Causes And Treatment Of Hair Loss In Men And Women

There are 13 recognised medical causes of hair loss and scalp dysfunction in men and women::

1. Male and female Alopecia Androgenica (Genetic)

Alopecia Androgenica occurs in both men and women. It is caused by an increased sensitivity to the hormone Dihydrotestosterone (DHT) which is a by-product of testosterone. Testosterone is secreted in the male testes and in females in the ovaries and adrenal glands. This condition is extremely distressing especially in young males (who frequently present in their teens) and in females. Its incidence has increased dramatically in females in the last 10 years.

Most patients will respond to medical treatment by prescription using a combination of Finasteride tablets, Minoxidil Lotion and Nizoral shampoo. A prescription will be given to the patient for these medications. A small percentage of men and women will eventually require hair transplant treatment. This is a minor procedure carried out in the doctor’s office under local anaesthetic (like a visit to the dentist). The patient can go home afterwards. The results are usually excellent.

2. Alopecia Areata:

Alopecia areata (AA) is an autoimmune disease where the human body forms antibodies against it’s own hair follicles. This is aggravated by stress and anxiety. It is an extremely distressing condition affecting 1.7% of the population. The most common type of alopecia areata presents as round or oval patches of hair loss most noticeably on the scalp or in the eyebrows. The treatment is by the use of corticosteroids either topically (creams applied to the affected area) or by local injection into the area. Minoxidil (available at the local chemist) can help in some cases. The outcome is good if the patient presents in childhood and much poorer in adults. It is recommended that patients be assessed and treated as early as possible by a registered ISHRS physician.

3. Trichotillomania:

This psychiatric condition is especially distressing. The patient (usually in their early teens) continuously pulls their own hair out. These patients require urgent referral to a Consultant Psychiatrist. Following intense psychiatric cognitive behavioural therapy (CBT) they may require hair replacement if the damage done to their hair follicles is permanent.

4.Traction Alopecia:

This form of alopecia (hair loss) is caused by braiding the hair or using hair ties and bobbles. It is commonly seen in teenage female patients and is quite distressing. The condition frequently responds to topical application of Minoxidil but in some cases may need some hair follicle replaced under local anaesthetic.

5. Stress, Anxiety, Depression and hair loss:

It is essential that the specialist hair doctor makes a diagnosis of whether hair loss is caused by stress, anxiety or depression or is a result of these conditions. Frequently only a doctor with vast general as well as hair loss experience can make this distinction. If your hair loss is caused by any one of these conditions then Dr.Kiely will prescribe appropriately e.g. anti depressant medication or will arrange psychological or psychiatric referral. If hair loss is the cause of these conditions then treating the hair loss appropriately will usually improve the general well being of the patient.

6. Chemotherapy Induced Alopecia

Hair loss cause by chemotherapy can be very upsetting for the patient. The hair usually grows back when the course of chemotherapy is finished. Sometimes certain areas such as the eyebrows do not grow back. These can be reconstructed quite simply using low scalp hair with excellent results.

7. Scarring Alopecia

Hair loss due to scarring of the scalp is called scarring alopecia. It causes immense distress to the patient. Scarring can be due to a variety of causes. 1.Traction alopecia over a period of time may lead to scarring and permanent hair loss. 2.Trichotillomania (compulsive hair-plucking) can cause permanent scalp scarring over time. 3.Injury to the scalp caused by physical trauma or burns may leave permanent scars and permanent hair loss. 4.Diseases that may cause permanent hair loss due to scalp scarring include (1) the autoimmune conditions lupus erythematosus and scleroderma, and (2) bacterial infections such as folliculitis, fungal infections, and viral infections such as shingles (herpes zoster).Many of these conditions can be treated medically but a small percentage require hair replacement in the scarred area.

8. Triangular Alopecia

The cause of triangular alopecia is not known, but the condition can often be treated medically or surgically. The characteristic pattern of hair loss in triangular alopecia is thinning or complete loss of hair in the scalp area around the temples. If hair loss is not complete, the remaining hairs are often "miniaturized"-fine-textured hairs of thin diameter. Triangular alopecia sometimes begins in childhood with unexplained hair loss in the temporal areas of the scalp.

9. Chronic Telogen Effluvium

Telogen effluvium is the name given to hair loss that is caused when a large percentage of scalp hair follicles are shifted into the telogen or "shedding phase" of hair growth. The cause of this abnormally timed telogen phase may be hormonal, nutritional, drug-related or associated with stress. Treatment is aimed at treating the cause.

10. Loose Anagen Syndrome

Loose-anagen syndrome occurs most frequently in fair-haired persons. During the anagen (growth) cycle of hair, scalp hairs sit so loosely in the follicles from which they grow that they can be easily extracted by combing or brushing. The condition may appear in childhood and gradually improve or disappear over time.

11. Seborrheic Dermatitis

Seborrheic dermatitis is a common, chronic condition that affects people at all ages from infancy through middle age; however, the two peak periods of occurrence are in the first 3 months of life when seborrheic dermatitis is known as “cradle cap”, and from approximately ages 30 to 70 years.

The most prominent features of seborrheic dermatitis are (1) excessive oiliness of scalp and hair, (2) greasy, yellowish scales that grow into crusts covering red, inflamed, moist scalp skin, and (3) intense itching. In more severe cases the condition involves the eyebrows, cheeks, and folds of the nose. The intense itchiness may encourage hard scratching that will enhance inflammation and open the way to secondary infection by bacteria, yeasts or fungi. The more severe forms of seborrheic dermatitis can closely resemble psoriasis, and may even overlap in a condition called sebopsoriasis. The cause of seborrheic dermatitis is not known. Treatment of seborrheic dermatitis usually includes daily to twice-weekly shampoos with a product recommended by the patient’s physician. Additional forms of treatment depend upon the severity of disease. as diagnosed by a physician. Although not curable, seborrheic dermatitis is very treatable and can usually be cleared with regular use of prescribed treatments.

12. Dandruff

The condition popularly known as dandruff is, in its most common and mild form, little more than a normal shedding of dead skin cells from the scalp. When the white flakes land on the collar or shoulders of one’s clothing they become an unattractive cosmetic nuisance. Some people experience a heavier accumulation of flakes that adhere to the scalp and fall in a literal blizzard onto clothing, bedding and furniture. When a person has excessive oiliness of the scalp, a heavy accumulation of flakes can be pasted to the scalp in oily mounds and adhere to hair in whitish globs. This condition is most likely when production of skin oils (sebum) is at its peak in puberty and adolescence, or when the production of androgenetic (male) hormones is out of balance. “Oily dandruff” that is not accompanied by inflammation or itching may be a mild form of seborrheic dermatitis that is discussed below.

Common, mildly shedding dandruff is usually managed successfully by regular use of a mild, anti-dandruff shampoo once or twice a week. Over-the-counter shampoos containing ketoconazole, zinc pyrithione tar or selenium oxide often work well to manage mild dandruff.

13. Hormonal and Nutritional Hair Loss

It is quite common, especially in female patients, for hair loss to be caused by nutritional deficiency or hormonal imbalance. Common causes are iron deficiency anaemia, underactive thyroid (hypothyroidism), low oestrogen in menopause and post pregnancy hair loss. The patients will have blood test performed where the deficiency is identified and treatment is then aimed at correcting the imbalance medically. The hair will quickly return to it’s original thickness and quality and there will also be associated medical benefits of improved general health and energy.