What is hair Loss?

Hair loss is a condition in which the hair falls at an abnormal rate eventually leading to partial or complete loss of hair.

The scalp has at an average 100,000 hairs. A healthy scalp sheds hair continously and new hair replaces them.

However when the scalp is not able to produce new hair to replace the shed hair, baldness develops.

The medical term for hair loss is “alopecia“. The alternative names are Hair Fall, Baldness, Loss of hair.

There are different types of hair loss based on the type and cause.

The most common type is androgenic alopecia also know as male pattern baldness (when it occurs in men) or female pattern baldness (when it occurs in women). This is a permanent type of hair loss which is incurable and is caused by heredity and genetics.

Other types are usually temporary and may be a symptom of serious illness, skin infection, stress, use of certain drugs, thyroid diseases etc. The hair loss halts once the underlying cause has been identified and treated.

Browse around this website and read more about the different types of hair loss, understand what are their causes and find out how they can be treated!

TYPES OF HAIR LOSS

1.       Alopecia Areata

2.       Alopecia Totalis

3.       Traction Alopecia

4.       Alopecia Univeralis

Alopecia areata

Alopecia areata (AA) is a medical condition in which hair is lost from some or all areas of the body, usually from the scalp. Because it causes bald spots on the scalp, especially in the first stages, it is sometimes called spot baldness. In 1–2% of cases, the condition can spread to the entire scalp (Alopecia totalis) or to the entire epidermis (Alopecia universalis). Conditions resembling AA, and having a similar cause, occur also in other species.

Classifications:

Commonly, alopecia areata involves hair loss in one or more round spots on the scalp.

ü        Hair may also be lost more diffusely over the whole scalp, in which case the condition is called diffuse alopecia areata.

   Alopecia areata monolocularis describes baldness in only one spot. It may occur anywhere on the head.

           Alopecia areata multilocularis refers to multiple areas of hair loss.

ü       The disease may be limited only to the beard, in which case it is called Alopecia areata barbae. 

           If the patient loses all the hair on his scalp, the disease is then called Alopecia totalis. 

           If all body hair, including pubic hair, is lost, the diagnosis then becomes Alopecia universalis.

Alopecia areata totalis and universalis are rare.

Signs and symptoms:

Typical first symptoms of alopecia areata are small bald patches. The underlying skin is unscarred and looks superficially normal. These patches can take many shapes, but are most usually round or oval. Alopecia areata most often affects the scalp and beard, but may occur on any hair-bearing part of the body. Different skin areas can exhibit hair loss and regrowth at the same time. The disease may also go into remission for a time, or permanently.

Common in children.

The area of hair loss may tingle or be painful.

The hair tends to fall out over a short period of time, with the loss commonly occurring more on one side of the scalp than the other.

Exclamation point hairs are often present. Exclamation point hairs are hairs that become narrower along the length of the strand closer to the base, producing a characteristic "exclamation point" appearance.

In the case of healthy hair, if you were to try to pull some out, at most a few should come out, and ripped hair should not be distributed evenly across the tugged portion of the scalp. In cases of alopecia areata hair will tend to pull out more easily along the edge of the patch where the follicles are already being attacked by the body's immune system than away from the patch where they are still healthy.

Nails may have pitting or trachyonychia.

Diagnosis:

Alopecia areata is usually diagnosed based on clinical features.

Trichoscopy may aid differential diagnosis. In alopecia areata trichoscopy shows regularly distributed "yellow dots" (hyperkeratotic plugs), micro-exclamation mark hairs, and "black dots" (destroyed hairs in the hair follicle opening).

A biopsy is rarely needed in alopecia areata. Histologic findings include peribulbar lymphocytic infiltrate ("swarm of bees"). Occasionally, in inactive alopecia areata, no inflammatory infiltrates are found. Other helpful findings include pigment incontinence in the hair bulb and follicular stelae and a shift in the anagen-to-telogen ratio towards telogen.

Causes:

Alopecia areata is not contagious.It occurs more frequently in people who have affected family members, suggesting that heredity may be a factor. Strong evidence that genes may increase risk for alopecia areata was found by studying families with two or more affected members. This study identified at least four regions in the genome that are likely to contain alopecia areata genes. In addition, it is slightly more likely to occur in people who have relatives with autoimmune diseases.

The condition is thought to be an autoimmune disorder in which the body attacks its own hair follicles and suppresses or stops hair growth. For example, T cell lymphocytes cluster around affected follicles, causing inflammation and subsequent hair loss. There are a few recorded cases of babies being born with congenital alopecia areata; however, these are not cases of autoimmune disease because an infant is born without a fully developed immune system.

There is some evidence that alopecia affects the part of the hair follicle that is associated with hair color. Hair that has turned gray may not be affected.

Treatment:

Though permanent cure or universally acceptable therapy is unavailable for alopecia areata, some treatments based on age or time span of disease are available. Steroids are the most common form of treatment. Ointments with steroids for topical application are available in the market. Another method of treating spot baldness is by injecting a steroid (usually triamcinolone) below the epidermis.

Oral corticosteroids are yet another option. However, they are considered to be the last resort for treatment due to their side effects. The use of steroids leads to re-growth of hair. However, the process is temporary and the condition redevelops when the medication is stopped.

Advanced medical sciences are working towards finding newer methods for the successful treatment of alopecia areata. Finding newer ways to treat this disease is the need of the hour.

Alopecia Totalis

Alopecia totalis is the loss of all head hair. Its causes are unclear, but it is currently believed to be an autoimmune disorder. Stress is sometimes thought to be a contributor in alopecia areata. However, many people leading relatively stress-free lives experience the syndrome.

Carrying a bald look is very common these days and it is becoming quite a fashion statement. But the condition can actually de-motivate you if it is caused by your own immune system which is meant to protect your body.

Causes:

Alopecia Totalis is just like Alopecia Areata, which also occurs due to a condition known as autoimmunity disorder which tends to affect the immune system of the body making it fight against its own body.

The white blood cells, which protect the body against diseases, consider hair follicles as unknown or unidentified objects and attack the cells that are responsible for hair growth in hair follicles. This leads to a decrease in the size of hair follicles ultimately leading to slowing down of hair growth. And then comes a time when the growth is totally stalled. However, the condition that triggers this immunity disorder is yet to be concretely verified by researchers.

It has also been scientifically proven that genetics can also be an important reason for development of Alopecia Totalis. According to a research, it was found that up to 20% of patients diagnosed with alopecia have a family history of the disease. Another research claims that some people are more likely to develop this condition because of the formation of their genes.

Stress, one of the major problems in today’s lifestyle, is also said to intensify the development of this immunity disorder, leading to Alopecia Totalis.

Treatment:

Based on research over the years, treatment measures for Alopecia Totalis are done with the help of topical creams, oral dosages or injections.

Therapy known as immunotherapy is undertaken whereby injections containing chemicals such as squaric acid dibutylester are given at the scalp. These help in stopping the autoimmune response due to which hair loss occurs. Steroids also commonly form a part of the treatment of Alopecia Totalis.

The good news is that hair tends to grow back after taking such therapies. But the condition is not permanent. It is said that hair loss in Alopecia follows a pattern whereby it can re-grow after medications, but can also be lost after stoppage of the treatment.

Alopecia Totalis does not lead to any kind of sickness in a person, nor is it a pain inducing disease. It is not a life threatening disease and neither does it hamper a person’s ability to lead a normal life. But the emotional trauma and stress it may create in a person can be difficult to handle by a person. The key to dealing with the stress can be either through taking counselling sessions or by talking to people in the same condition.

Traction Alopecia

The only thing that is constant is change, and this statement applies to trends and fashion statements that keep on changing their course every now and then. Following trends is the main reason why people use hair styling products or methods that harm their precious locks, sometimes taking things to the extent of baldness.

The loss of hair due to hair styling methods is known as Traction Alopecia. It is caused by the pulling of hair during tight braiding, hair weaving or cornrows over a long period of time.

The usage of harsh chemicals over a long period of time damages hair follicles causing hair loss. Chemical treatments such as colouring, bleaching, or straightening and perms of hair, often disrupt the hair protein known as keratin and reduces the tensile strength of hair. This causes hair to fall even at a small pull during combing or brushing.

Traction alopecia is more common amongst African-American people because of their style of braiding using micros or tree-braids or usage of extensions whereby human or synthetic hair is attached to braids. These styles pull the hair constantly, causing hair to become weak leading to hair breakage. Among Indians, Sikhs also suffer from this because of wearing hair in tight buns causes constant hair pulling. Apart from the African-Americans, Sikhs and Japanese women, traction alopecia can be noticeable in individuals who wear tight braids or ponytails. They may experience a receding hair line.

Traction alopecia is more prevalent amongst young adults or teens rather than older aged people.

Causes:

Just like any other forms of Alopecia, the real cause of Traction Alopecia is accredited to genes, heredity, hormonal disturbances apart from the braiding patterns and chemical usages as discussed above.

A receding hair line and thinning of hair near the hair line is the most evident symptom of Traction Alopecia. Also, a headache after getting braids, sore scalp after wearing a tight ponytail for a long period of time, tiny bumps and swollen redness near the hairline may indicate the onset of Traction Alopecia.

Treatment :

Diagnosing Traction alopecia at an initial stage is most important step in reversing its effects. Tight hairstyles causing extra pressure on the hair follicles leading to hair loss should be avoided completely. Also, chemical treatments which are harsh on the hair should not be repeated over a long period of time.

If you have been diagnosed with traction alopecia, you should consult a specialist without wasting any further time. Ignorance of the situation can lead to permanent hair loss. Hair transplant is a suggested medical procedure for treating extreme cases of Traction Alopecia.

However, before going in for hair transplant, oral and topical steroids form a very common way of treating extremely damaged hair follicles. It is usually seen that hair tends to grow back following such treatments within a span of minimum six months into the treatment.

Learning about the condition and the treatment measures can help you deal with the same if you notice the symptoms randomly.

Alopecia Univeralis

Alopecia universalis or alopecia areata universalis is a medical condition involving rapid loss of all hair, including eyebrows and eyelashes. It is the most severe form of alopecia areata, with an incidence of .001% (1 in 100,000).

Alopecia Universalis is identified and listed as a rarely occurring disease by the National Institute of Health’s Office of Rare Diseases. The number of new cases of Alopecia Universalis that is diagnosed each year is 0.001% in the U.S, and this is also termed as the Annual Diagnosis Rate.

Diagnosis:

      The best test to confirm the diagnosis of Alopecia Universalis is by looking for commonly observable symptoms. Ask the patient or the parents of the patient about the first emergence of the café–au–lait spots. Café–au–lait spots are pigmented or colored birthmarks and generally refer to the light brown colored skin pigmentation in affected individuals. 

           Find out about family history of neurofibromatosis – a genetic disorder in which nerve tissues grow tumors. Distinctive skin lesions or grazing with patterns like mottling or axillary freckling should be noted.

      A person with Alopecia Universalis is generally a healthy individual but is more likely to experience thyroid and Vitiligo. People who are born with Alopecia Universalis have hair as children but tend to lose this hair fairly quickly.

      Another distinguishing characteristic of people with Alopecia Universalis is distortion in nail patterns. Their nails normally tend to have indentations like pin pricks.

Alopecia Universalis  –  The Causes Behind the Condition

People with Alopecia Universalis are born with a hairless gene. The gene is mutated and occurs very rarely. Researchers have found that this rare mutated gene is the same that causes hairlessness in mice. There are no other known causes that may cause alopecia universalis.

Treatment :

In addition to a physical observation of the area a diagnosis is necessary. This can be done with the help of a biopsy. The sample for the biopsy is usually taken from the skin on the scalp. In addition to this, blood tests may be required in order to determine if you have the auto immune condition.

Alopecia Universalis – The Solutions  Available

The disorder does not have a standard treatment and there are drugs which work on the immune system called immunomodulators, which have shown hair growth in some patients. Re-growth of hair is a possibility even with patients who have lost all their hair. However, there is no guaranteed method to predict that hair growth will definitely occur. If you are suffering from Alopecia Universalis, you can opt for any one of the solutions listed below. Some of these solutions are cosmetic in nature and may not seem as effective, but they can save you the embarrassment of a stark scalp.

 The Use of a Wig or a Hairpiece – If you are looking for a quick and simple solution for alopecia universalis with minimal number of complications, you can use a head covering. Head coverings like wigs, hairpieces, scarves and other turbans are a good option.

Topical Immunotherapy – This is one of the most popular solutions for curing Alopecia Universalis. The National Alopecia Areata Foundation recommends this treatment as there is a 50 percent chance that the treatment will be successful. Topical Immunotherapy involves the topical applications cream and lotions on the scalp. The lotions and creams cause an itchy sensation on the scalp and cause an allergic skin reaction.

This in turn excites the follicles of the skin which grows hair in effect. The treatment has shown success in select patients, however, the side effects of this treatment can cause a lot of discomfort. Commonly observed side effects include excessive itching and skin rashes. Another downside of this treatment is that it must continue until the hair regains its regular growth pattern or the condition may recur and hair loss will be inevitable in this case.

Cortisone Treatment – Alopecia Universalis can also be cured using cortisone shots or cortisone pills. The problem with this treatment however is that these shots need to be taken continuously. In addition to this, the side effects of this treatment are known to be extreme. The shots need to be administered by a certified practitioner and these shots need to be administered continuously.

UV Light Therapy – Kromayer’s ultraviolet lamp is used in this treatment. The treatment may be administered on a weekly basis or once every alternate week. Depending on the extent of hair loss, patients have seen to re grow their hair during the course of the treatment itself. Ultraviolet light stimulates biological reactions in the cells of the epidermis of the scalp and other regions and reduce the number of cells which grow fast.

Steroid Injections – Steroid injections have also been shown to stimulate hair growth in patients suffering from alopecia universalis. Patients are given these shots in the hairless regions of the epidermis and these include the beard, eyebrows and scalp. In approximately one month’s time, hair growth is observed in the injected areas. The steroids have to be injected in small amounts in order to prevent side effects and attain the right amount of hair. The shots are then repeated on a monthly basis.

Identifying the problem is primary, and you should contact your health care provider immediately in order to zero in on the problem. Following this, diagnostic procedures and recommended treatment measures can be followed in order to counter the condition.

 

HAIR LOSS IN MEN

Male Pattern Baldness

Androgenic alopecia (also known as androgenetic alopecia or alopecia androgenetica) is the most common cause of hair loss and thinning in humans. Variants appear in both men and women. Androgenic alopecia also occurs in chimpanzees, and orangutans. In humans, this condition is also commonly known as male pattern baldness. In classic pattern baldness, hair is lost in a well-defined pattern, beginning above both temples. Hair also thins at the crown of the head. Often a rim of hair around the sides and rear of the head is left. This type of pattern is dubbed "Hippocratic balding" and may rarely progress to complete baldness. Women do not suffer classic male pattern baldness, instead the hair becomes thinner around the whole scalp, and the hairline does not recede. This is dubbed "female pattern baldness" and may occur in males. This variety of androgenic alopecia in women rarely leads to total baldness.

Causes:

A variety of genetic (and possibly environmental) factors apparently play a role in androgenic alopecia. Although researchers have long studied the factors that may contribute to this condition, many remain unknown. Minimally, pattern hair loss is related to hormones called androgens, particularly dihydrotestosterone (DHT). Androgens are important for normal male sexual development before birth and during puberty. Androgens also have other important functions in both males and females, such as regulating hair growth and sex drive.

Male pattern baldness is caused by a genetic sensitivity of hair follicles to DHT. This hormone causes follicles to shrink or "miniaturize". In turn, this shortens their lifespan and prevents them from producing hair normally.

Recently the existing theories have been challenged on the ground that while the androgens in question are responsible for hair growth on the face and all over the body of men, hair loss only occurs at the top of the scalp. For example, it has been suggested that androgenic alopecia is a consequence of the anabolic effect of androgens such as hormonal changes leading to structural changes in skin and scalp which in turn cause hair loss.  It should be noted however, that there are as of yet no experiments testing this hypothesis.