The medical term for hair loss is ‘alopecia’. Thinning of the hair is a normal part of the ageing process in both men and women, but alopecia in younger people can have many different causes.
Baldness in Patches
In the condition known as ‘secondary scarring alopecia’, bald patches occur following direct damage to the hair follicles on the scalp. This may be due to an injury, a burn, a skin tumour, or exposure to radiation or caustic chemicals.
Alopecia areata is patchy hair loss that is thought to occur when the follicles are attacked by the body’s own immune system. There may be a genetic element, too, as the problem sometimes runs in families. It is common in both men and women, and can occur at any age. As well as hair loss, some people see changes in their fingernails, which can become roughened and pitted. Alopecia areata sometimes spreads until the whole scalp is affected (alopecia totalis) or even the entire body (alopecia universalis).
Trichotillomania is a disorder in which a person pulls out his or her own hair, leading to bald patches. This can be a psychological problem or simply a nervous habit.
Loss of Hair at the Hairline
In traction alopecia, hair is lost from around the hairline only. In most cases, hairstyling is at the root of the problem, in the form of a ponytail or braids tied too tightly, or excessively heavy hair extensions.
Thinning Hair Over the Whole Scalp
At any time, up to one-tenth of the follicles on a human scalp are in a resting state called ‘telogen’ – the period between an old hair falling out and a new one beginning to grow. In telogen effluvium, a larger than normal number of follicles enter the resting state at the same time, leading to thinning of the hair over the entire scalp. Telogen effluvium can be triggered by any process that places the body under stress, including pregnancy, a severe illness or injury, high fever, surgery, eating disorders, iron deficiency, hypothyroidism or psychological stress.
Androgenic alopecia, or male-pattern baldness, is normal as men grow older. Commonly, the hair recedes from the crown of the head, the front hairline and the temples. Androgenic alopecia in women is thought to have a genetic cause, with hair lost mainly from the crown. Male-pattern baldness may also occur in women with polycystic ovary syndrome.
Dealing with Hair Loss, Thinning and Balding
In secondary scarring alopecia, the affected follicles are destroyed or so severely damaged that the hair is unable to regrow. Research into possible medical treatments is continuing. Small bald areas may be amenable to hair replacement surgery (a hair transplant), in which follicles are taken from unaffected regions and implanted into the bald patch.
People with mild alopecia areata often regain their hair eventually, though the problem is likely to recur. The most common treatment is with corticosteroids, which are applied as a cream or by injection into the bald patches. However, these drugs cannot be given for long periods of time due to their serious side-effects. Phototherapy is sometimes used in an attempt to stimulate the follicles.
People with trichotillomania may be helped by psychological therapies, and by simple measures such as wearing gloves when hair-pulling is likely to occur. The hair should regrow naturally, unless the trichotillomania has persisted for years, in which case there may be a degree of permanent follicle damage.
Traction alopecia is treated by simply avoiding hairstyles that place excessive strain on the roots of the hair. It may take several months for the lost hair to regrow. As with trichotillomania, chronic traction can sometimes cause permanent damage.
Telogen effluvium can last weeks or months, but the hair is usually regained completely once the affected person has recovered from the stress that caused the hair loss. Depending on the problem, this may require treatment of an underlying condition, therapy for anxiety, nutritional supplements, or simply waiting until the episode has passed.
Most men with androgenic alopecia accept their baldness as a normal part of life; for women, however, the problem can be extremely distressing. In the early stages of hair loss, drugs such as finasteride and minoxidil may stimulate growth. Herbal supplements such as borage oil and green tea extract are also claimed to be effective. In people with advanced androgenic alopecia, however, the only solution may be hair replacement surgery, or a hairpiece or wig.
Alopecia is a Problem in Many People
Anyone who is concerned about hair loss, thinning or balding should discuss the problem with their doctor. While some forms of alopecia are permanent, or a natural process that may have to be simply accepted, others may respond to therapy if treated early enough.
References
Fenton DA. Hair and Scalp Disorders. Medicine 2004; 32(12): 26–31.
HairDiseases.com. Accessed 26-06-09
Hair Loss Information. Accessed 26-06-09
Disclaimer
The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
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