Hair loss
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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 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 | 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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