Hair loss
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| Hair loss is extremely common in both men and women; it is slightly more common in people with Caucasoid hair than in other types |
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Hair loss
Natural shedding
As we saw in Chapter 1, all hairs naturally fall out at the end of the growing period. Everyone loses between 50 and 80 hairs a day. They tend to come out with brushing and shampooing. So if you wash your hair only once a week, it is perfectly in order for you to lose several hundred hairs at one go!
Sometimes, however, a person may start to lose more hairs than usual. If this hair loss is significant, and if it persists, then sooner or later the scalp may become visible through the thinning hair. The condition is called alopecia. The name comes from the Greek word alopekia, which means 'fox': foxes (and also dogs) sometimes suffer from bald patches due to an unpleasant disease called mange. (Fortunately, humans do not get mange!)
Baldness
The commonest kind of hair loss is simple baldness. Many people find this type of baldness embarrassing and distressing, but it is not a disease - it is a perfectly normal event. For thousands of years, however, it has caused concern and anxiety, and people have sought remedies and 'cures' without number, in spite of some of them being uncomfortable and even painful.
Baldness affects both men and women. It is much more obvious in men, however. By the age of 25, 25% of men have lost some of their hair, and the proportion rises to 50% by the age of 50. Many men accept, however reluctantly and vainly hoping that it may not be so, that they are likely to go partly or completely bald if their fathers have done so. They are right, in that baldness is genetically determined in both men and women. In women, however, baldness is not only unexpected, particularly in the twenties and thirties let alone later, but understandably unacceptable.
In men, baldness usually begins at the temples, above the forehead and at the crown of the head. In these areas the hair follicles of sufferers are genetically pre-programmed to revert from producing terminal hairs to producing vellus-like hairs. The growth phase of
the hair (anagen) becomes shorter and shorter, with a greater proportion of hairs in the shedding (telogen) phase.
This change happens under the influence of male hormones (androgens) and can begin as early as the time of puberty or soon after, when androgen production in the body reaches a peak. Scientists call this kind of baldness androgenetic alopecia (meaning 'baldness due to androgens'). The eunuchs who served the harems of the east in days gone by never went bald!
Most women who come to dermatologists with hair thinning have androgenetic alopecia too. Baldness in women usually starts ten years or so later than in men, however. Fortunately for the sufferers, the amount of loss in women is differently distributed and less dramatic. The hairline usually remains intact and there is little or no loss at the temples.
The patterns of baldness thus differ between men and women. Hair scientists speak of male pattern baldness and female pattern baldness. Occasionally, though rarely, women suffer from male pattern baldness and men from female pattern baldness.
Progressive hair loss in Hamilton-type male pattern balding: (top) from the crown of the head, (centre) from the mid area, ( bottom) from the forehead and temples
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From this... ...to this |
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The Ludwig pattern of hair loss, which is most common in women
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The typical Ludwig pattern of baldness, seen here in a young woman
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Extreme Ludwig pattern hair loss in a elderly lady
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Female pattern balding: in spite of extensive hair loss, this lady has (just) retained her original hairline
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Diffuse hair loss
The second most common cause of hair loss is the general, or so-called diffuse, hair loss. In this condition the hair is shed from all parts of the scalp. A great deal of hair has to be lost before the effects become visible, however. The hair may fall during either the growing (anagen) or the resting (telogen) phase.
A sudden diffuse loss of hair may be both dramatic and distressing. One well-known cause of the loss of large amounts of hair is the drugs that are taken during cancer treatment, and in this case the hair is lost while it is in the growing phase. Fortunately the hair re-grows when the treatment is stopped.
Often women have some diffuse hair loss after the birth of a baby. During a pregnancy hair tends to grow well and to look healthy, under the influence of high levels of female hormones. It may in fact stay in the anagen phase throughout the pregnancy. When the baby is.
born this stimulation stops, and many of the follicles enter the catagen stage. Soon afterwards they enter the telogen phase in the normal course of events. They will be lost some two or three months later as the new hairs start to grow again. This is called telogen effluvium.
Two cases of telogen effluvium: the young woman above had a baby three months ago ...
... while this lady's condition is due to iron deficiency
Other causes of diffuse hair loss include the following:
No one knows what causes alopecia areata. It usually disappears without treatment. Steroid injections given by a doctor may help in persistent cases of localised alopecia areata.
Acute and severe alopecia areata, in which hair over large areas may fall off at a touch
Acute alopecia areata in a young boy
Alopecia totails, a condition in which all the body's hairs
are affected and the sufferer become completely hairless
A typical case of alopecia areata seen in the salon
| HAIR FACTS |
Alopecia areata
Alopecia areata is not particularly rare: one person in every thousand can expect to suffer from it at some time in their lives. |
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Hair pulling
People with the condition called trichotillomania feel compelled to pull out their hair. The effects are seen on both the scalp and the upper eyelids. In the affected areas there are hairs of different lengths. When looked at under the microscope they show fractures.
The condition is common but not severe in children between the ages of two and six. In teenagers it is twice
as common in girls as in boys, and can indicate the
presence of a serious emotional difficulty.
Traction and trauma
So-called traction alopecia is seen in people whose
hair is regularly subjected to strong traction (pulling).
This can occur with ponytails or from backcombing or heavy-handed brushing. The braided styles and hair
weaves often worn by Afro-Caribbean people put considerable tension on the hair, and can give rise to the condition.
The effect of braiding, leading to traction hair loss
- high fever
- blood loss
- low levels of iron in the diet (possibly)
- starvation, or drastic dieting
- dental treatment or a surgical operation
- certain medicines
- disorders of the thyroid gland
- severe and prolonged emotional stress (possibly).
Anyone with diffuse hair loss, especially if it has begun fairly suddenly, should see a doctor who understands the condition, since the causes are not always easy to identify.
The amount of hair shed naturally by one person over one year
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One day's natural hair loss
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Bald patches
The sudden patchy loss of hairs may be due to a condition called alopecia areata. The condition can be recognised by examining the shed hairs under the microscope: in alopecia areata these look like exclamation marks. The sufferer may be only mildly affected, with thinning patches on the scalp, but occasionally the disorder becomes so widespread and severe that all the body hair is lost see (opposite page).
Classical alopecia areata, showing an isolated patch of almost complete hair loss
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Hair loss in children
We have already looked at several conditions which can
lead to hair loss in children. Often an area of hair loss is
seen at the age of two or three months, and this is quite normal. Sometimes the development of mosaic patterns
of hair growth leads to apparent hair loss. Alopecia areata and trichotillomania are both seen from time to time in children.
In addition some children have a condition called loose anagen syndrome, in which the hair can be easily and painlessly pulled out. It is most common in fair-haired
girls. It tends to improve as they grow older.
Hair shaft abnormalities
Sometimes hair is lost because the structure of the hair shaft is not normal. There are four main types of abnormality:
- fractures
- irregularities
- coiling and twisting
- extraneous matter.
Some of these characteristics are genetically determined (inherited). Others are the result of something that has happened during the person's life. Yet others are the result of an underlying disease. The photographs reproduced here show some examples These cases are very rare, however: only about one person in every 10,000 is affected.
The pictures above illustrate a type of hair malformation known as trichorrhexis invaginata
An abnormally shaped hair shaft associated with the condition known as cheveux incoiffables
Two more examples of the congenital condition known as cheveux incoiffables
Woolly naevus is another congenital hair condition
| HAIR FACTS |
Shampoos and hair loss
When people change their regular shampoo, mousse, conditioner or other hair product, they naturally give some extra attention to the condition of their hair and scalp. If they notice any improvement they give credit to the new product. Equally, if they notice anything amiss they blame the product. If they find that they are shedding hairs, they blame the product too - even if the loss has been going on for months. They can begin to believe they are going bald.
Research has shown that while many people understand that hair fall is a natural process in hair re-growth, others link it to the use of 'unsuitable' shampoos rather than to combing or brushing or to chemical changes like perming. Only a few people recognise factors like childbirth, medication, diet, genetic inheritance or illness as possible causes of hair loss, although all these are well known to hair scientists.
The fact is that shampoos do not cause hair to fall. Nor do they have any effect on the daily rate of loss, or on the rate of hair growth. Not surprisingly, more hair is shed on days when the hair is shampooed than on other days because of the simple mechanical action of washing the hair. Scientists studying different kinds of shampoos (including '2-in-1' products) could find no differences between their effects on hair loss. |
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