What causes hair loss?

FIGHT AGAINST DIFFERENT TYPES OF HAIR LOSS

by Kylee Wang

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Why am I getting Hair Loss?

From offering protection against the environment to highlighting personality and beauty, hair is important to our wellbeing, both biologically and psychologically. Thus, hair loss, a common problem that affects millions of people of all genders, races, and age groups, is increasingly growing as a persistent issue that many wish to treat and solve. Male and female pattern hair loss occurs in over 50% of men and 25% of women by 50 years of age. With a wide variety of hair loss types, understanding the causes of the condition and the different treatments available is vital to protecting our hair.

What is Hair made of?

Hair, made of a strong protein called keratin, consists of a shaft and a follicle. The shaft constitutes the visible portion of the hair outside the skin while the follicle rests underneath the skin. At the base of the follicle, cell division occurs in the hair bulb which is found in the dermis layer of the skin. The hair growth cycle has three main phases: anagen, catagen, and telogen. During the anagen phase, hair actively grows. Shorter hairs, such as eyelashes and eyebrows, have shorter anagen periods than hairs located on the scalp. The majority of a person’s hair is in the anagen growth phase. The catagen phase, or the transitional phase, occurs when hair growth stops, the follicle shrinks, and the hair is pushed up to the epidermis layer of the skin. This phase typically lasts two to three weeks before moving into the telogen phase. Hairs in this phase have club-shaped roots and remain for about three to four weeks until new anagen hairs push them out of the skin.

How do I know what type of hair loss I have?

Hair loss can be divided into two categories: non scarring and scarring. Non scarring means that hair has the possibility to regrow as the hair follicle is not usually permanently injured. Conditions such as alopecia areata, androgenic alopecia, and telogen effluvium are considered to be non scarring. Scarring hair loss, however, results in irreversible hair loss, where hair is permanently lost as the affected follicles are scarred and destroyed. Lichen planopilaris, frontal fibrosing alopecia, and discoid lupus are all examples of scarring hair loss.

What is Alopecia Areata? What causes Alopecia Areata?

Alopecia areata is an autoimmune disease that affects anagen hair follicles. The name of the condition is a broad term that includes more specific types of the disease such as alopecia totalis, the loss of all hair on the scalp, and alopecia universalis, the loss of all hair on the body. Typically, alopecia areata is characterized by bald patches of hair on the scalp, with about six to seven million people, adults and children alike, affected in the U.S. If the condition presents at or before 10 years of age, it is usually associated with lupus and atopic dermatitis. The body’s immune system is one of the main causes of alopecia areata, attacking hair follicles and prompting an early transition of hairs into the telogen phase, thus resulting in hair loss. Certain genes, down syndrome, thyroid disease, and a family history of the condition all may increase the risk of alopecia areata. Treatments include triamcinolone injections, which can suppress the immune system from attacking hair and allowing it to regrow, as well as topical creams, ointments, and oral medications such as oral minoxidil and even antihistamines (second generation, non-drowsy ones of course).

Is Male and Female Pattern Hair Loss the Same?

Also called pattern hair loss, androgenetic alopecia is an inherited condition that generally affects males more than females. This condition is the most common type of hair loss and thinning for males, presenting with a receding hairline and loss of hair on the top of the head. For females, androgenetic alopecia starts with a receding hairline and can eventually lead to a bald patch on the top of the head. By the age of 50 and usually after menopause, about 40% of women show signs of hair loss, but compared to men, women have a lower rate. A sensitivity to dihydrotestosterone, a hormone that shortens the anagen phase in the hair growth cycle is the root cause of the condition. The genes that most likely contribute to the disease are inherited from both the mother and father. Hair replacement, where pieces of hair and follicles from an area like the back of the head are moved to balding spots, is a common treatment that addresses androgenetic alopecia. A newer treatment option is platelet-rich plasma therapy, a medical treatment that involves drawing blood, processing it, and injecting it into the scalp to stimulate hair growth. Other options include cosmetics with the use of wigs and hair sprays, low-level laser therapy, and minoxidil solution that helps promote hair regrowth.

How do I treat and stop telogen effluvium?

Telogen effluvium, characterized by temporary excessive shedding of hair, may occur in response to a shock to the body. A poor diet or stressful events such as severe injury, illness, or childbirth can prompt the disease as more than 50% of the hair may enter the telogen phase and fall out. There are two types of telogen effluvium: acute and chronic. People with acute telogen effluvium can be of any age or sex, but those with chronic telogen effluvium,where hair shedding may last for years, are usually women from 30 to 60 years of age. The condition can be self-corrected, with a healthy diet and gentle handling of hair as recommended treatments. 

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What is Lichen Planopilaris and is it permanent?

Lichen planopilaris is an inflammatory condition that affects the hair follicles, leading to patchy permanent hair loss. While the condition usually affects the scalp, it can affect other parts of the body as well. Symptoms such as burning, itching, or discomfort are often associated with lichen planopilaris. Women are the most affected with a wide age range, but men can also be affected. There is no apparent cause for this disease, and since hair loss is typically permanent with this condition, treatments are focused on reducing hair loss and minimizing the symptoms. They vary from patient to patient, with corticosteroids, antimalarial drugs, and hydroxychloroquine as common treatment options. Avoiding damage to the hair such as coloring or perming the hair is typically advised.

What is Frontal Fibrosing Alopecia?

One form of lichen planopilaris, frontal fibrosing alopecia, results in hair loss along the front of the scalp and thus yields a receding hairline. The affected skin is pale and does not have visible follicle openings compared to the skin on the forehead that often looks sun damaged. As with lichen planopilaris, women who have reached menopause are typically affected, but men, children, and younger women can all get the condition. As family cases have been increasingly reported, a genetic factor may contribute to frontal fibrosing alopecia. However, environmental factors can have a role in triggering the disease as well. Currently, there is no treatment for frontal fibrosing alopecia. Corticosteroids and minoxidil solution do not effectively treat the condition. On the other hand, finasteride and dutasteride, 5-alpha-reductase inhibitors, have yielded the best results on reducing further hair loss. However, as frontal fibrosing alopecia is often associated with androgenetic alopecia, the inhibitors may be treating the latter.

Can Lupus cause Hair Loss?

A chronic condition that mainly affects the skin, discoid lupus is the most common form of cutaneous lupus. Presenting with scaly plaques on the scalp and face, the condition can lead to permanent scarring and thus hair loss. While all age groups can be affected by discoid lupus, women are often more affected than men. Ethnicity also plays a role in who is more likely to have this condition, with African American women having a much higher prevalence. Genes are a predominant cause of the condition, but smoking and UV radiation are also factors. Early treatment is important to reduce the risk of permanent scarring. Applying sunscreen or generally avoiding the sun are recommended. Topical corticosteroids or intralesional corticosteroids that are injected usually are the first treatment methods. Systemic therapy, or drug therapies that can reach the whole body, can be used if the condition affects the whole body. 

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Hair loss can additionally have devastating psychological effects, including low self-esteem, depression, and negative body image. Understanding the various hair loss conditions and the treatment options available are vital to both protecting our hair and mindset. According to a telephone study conducted in major cities throughout Europe, up to 60% of the participants who received successful treatment for hair loss reported increased levels of self-esteem and personal attractiveness. By arming oneself with knowledge as well as visiting a dermatologist regularly, hair loss and its psychological impacts can become a problem of the past.

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