Hair has been called our "crowning glory". Society has placed a great deal of social and cultural importance on hair and hairstyles. Unfortunately, many conditions, diseases, and improper hair care result in excessive hair loss. People who notice their hair shedding in large amounts after combing or brushing, or whose hair becomes thinner or falls out, should consult a dermatologist. With correct diagnosis, many people with hair loss can be helped.
Dermatologists, physicians who specialize in treating diseases of the hair and skin, will evaluate a patient's hair problem by asking questions about diet, medications including vitamins and health food taken in the last six months, family history of hair loss, recent illness and hair care habits. Hormonal effects may be evaluated in women by asking about menstrual cycles, pregnancies and menopause. After examining the scalp and hair, the dermatologist may check a few hairs under the microscope. Sometimes blood tests or biopsy may be required for an accurate diagnosis. It's important to find the cause and whether or not the problem will respond to medical treatment.
Normal Hair Growth
About 90 percent of the hair on a a person's scalp is growing at any one time. The growth phase lasts between two and six years. Ten percent of the hair is in a resting phase that last two to three months. At the end of its resting stage, the hair is shed. When a hair is shed, a new hair from the same follicle replaces it and the growing cycle starts again. Scalp hair grows about one-half inch a month. As people age, their rate of hair growth slows. Natural blondes typically have more hair than brunettes or redheads.
Most hair shedding is due to the normal hair cycle, and losing 50-to-100 hairs per day is no cause for alarm. However, if you are concerned about excessive hair loss or dramatic thinning, consult your dermatologist.
Causes of Excessive Hair Loss
Excess hair loss can have
many different causes. Hair will regrow spontaneously in some forms of
hair loss. Other forms can be treated successfully by a dermatologist.
For the several forms of hair loss for which there is no cure at
present, there is research in progress that holds promise for the
future. Talk to your dermatologist about the best options for you.
Improper Chemical Treatments
Many
men and women use chemical treatments on their hair, including dyes,
tints, bleaches, straighteners, and permanent waves. These treatments
rarely damage hair if they are done correctly. However, the hair can
become weak and break if any of these chemicals are used too often. If
hair becomes brittle from chemical treatments, it is best to stop until
the hair grows out.
Hereditary Thinning or Balding
Also
known as androgenetic alopecia, this is the most common cause of hair
loss, and can be inherited from either the mother's or father's side of
the family. Women with this trait develop thinning hair, but do not
become completely bald. Hereditary hair loss can start in one's teens,
twenties, or thirties. While there is no cure, medical treatments are
available that may help some people, including:
- Minoxodil, a lotion applied to the scalp twice a day, which can be used by men and women
- Finasteride,
an oral prescription medication used by men only which blocks the
formation of the active male hormone in the hair follicle
Alopecia Areata
The cause of alopecia areata is
unknown, but it is thought to be an autoimmune condition (the body
makes antibodies to its own hair) that may affect children or adults of
any age. The affected persons are generally in excellent health. This
type of hair loss usually causes totally smooth, round patches about
the size of a coin or larger. Although rare, it can result in complete
loss of scalp and body hair. In most cases the hair regrows; however,
dermatologists treat many people with this condition in order to make
hair regrow faster.
Treatment includes:
- cortisone injections in the scalp where the hair loss occurred
- topical medications
- a special kind of light treatment
- pills
Telogen Effluvium
Illness,
stress, and other factors can cause too many hairs to enter the resting
(telogen) phase of the hair growth cycle, and it produces a dramatic
increase in the amount of hair shed (effluvium), usually without bald
patches. In many cases, telogen effluvium usually resolves in a few
months on its own. Causes of telogen effluvium include:
- High Fever, Severe Infection, Severe Flu
- Major Surgery/Chronic Illness
- Thyroid Disease
- Inadequate Protein in Diet
- Low Serum Iron
- Medications
- Birth Control Pills
- Cancer Treatments
Tinea Capitis (Scalp Ringworm)
Caused
by a fungal infection, tinea capitis is characterized by patches of
scaling that can spread and result in broken hair, redness, swelling,
and even oozing on the scalp. This contagious disease is most common in
children, and oral medication will cure it.
Trichotillomania (Hair Pulling)
Children,
and sometimes adults, will twist or pull their hair, brows, or lashes
until they come out. Oftentimes this is just a bad habit that gets
better when the harmful effects of that habit are explained. Sometimes
hair pulling can be a coping response to unpleasant stresses and
occasionally is a sign of a serious psychological problem.
Cicatricial (Scarring) Alopecia
This
rare disorder can cause patchy hair loss and associated itching and/or
pain. Inflammation around the hair follicle causes damage, scarring,
and permanent hair loss in the affected area. The cause or trigger of
cicatricial alopecia is unknown. Treatment focuses on stopping the
spread of inflammation.
Hair Restoration Surgery
Dermatologists
and dermatologic surgeons perform hair restoration surgery to correct
hair loss and create a natural-looking hairline. Patients with
well-defined baldness, thinning hair, and those with limited hair loss
due to scalp injury or burns are generally good candidates for hair
replacement surgery.
48-year-old male with male pattern baldness
Seven months later after three sessions
The
type of hair replacement surgery chosen depends on the extent and
pattern of hair loss. To achieve the best results, a dermatologist may
use one or more of the following procedures:
Hair Transplants
Hair
transplant surgery is based on the principle of donor dominance, which
means that hair from healthy donor sites will take root and grow
normally when transplanted into balding, recipient sites. Hair
transplantation involves:
- removing small strips
of hair-bearing scalp from the back and sides of the head, known as the
"donor region," which contains hair that will grow throughout a lifetime
- repairing the donor region, usually resulting in a very narrow scar which is hidden by overlying hair
- harvesting strips of hair-bearing scalp and dividing into grafts for placement in the balding areas
The
amount of coverage varies depending on the extent of baldness and the
specific procedure performed. Within one month, much of the
transplanted hair is shed. About two months later, hair starts to grow
and continues to grow at a normal rate. After six months, the
transplanted hairs begin to take on a natural appearance.
Scalp Reduction
Scalp
reduction offers a special benefit to patients with extensive balding.
In this procedure, bald areas are reduced or even eliminated by
removing several inches of the bald skin, then pulling the sides
together and suturing them. Scalp reduction surgery can be performed
alone or in conjunction with a hair transplant.
Scalp Extenders or Tissue Expanders
These
devices are inserted under the scalp for about three to four weeks to
stretch hair-bearing areas, and may be used to increase the
effectiveness of scalp reductions. The extender acts like a large
rubber band, and the expander works like a balloon, allowing for an
even greater reduction in the balding area.
For hair restoration surgery, the patient can expect:
- Treatment
performed using local anesthesia in the dermatologist's office, an
ambulatory surgery center, or other outpatient facility.
- To resume their normal activities, avoiding strenuous physical exercise until further notified.
- Mild
side effects which may include: some swelling and brusing around the
eyes after two or three days (which can be minimized by ice compresses
and sleeping in a semi-reclined postion), and some numbness at the
donor and recipient sites which usually disappears within three months.
- Multiple sessions at various intervals are usually required, and the entire process can take months to years to complete.
- As
with all surgical procedures, there is always some risk. However,
complications from the surgical treatment of hair loss are rare and
generally minimal.
