Understanding hair loss
Introduction
One of the ‘gifts’ that being a doctor has bestowed on me is the ability to spot health disorders in people I meet everywhere outside the hospital. Alopecia commonly known as hair loss, has become one of the commonest medical disorders in the society today that is easily recognizable even to the untrained eye.
What is alopecia?
It is the sudden or chronic abnormal loss of hair and can be precipitated by several hundred disease states or events.
Loss of scalp hair is considered abnormal in many societies including Nigeria. Hair is perceived to be important for many reasons. It serves as a means for wealth display, beauty, desirability, social status, and youthfulness.
With that perception comes the reality that millions of naira are spent annually for hair care and its perceived abnormalities.
To help us better understand hair loss, I will classify it simply.
Classification of hair loss
Clinically, hair loss is classified into:
1. Scarring: The hair follicle is destroyed leading to permanent hair loss and there is associated inflammation, shrinkage, and scarring of the scalp.
2. Non-scarring: There is loss of hair without destruction of the hair follicle, no sign of tissue inflammation, scarring, or shrinkage of the skin of the scalp. Examples include Traction alopecia and Androgenetic alopecia.
The hair loss could be generalised or localised, complete (affecting the whole scalp) or partial, patterned (like in Female pattern hair loss) or non-patterned.
CAUSES OF HAIR LOSS
Non-scarring hair Loss
This is the commonest type of hair loss. Traction alopecia is caused primarily by unhealthy hair care practices. It results from cosmetic stress due to poor knowledge of hair type, poor styling (untrained stylist, tight styles [braids, weaves, ponytails, rollers], repetition of styles, etc).
Prolonged traction alopecia can lead to scarring of the scalp and irreversible hair loss.
Other causes of non-scarring hair loss include chemical damage from relaxers and dyes, pressure-induced traction (from repetitive use of tight-fitting wigs, scarves/ turbans, and Trichotillomania (neuromechanical alopecia).
Telogen Effluvium is the rapid shedding of a large number of hairs throughout the scalp due to a variety of physical or mental stressors such as: Hormonal imbalances after childbirth, around menopause or hypo/ hyperthyroidism, physical stress from anaemia, surgery, systemic illness, and psychological stress. The precipitating event precedes the telogen effluvium by 6 to 16 weeks and removal of inciting cause leads to resolution over the next few months as the number of hairs in telogen return to normal.
Some anti-hypertensive drugs, anticoagulants, anticancer agents, Anti-epilepsy drugs, Beta blockers, Cholesterol-lowering drugs, and so on have been connected to hair loss.
Systemic diseases like Systemic Lupus erythematosus, secondary syphilis, polycystic ovarian syndrome, and adrenal diseases can cause hair loss.
Nutrient Deficiencies including Protein, Iron, Biotin, Zinc, Copper, Selenium, Iodine, Calcium, Essential Fatty Acids (Omega 3 & 6) and Vitamins (A, Bs, C, D, ) can trigger hair loss.
Abnormal and imbalanced diets like Crash Diets, FAD Diets and Eating disorders (Anorexia nervosa, Bulimia) are also causes of hair loss.
Androgenetic (female-pattern) alopecia is common in postmenopausal women who may develop a receding hairline. Acne, excess facial or body hair, male-pattern escutcheon, irregular menses may be present in younger women.
Scarring Hair Loss
CENTRAL CENTRIFUGAL CICATRICIAL ALOPECIA
This is commoner in blacks than whites and presents as an area of slowly expanding scarring alopecia on the vertex or crown. It may be asymptomatic or accompanied by itching, tenderness, redness or pustules. Chemical or mechanical processing of the hair may play a role. It is a common cause of permanent hair loss.
Management
Healthy hair practices are advocated to prevent hair loss; incorporating the appropriate products, techniques and styling are beneficial.
A healthy lifestyle including appropriate nutrition, regular health checks and stress management are encouraged.
Hair loss may be a pointer to systemic illnesses and most cases of hair loss can be successfully managed with EARLY and ACCURATE diagnosis.
If within the first 2 weeks to 3 months of hair loss, there is no regrowth after commencing self-treatment, seek professional help from a doctor or Trichologist to avoid permanent hair loss.
Dr Agility U. Obi-Ihesie