of the family or both. Looking at your family can give you at best an educated guess about how you’ll turn out. Studies are ongoing in this field, and current research has been inconclusive about the inheritance patterns.
- Longer hair puts a strain on roots. It doesn’t. And hats don’t choke off the circulation to the scalp to cause hair loss either.
- Shampooing does not accelerate balding.
- “Poor circulation” does not cause hair loss, and massaging doesn’t stop it.
Is hair loss in women different than men?
Women lose hair on an inherited (genetic) basis, too, but the female pattern tends to be more diffuse, with less likelihood of the crown and frontal hairline being lost. Although some women may notice hair thinning as early as their 20s, the pace of hair loss tends to be gradual, often taking years to become obvious to others. There seems to be a normal physiologic thinning that comes with age and occurs in many women in their early to mid 30s. More women have underlying causes of hair loss than men. These include treatable conditions like anemia and thyroid disease.
Hair loss “myths” of special concern to women:
- Longer hair does not necessarily put a strain on roots.
- Shampooing does not accelerate hair loss; it just removes those that were ready to fall out anyway.
- Coloring, perming, and conditioning the hair do not usually cause hair loss. Burns or severe processing may cause hair loss and breakage. Styles that pull tight may cause some loss, but hair coloring and “chemicals” usually don’t.
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