Dermatologist answers your questions on hair loss

1. What is alopecia?

Alopecia is the medical term for hair loss. It comes from the Greek word “alopex”, which originally referred to mange (the animal version of the disease scabies that causes fur loss) in foxes.

It can occur on any part of the body, in both males and females and at any age in life (both children and adults).

2. What causes the hair loss?

There are very many causes of alopecia, which may be related to hereditary factors (inherited, family history), medical conditions, medications, supplements, hormonal changes, very stressful events, radiation, significant weight loss, nutritional deficiencies, and certain hairstyles and hair care practices.

The most common forms of alopecia are:

• Male and female pattern balding (androgenetic alopecia)
• Telogen effluvium – this is a temporary, non-scarring alopecia that occurs when a body change, stressful event or shock  causes increased diffuse shedding of resting hairs. Common triggers include major physical trauma or psychological stress, surgery, severe illness and high fevers, extreme dietary changes and weight loss, sudden hormonal changes as usually occurs after childbirth and during menopause, thyroid abnormalities and iron deficiency. It may also be caused by excessive blood loss and medications such as contraceptives, anticonvulsants and anticoagulants.
• Alopecia areata – this is a common autoimmune disorder (where your immune system attacks your own body) that causes hair to fall out in patches. It can happen anywhere on the body. If all the hair on the scalp is lost it is called alopecia totalis and if all the hair on the entire body is lost it is called alopecia universalis.
• Alopecia from infections such as tinea capitis , which is a type of fungal infection of the scalp, commonly known as ringworm. Other bacterial, viral and fungal infections can also cause hair loss, such as folliculitis, boils, shingles and so on.
• Scarring alopecias (cicatricial alopecia): this is a large group of different disorders. A common form in our set up, especially in women, is CCCA ( Central Centrifugal Cicatricial Alopecia). This is a chronic and progressive scarring alopecia that spreads outwards from the vertex of the scalp. Inflammatory skin diseases may also cause scarring alopecia. Examples of these include include: folliculitis decalvans, dissecting cellulitis, localised scleroderma, discoid lupus erythematosus, frontal fibrosing alopecia and lichen planopilaris.
• Hair loss from over-processing hair (for example with relaxers and bleach), excessive brushing, excessive heat from hair dryers, traction alopecia (hair loss from hairstyles that excessively pull hair) and other causes of physical damage such as trichotillomania (also called hair-pulling disorder – a mental condition that gives some people strong urges to pull out their own hair). Examples of hairstyles that cause traction alopecia include tight braids (especially cornrows), dreadlocks, ponytails, foam rollers and tight scarf styles.
• Anagen effluvium – a type of diffuse hair loss that develops quickly (the hair does not enter resting phase like in telogen effluvium)  and is most commonly seen in people taking certain types of cancer medications and in people who have ingested toxins like rat poison.  The hair shedding is due to interruption of active hair growth by the drugs or toxins.
• Congenital hypotrichosis – a condition that where there is little to no hair growth from birth.
• Alopecia from systemic diseases such as systemic lupus erythymatosus, syphilis, iron deficiency and thyroid hormone disorders.

3. What are the early signs of balding?

• When you part your hair, you may notice a gradual widening of the part (more scalp showing).
• An M-shaped receding of your front hairline. This may be more visible on photographs taken months or years apart. Caution: you should compare photos of dry hair taken in similar lighting, as many people’s hair looks thinner (even when it’s normal) in bright down lighting, especially fluorescent light.
• Thinner hair at your temples.
• Gradual thinning of the hair at the top of your head.
• Smooth bald patches the size of a coin. (Especially in alopecia areata).
• Hair easily coming out in excessive amounts after gentle tugging, combing or washing hair due to loosening of the hair.
• Excessive hair on your pillow.
• Having signs of a medical condition that may cause alopecia, such as redness, itch, scaling, and so on.
• Hair growing slower and the hair texture changing may occur in the early stages of male and female pattern balding.
• Thin, whispy hair.
• Your ponytail is getting smaller/thinner (the circumference is reducing). You may find that you need to loop your ponytail one more time than usual to secure it.
• When you pull your hair back, more of your scalp is seen through the hair (scalp show-through).
• A prickly and burning discomfort called trichodynia may accompany hair shedding.
• For traction alopecia: before hair loss, there are warning signs of a tight, damaging hairstyle such as pain, stinging, pimples and crusting. Braids and other hair styling should not be painful.

4. How can hair loss especially among women be prevented?

 Most forms of hair loss cannot be actively prevented. However, one can still be gentle to the scalp and hair shaft to avoid further trauma and damage to the already vulnerable hair shaft. Examples of this include:

Other tips:

• Avoid compulsive pulling, rubbing or twisting of your hair.
• Use a wide-toothed comb.
• Do not use too much shampoo, avoid brushing your hair when wet, do not rub hair dry with a towel, do not brush too hard or too often.
• Avoid medications that may cause hair loss.
• Manage your stress.
• Eat a healthy, a balanced diet especially rich in proteins, vitamins, minerals such as iron, and antioxidants.
• Stop smoking, as this has been shown to also contribute to hair loss, especially in men.

5. Is there a treatment for hair loss?

Yes.

(However, areas that have undergone scarring alopecia are not reversible – scarring alopecia is permanent – but it can be prevented from spreading to a wider area.)

The most important step is visiting a dermatologist to get the correct diagnosis of what type of alopecia you have. The earlier you get your diagnosis, the better the chance you have of successfully treating the alopecia.

Hair loss that is caused by a medical condition should gradually resolve after that medical condition is treated. If certain medications/drugs are the cause of the alopecia these may be discontinued.

Different types of alopecia have different treatments. Diagnosis is important, and this will determine the treatment and prognosis. Early treatment of male and female pattern alopecia may reduce the speed of thinning.

Alopecia treatments depend on the diagnosis and include topical medications such as minoxidil, topical corticosteroids, injectable steroids, oral medications for the different diagnoses for example to treat infections, suppress inflammation in inflammatory diseases, hormone inhibitors and suppressors, nutritional supplementation to treat deficiencies, low-level laser therapy (LLLT) devices, microneedling, Platelet Rich Plasma (PRP), hair transplantation, and various camouflaging techniques (to disguise or cover the hair loss) such as hair fibres (their static charge makes hair look thicker), wigs, hair pieces, hats, scarves.