iAremyhair believes in giving our customers ample information so that they can make wise decisions regarding hair loss treatment.
For this purpose, we are introducing a series of topics that offer insight and objective viewpoints. Topics range from basics of hair to hair loss causes to treatment options to other related and interesting issues.
To ensure that our readers get the most out of our newsletters, we have condensed information from established publications and online reference materials such that each topic can be easily digested. iAremyhair invites you on this journey and welcomes your comments.
Alopecia can occur as a result of a disease or the treatment that follows it. There are two main categories : nonscarring and scarring. If properly treated, a non-scarring disorder will resolve in due time and hair can potentially grow back. With a scarring hair loss disorder, the chances of regrowth are slim as the hair follicles in this case are permanently damaged. In this chapter, we will look at the common medical causes of alopecia and its cures.
ALOPECIA AREATA
Alopecia Areata (AA) is an autoimmune disease whereby your immune system turns on itself and attacks components of your body. AA occurs when a person's white blood cells attack and destroy the body's hair follicles, causing them to stop producing hair. It is sometimes called spot baldness because of the distinctive round bald patch. In 1%-2% of cases, the condition can spread to the entire scalp (Alopecia totalis) or to the entire epidermis (Alopecia universalis) where hair on the scalp, eyebrows, eyelashes and other parts of the body are lost.
AA affects both males and females and it occurs at any age, with most patients between the ages of 15 and 29. It is not contagious and occurs more frequently in people who have affected family members, suggesting that heredity may be a factor. An unknown environmental trigger such as emotional stress or a pathogen is thought to combine with hereditary factors to cause the condition.
First symptoms are small bald patches which are usually round. It most often affects the scalp and beard but may occur on any hair-bearing part of the body. Some patients feel burning or itching in the area of balding but others don't. 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.
Another important diagnostic clue to AA are exclamation point hairs. Exclamation point hairs are hairs that become narrower along the length of the strand closer to the base, producing a characteristic "exclamation point" appearance. Your doctor may gently pull hair along the edge of a bald patch as a diagnostic test. Healthy hair doesn't come out when pulled gently but hair afflicted with AA is easily removed.
In 90% of cases, the hair will, ultimately, grow back. In the other 10%, only some or no hair will regrow. If the affected region is small, it is reasonable to expect regrowth with time. In cases of severe hair loss, treatment options include steroid injections and other medications such as minoxidil, topical immunotherapy cyclosporine, elocon ointment (steroid cream) or irritants (anthralin or topical coal tar); each of which are sometimes used in different combinations.
For small patches on the beard or head, it is possible to suppress with topical tacrolimus ointments like Protopic. Topical corticosteroids can be used to curb initial stages of hair loss but they frequently fail to enter the skin deeply enough to affect the hair bulbs, which are the treatment target.
In terms of adapting to the disease rather than treating in an effort to cure, there are also many options available. Wigs are often used by those with Alopecia, particularly Alopecia Totalis, in which hair is entirely lost from the scalp. Most of the wigs available are so well made that it is impossible without close investigation to tell whether they are a person's actual hair, or a wig.
TELOGEN EFFLUVIUM
Telogen effluvium is a type of non-scarring hair loss characterised by sudden, widespread hair shedding. You can lose more than 400 or more hairs daily, more than double the normal amount a person should be shedding! It can occur at any age and may be more common in women due to hormonal changes in menopause. This condition is usually a result of dramatic occurrence such as acute or chronic illness, hormonal changes, sudden changes in diet, medications, a major surgery or a big life event.
It is diagnosed with a hair pull test; pulling out significantly more than 10 percent of the hair indicates the condition in its early stages. The condition can be either acute, lasting less than six months, or chronic, lasing longer than that. Good news is that hair loss from telogen effluvium usually isn't permanent and your hair will grow back in due time.
THYROID CONDITIONS
The thyroid is a small gland found in the neck, below the Adam's apple. It controls how quickly the body uses energy, makes proteins and controls how sensitive the body should be to other hormones. It also regulates your metabolism through the production of thyroid hormone. Diseases of the thyroid gland can affect hair growth, the non-scarring type. Hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) are the most common problems of the thyroid gland.
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Hyperthyroidism : Symptoms include becomes extremely thin and sparse.
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Hypothyroidism : Symptoms include fatigue, cold intolerance, lack of energy, puffiness of face and dry skin. Hair becomes dry, brittle, coarse and sparse.
Doctors aren't sure why patients with thyroid disease lose their hair. It could be because the thyroid hormone affects the body's metabolism, including the hair follicles, and so problems with the hormone cause hair regrowth to slow and hair to become thinner and possible more brittle.
The most common medicine to treat hyperthyroidism is propylthiouracil and patients with hypothyroid are usually prescribed synthroid which is essentially a replacement of the thyroid hormone. Proper medical treatment and allowing time for adjustment to the medication increase the likelihood that your hair will regrow but it may take up to three years for your hair to return to normal.
SCARRING ALOPECIA
Scarring alopecia, also known as cicatricial alopecia, refers to a diverse group of rare hair disorders. These disorders destroy the hair follicle and replace the follicle with a scar tissue causing permanent hair loss. Despite the name, it doesn't always cause visible scars on top of your head; the scarring is usually beneath the scalp, where hair follicles are replaced with scar tissue. If severe, it can cause the surface of the scalp to appear smooth and shiny. In broad terms, scarring alopecias are of two types :
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Primary alopecias occur when a condition attacks the hair follicles directly but does not affect other tissues and organs of the body. It is also sub categorised into types on the basis of the inflammatory cells. The exact diagnosis of the different types of primary scarring alopecia is necessary as different types of categories have a different identification and treatments.
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Secondary alopecias are more generalized disease mechanisms. They occur in various organs of the body and damage several tissues, organs as well as induce scarring alopecia. The causes of secondary cicatricial alopecia include radiation, drugs, surgeries, tumors and others.
LUPUS
Lupus is an autoimmune disease that causes inflammation of organ tissue and it has two types :
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SLE (systemic lupus erythematosus) : Systemic means that it impacts many parts of the body and may cause non-scarring hair loss. SLE spares the hair follicles, so hair grows back after the disease is successfully treated.
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DLE (discoid lupus erythemaosus) : It is localised and may cause scarring hair loss. It causes irregular patches of hyperpigmented (dark skin) and hypopigmented (skin that appears almost white) skin, along with redness, scales and hair follicles devoid of hair. It can occur anywhere on the body but is most common on the head and neck, particularly the scalp and ears.
General symptoms of lupus include reddish facial rashes, sensitivity to the sun, mouth ulcers, arthritis, fevers and persistent fatigue. If commonly affects women in the 20 - 50 age bracket and blood tests are needed to identify the condition.
There's no specific treatment for hair loss associated with SLE but medications used to treat the disease may help with the hair loss issue. To complicate matters, some oral medications (such as Plaquenil) used to treat lupus may cause hair loss. DLE is a much less serious condition than SLE. It can be arrested in the early stages with Plaquenil and steroid injection.
Reference Materials
http://en.wikipedia.org/wiki/Alopecia_areata
http://en.wikipedia.org/wiki/Thyroid
http://www.hairdiseases.com/diseases-that-cause-alopecia/alopecia-causes.shtml
Rassman, William R, M.D. and Bernstein, Robert M, M.D. "Hair Loss & Replacement for Dummies" USA : Wiley Publishing, Inc, 2009.
