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Hair loss has afflicted mankind forever. Aristotle, who considered baldness a natural phenomenon, described the condition as alopecia (from the Greek word for fox), because of the bare spots foxes develop from mange. Alopecia is now the accepted medical term for baldness.
Excess hair loss can have many different causes. People who notice their hair shedding in large amounts after combing or brushing may be experiencing some form of hair loss.
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In order to determine what excess hair loss is, we must first determine how much of that shedding is normal.
 Hair grows in cycles. Every hair is constantly in one of three phases-resting, growing, or shedding. During the growing, or anagen phase, there is a continual division of living cells in each hair root promoting new growth. About eighty-five to ninety percent of naturally growing hair is in this phase at any one time.
At the end of the growing process, hair goes into the resting, or telogen, phase in which cells stop dividing and hair growth ceases. About ten to fifteen percent of one's hair is constantly in this phase.
During the shedding phase, the hair separates from the root and begins to fall out. The hair you find in your comb or brush was in this stage. Shedding 50 to 100 hairs a day is normal. This entire resting/shedding phase lasts from two to six months. When a hair is shed, it is replaced by a new hair from the same follicle and the growing cycle starts again.
Scalp hair grows about one-half inch a month. As people age, their rate of hair growth slows.
When addressing hair loss, a full medical history and close examination of the scalp will be required. Questions regarding diet, medications, including vitamins taken in the past six months, family history of hair loss, recent illness and hair care habits will be asked.
Laboratory work-up and even a scalp tissue biopsy may be required in some cases.
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As you are about to see, although there are many possible causes of hair loss, the vast majority is due to a Hereditary condition: Androgenic Alopecia.
I.- Male/Female Pattern Baldness: Androgenic Alopecia
 Hereditary hair loss is the most common cause of thinning hair. The tendency 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 commonly become completely bald. The condition is called Androgenic Alopecia and it can start in the teens, twenties or thirties. There is no real cure, although medical treatments have recently become available that may help some people.
Here is what happens. The male hormone testosterone when exposed to the enzyme ‘5-a-reductase', located in the hair follicles, metabolizes testosterone and produces another hormone derivative-dihydrotestosterone (DHT). Oddly enough, while DHT causes new hair growth, it is also responsible for hair loss. On certain parts of the scalp, as predestined by genetics, the hair follicles automatically seek out the DHT hormone. These follicles literally overdose on DHT causing them to shrink. With this shrinkage, the hair undergoes shortened growth cycles or lengthened resting periods. The hair becomes thin and weak until it is finally lost and regrowth does not occur.
The balding process is gradual, occurring as more and more of the hair goes into telogen phase and falls out. The hair remaining in the balding area grows more slowly with noticeable thinning. Surprisingly, many hairs do continue to grow in the bald area, but they are short, soft, almost invisible hairs known as vellus hairs. They are comparable to fine down. Unfortunately this hair never converts to regular hair.
As the balding process continues, the metabolism of hair follicles decreases, cutting off the blood supply to the area and shrinking the outer layer of skin or epidermis of the scalp. With the thinning of this skin, the sebaceous glands in the bald area are activated producing an oil which causes the scalp to shine.
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II.- Other Causes of Hair Loss:
A.- Alopecia Areata. In this type of hair loss, hair usually falls out resulting in totally smooth round patches about the size of a coin or larger. It can rarely result in complete loss of scalp and body hair. This disease may affect children or adults of any age. Even though the cause is unknown, there seems to be an immune element involved, as evidenced by the response to local steroid treatment in some patients. In other cases , the hair may regrow by itself. Apart from the hair loss, affected persons are generally in excellent physical health.
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B.- Child Birth. Pregnant women do not lose as much hair as they did before they were pregnant. However, after delivery, many hairs enter the resting phase of the cycle. So that within 2 to 3 months, some women will notice large amounts of hair falling out. This can last 1 to 6 months, but resolves completely in most cases.
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C.- High Fever, Severe Infection, Severe Flu. 1 to 3 months after any of these conditions, a person may be shocked to see a lot of hair falling out. This shedding usually corrects itself.
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D. -Thyroid Disease. Both an overactive thyroid and an underactive thyroid can cause hair loss. This can be diagnosed by your physician with laboratory tests. This type of hair loss can usually be reversed with proper treatment. |
E.- Inadequate Protein Intake. Crash diets excluding protein, or abnormal eating habits, may develop protein malnutrition. The body will help save protein by shifting growing hairs into the resting phase. Massive hair shedding can occur 2 to 3 months later. Hair can then be pulled- by the roots- fairly easily. This condition can obviously be reversed and prevented by eating proper amounts of protein, particularly when dieting.
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F.-Medications. Some prescription and over the counter drugs may cause temporary hair shedding in some people. Some of these include medicines used to treat gout, arthritis, depression, heart problems, high blood pressure, , or blood thinners. High doses of vitamin A and Selenium may also cause hair shedding. |
G.- Cancer Treatments. These will cause hair cells to stop dividing. Hairs then become thin and break off as they exit the scalp. This may occur 1 to 3 weeks after treatment. Patients can lose as much as 90% of their scalp hair. The hair will regrow after treatment ends.
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H.- Birth Control Pills. Women who lose hair associated to birth control pills, usually have an inherited tendency toward hair loss. If this occurs, they should consider switching to another birth control pill. When they stop the contraceptive, hair will begin shedding 2 to 3 months later, continue for 6 months when it usually stops. This is similar to what happens after childbirth.
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I.- Low Serum Iron. On occasions, iron deficiency produces hair loss. There may be a deficiency in the diet or inability to absorb iron. Heavy menstrual periods may also develop iron deficiency. Low serum iron can be detected by laboratory tests and can be corrected by taking iron pills.
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J.- Major Surgery/ Chronic Illness. Major operations may be a tremendous shock to the system. These patients may notice increased hair shedding within 1 to 3 months afterwards. The condition may reverse itself within months, but those with severe chronic illness may shed hair indefinitely. |
K.- Traction Alopecia. Cases where patients may pull their hair back very tightly, may cause permanent hair loss in the areas of traction.
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L.- Trichotillomania. A condition in which the hair is pulled due to a neurotic habit that usually appears in children, and may remain undiagnosed for a long time. The hairs may be broken off or pulled out. Some stubby regrowth may be visible. This condition may be hard to differentiate from alopecia areata.
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M.- Fungus Infection (Ringworm) of the Scalp. Has nothing to do with a worm. It is caused by a fungus infection, also known as ringworm. It begins with small patches of scaling that can spread and result in broken hair, redness, swelling, and even oozing. This contagious disease is more common in children and oral medication will cure it.
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N.- Improper Hair Care. Many men and women use chemicals on their hair: 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 the solution is left on too long, or if two procedures are done on the same day, or if bleach is applied to previously bleached hair. If you notice your hair becoming brittle from chemical treatments, it is best to stop until the hair has grown out.
Shampooing, combing and brushing too often can also damage hair, causing it to break. A cream rinse or conditioner can be used after shampooing to make it easier to comb and more manageable. When hair is wet, it is more fragile, so vigorous rubbing with a towel, and rough combing and brushing should be avoided. Don't follow the old rule of 100 brush strokes a day- that damages hair. Instead use wide-toothed combs and brushes with smooth tips.
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O.- PCOS, or polycystic Ovarian Syndrome, also known as Polycystic Ovarian Disease or Stein-Leventhal Syndrome is a condition which affects approximately 6-10% of all pre-menopausal women. The most common symptoms of PCOS include irregular menstrual periods, male-pattern baldness, obesity or unexplained weight gain, excessive facial and/or body hair, insulin resistance and infertility.
Although the root cause of PCOS is not known, there is much research underway in an attempt to determine and explain what is happening. Many researchers believe the underlying cause of PCOS can be linked to a condition known as hyperinsulinemia. With this condition, high insulin levels trigger reactions in the body which ultimately cause androgen levels in the ovaries to skyrocket. This elevated androgen level is what ultimately leads to the male-like symptoms commonly seen in PCOS. Some studies also indicate the possibility of PCOS being passed onto the female offsprings of pre-maturely balding men. In fact, the father and daughter may share a common gene defect to which both conditions may possibly be attributed.
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P.- Hyperinsulinemia or high insulin levels. Exciting new research from Harvard School of Public Health shows that men who have the highest blood levels of insulin-like-growth factor-1 and women who have high levels of insulin (as in Polycystic Ovary Syndrome) are the ones most likely to suffer male pattern baldness.... It still is early in this research, but evidence is accumulating that male pattern baldness may be caused by high levels of insulin that are produced by eating lots of sugary and floured foods such as bakery products and pastas. Future research will show if male pattern baldness can be prevented by avoiding flour and sugar, eating fruits only with meals, and taking drugs such as Glucophage and Rezulin to lower insulin levels. |
Q.- Ultraviolet Radiation. Australian researchers have found evidence which indicates that U.V. radiation, sunlight exposure , may be damaging to hair follicles and in particular to transplanted hair. It is highly recommended to wear hats and/or sun blocks when prolong exposure to the sun is contemplated.
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© 2007
Saeed Solhi, M.D., Chartered. All rights reserved.
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| Every procedure and treatment in medicine carries some degree of risk. Medicine is an inexact science as well as an art. Therefore, there cannot be guarantees of outcome. However, physicians are under a legal obligation to adhere to the standard of care and disclose risks inherent in the recommended procedure and/or treatment. You have the responsibility to decide whether these risks are acceptable to you. If you have any questions, please ask your physician. |
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