Hair Loss Causes

HAIR CLINIC

Hair Loss Causes

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Hair Loss Causes2020-11-20T10:08:44+00:00

Hair Loss Causes

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CLINIC
      • Female patterned hair loss (FPHL) is a distinct pattern of hair thinning. Approximately 40% of women show signs of FPHL by the age of 50.
      • The cause of FPHL is a combination of genetic and hormonal factors. FPHL is also associated with conditions in which androgens are elevated, such as in polycystic ovarian syndrome.
      • There is often widespread thinning throughout the scalp, particularly the crown. The frontal hairline is often maintained. Hair follicles also reduced in diameter (known as minaturisation), before they are lost.
      • Historically minoxidil and hormonal therapies (eg. spironolactone) have been the mainstay of treating FPHL However, there is evolving evidence for the use of platelet rich plasma (PRP), microneedling, newer cell based therapies (Regenera) and low level light therapy (LLLT). In some cases hair follicle transplantation might also be appropriate.
      • Male patterned hair loss (MPHL) is the most common type of hair loss in men, affecting about 50% of men over the age of 50.
      • The cause of MPHL is a combination of genetic and hormonal factors. MPHL is a genetically determined increased sensitivity to the effects of dihydrotestosterone (DHT). DHT causes scalp hair to become thinner, shorter and lighter in colour until eventually the follicles shrink and stop producing hair.
      • At any time after puberty men can become aware of a receding hairline or hair thinning. The pattern of hair loss in men is from the top and front of the head. The diagnosis is based on history and the clinical examination.
      • Treatments can include minoxidil, hormonal treatments (eg. finasteride), PRP, cell based therapies, LLLT or hair transplantation.
  • Alopecia areata is a common type of non-scarring hair loss, that can occur in any age and sex. Patches of baldness appear and can affect the scalp, facial or body hair. Hair regrowth is typical, but can’t be guaranteed for some patients.
  • Alopecia areata is caused by the immune system attacking the hair follicles. Having a family history of alopecia areata, suffering with other autoimmune conditions and stress triggers are associated with having alopecia areata.
  • Smooth bald patches occur, which are not inflamed or scaly. Hair re-growth usually occurs at the centre of the patch with short, tapered hairs that are often white that later re-pigment. Sometimes, nail changes are associated with alopecia areata.
  • There are many treatments options that can include topical or oral steroids, topical immunomodulators, light therapy, immunosuppressive therapies and newer biological therapies. When the hairs are growing back minoxidil can also be used to boost the re-growth period. Allowances for camouflage and wigs might also be made.
  • Telogen effluvium is a temporary hair loss. There is an increase in hair shedding during the resting, or telogen, phase of hair growth. Normally we shed 30-150 hairs a day.
  • This can be in a response to stress, pregnancy, illness, withdrawal of hormonal medicines, starting a new medication and weight loss.
  • Most people notice an increased amount of hair in their brushes, in plug holes, on the floor around the house or on their pillows. The reduction in hair thickness is often markedly noticeable.
  • Diagnosis is made clinically, and sometimes a ‘hair pull’ test is performed to confirm the diagnosis.
  • Telogen effluvium usually self resolves, and no specific treatment is required. Hair will usually start growing back after the trigger is removed.
  • Anagen effluvium is when there is an abrupt increase in hair shedding during the growing, or anagen, phase of hair growth.  Much of the hair on the scalp, and often body hair, is lost.
  • Causes of anagen effluvium include drugs such as chemotherapy, radiation, infections and autoimmune disease.
  • Diagnosis is made by taking a thorough history and examination. The anagen hairs that are shed from the scalp have roots covered in pigmented sheaths, in contrast to the club shaped telogen resting hairs. Blood tests, hair pull test and a scalp biopsy might be useful to confirm the diagnosis, and exclude other potential causes.
  • Anagen effluvium due to causes such as chemotherapy can expect a full recovery in 3-6 months. Regrowth of straight hair can be curly, and there may also be a colour difference in the new hairs.

Scalp disease

  • Psoriasis is a common skin condition characterized by a thick scale on well-defined, red, thickened skin. It can often affect the scalp, either affecting a small area to the whole of the scalp. There is often constant flaking, which may have no symptoms or be somewhat itchy. Only in very severe cases does scalp psoriasis lead to hair loss. In such cases the hair usually grows back after time, and a resultant scarring hair loss is extremely rare.
  • Lifestyle factors play a role in managing psoriasis. Furthermore, careful attention to appropriate shampoos and leave on scalp preparations is vital. Light therapy, immunosuppressive therapies and biologic agents are also effective in more severe cases.
  • Seborrhoeic dermatitis is when you get red, itchy, flaky skin in the hair bearing areas of the body. Mild seborrhoeic dermatitis of the scalp is known as dandruff.  Severe seborrhoeic dermatitis can be present in people with HIV infection and Parkinson’s disease. Babies can also get a form of seborrhoeic dermatitis of the scalp (cradle cap) and nappy area.
  • Seborrhoeic dermatitis is thought to be an eczema like reaction to an overgrowth of harmless yeast called Malassezia on the skin. Cold weather and stress can also be triggers for seborrhoeic dermatitis.
  • Good clinical examination is normally sufficient to establish a diagnosis of seborrhoeic dermatitis. Affected areas are red with greasy skin flakes. The most common sites are the scalp, face (eyebrows, nose, cheeks, ears), chest and in the skin folds. In severe or resistant causes of seborrhoeic dermatitis, a HIV test might need to be done. Sometimes a skin biopsy to confirm diagnosis and skin scrapings to exclude fungal infection is required.
  • Descaling preparations containing coconut oil and salicylic acid are often effective when left on the scalp for several hours or overnight. Then applications of medicated shampoos that target the Malassezia yeast are an important strategy to manage seborrhoeic dermatitis.  These shampoos are best left on the scalp for 15-20 minutes prior to washing out. Application of topical steroids, immunosuppressants and anti-yeast treatments can help settled inflammation.
  • Fungal infection of the scalp is known as tinea capitis. It is common in children, and less often seen in adults.
  • Tinea capitis can present with a dry scaling and smooth areas of hair loss. A kerion or very inflamed mass, if left untreated, can result in permanent scarring and hair loss. Neck lymph nodes can also be significantly enlarged.
  • Diagnosis is often suspected if there is a combination of scale and hair loss. Wood light fluorescence can be helpful and scrapings from the scalp / hair clippings can be cultured to isolate the causative fungus.
  • Tinea capitis is usually treated with oral antifungals. If a child is affected, all family members should be examined for signs of infections. Parents should also advise infection to the child’s nursery or school so other potentially affected children can be diagnosed and treated.
  • Lichen planopilaris is a rare inflammatory condition that causes a scarring hair loss. It can also affect the skin, mucosa and nails. Smooth, white patches of hair loss occur. Redness and scalp might be present around the hair follicles. Symptoms can be absent, but can also be associated with pain and itching.
  • Diagnosis is often made on taking a history and careful examination. A scalp biopsy is sometimes required to help confirm the diagnosis.
  • Treatment should be sought early, with an aim to prevent the condition from progressing and causing further permanent hair loss. Options include corticosteroids (topical and oral), topical tacrolimus, hydroxychloroquine, tetracycline antibiotics, ciclosporin, mycophenolate mofetil, methotrexate and pioglitazone. There is also evidence that PRP can be helpful. When the disease activity is burned out, hair transplantation can be considered.
  • Frontal fibrosing alopecia is a localized form of lichen planopilaris, where scarring and hair loss occurs in the hair line. Post menopausal women are most commonly affected, though it can occur in younger women and men.
  • The exact cause of frontal fibrosing alopecia is currently unknown. However, environmental factors such as sunscreen and cosmetic use has been associated with the condition.
  • Frontal fibrosing alopecia is characterized by a symmetrical band of hair loss at the front and sides of the scalp. Eyebrows and hair elsewhere on the body can also be affected. The scalp is scarred so often looks shiny, and at the margins of the affected areas a redness and scale might be visible. Skin papules might also be present in this condition. Diagnosis is usually made on examination, but if a scalp biopsy is required the histological findings are the same to those of lichen planopilaris.
  • Treatment should be sought early, with an aim to prevent the condition from progressing and causing further permanent hair loss. Options include corticosteroids (topical and oral), topical tacrolimus, hydroxychloroquine, tetracycline antibiotics, ciclosporin, mycophenolate mofetil, methotrexate and pioglitazone. There is also evidence that PRP can be helpful. When the disease activity is burned out, hair transplantation can be considered.
  • Folliculitis decalvans is a scarring form of hair loss. It is characterized by redness and pustules around the hair follicles that leads to destruction of the hair follicles and a permanent hair loss. Any hair bearing area can be affected such as the scalp, beard, underarm and pubic area. There are often scar like patches of hair loss, with pustules surrounding the hair follicles. Multiple hairs can be seen coming out of a single follicle, giving a ‘tufted’ appearance.
  • Management options include antibacterial washes, topical treatments, long courses of antibiotics and oral retinoids.
  • Traction alopecia is caused by repeated and prolonged tension on the hair leads to alopecia.
  • Traction alopecia can affect people of any background or sex. However, it is commonly described in women who wear tight ponytails, plaits, weaves, dreadlocks and the use of hair extensions. It is also seen in Sikh males who twist their uncut hair underneath their turbans.
  • The clinical pattern of hair loss depends on the causative hair care practice. Often hair can be thinner or absent in the hairline at the front or sides of the scalp. Initially, hair loss is non-scarring but if left untreated unopposed tension can lead to permanent destruction or scarring of the hair follicles. Diagnosis is often made on history and clinical examination findings. A scalp biopsy might sometimes be required to confirm the diagnosis, and exclude other causes, in which cases characteristic findings can be found.
  • Education on hair care practices to limit tension and exposure to chemicals/ heat is vital in managing traction alopecia.  Further treatment options can include minoxidil to encourage re-growth and hair transplant surgery.
  • Central centrifugal cicatricial alopecia (CCCA) is a form of scarring hair loss, most commonly seen in darker skinned individuals.
  • There is some evidence that the cause of CCCA might be genetic, however, there is a strong correlation with chemical/ heat hair care practices such as hot combs, relaxers, extensions and weaves.
  • Hair shaft breakage is often an early sign of CCCA. Hair loss occurs at the crown, and extends outwards. There is a loss of follicular openings, so the scalp appears shiny. Patients either have no symptoms, or experience itch or pain. Diagnosis is usually made on the history and clinical examination findings. In some cases a scalp biopsy from the edge of the hair loss will show characteristic findings that might be needed to confirm the diagnosis.
  • The most vital aspect of managing CCCA is to educate patients to discontinue any potential causative hair care practices. Further treatment options include topical steroids, topical immunomodulators, tetracycline antibiotics and hydroxychloroquine. In some cases, when the disease activity is under control, hair transplantation can play a role in managing CCCA.
  • Trichotillomania is characterized by a repeated urge to pull at one’s own hair, resulting in hair loss. It can affect males and female, but is more common in children.
  • The cause of trichotillomania is unknown, but it is thought to be a coping mechanism to stress or anxiety.
  • Patches of hair loss usually occur on the scalp, but facial and body hair can also be affected. Clinical examination can reveal short, broken or absent hairs. Children normally grow out of trichotillomania, but repeated removal of hairs can lead to irreversible scarring.
  • Treatment usually involves some form of behavioural therapy. In younger children preventing hair pulling by covering up the child’s hands and cutting hair short might be effective. In older children and adults techniques such as habit reversal training and medications (such as N-acetylcysteine or antidepressants) might be useful.