Alopecia (Hair Loss)


  • Introduction of Alopecia(Hair Fall)
  • Stages of Alopecia
  • Types of Alopecia

Hair Loss Overview

Hair grows everywhere on the human skin except on the palms of our hands and the soles of our feet. 

Hair is made up of a protein called keratin that is produced in hair follicles in the outer layer of skin. As follicles produce new hair cells, old cells are being pushed out through the surface of the skin at the rate of about six inches a year. The hair you can see is actually a string of dead keratin cells. The average adult head has about 100,000 to 150,000 hairs and loses up to 100 of them a day; finding a few stray hairs on your hairbrush is not necessarily cause for alarm.

At any one time, about 90% of the hair on a person’s scalp is growing. Each follicle has its own life cycle that can be influenced by age, disease, and a wide variety of other factors.

Stages of Alopecia:

The life cycle of hair growth:

This life cycle is divided into three phases:

  1. Anagen — This is the phase in which the hair grows out from the follicles, and the shaft is continuously constructed, increasing the length of your hair. This phase can last for 2-6 years.
  2. Catagen — transitional hair growth that lasts two to three weeks
  3. Telogen — resting phase that lasts about two to three months;
  4. Neogen And Exogen–Neogen is the regeneration stage of a hair follicle, where a new follicle grows in place of the old one. Exogen is the releasing of the old anagen. As people age, their rate of hair growth slows.

About 10-20% of your hair is always in the resting phase at any given time. Hair loss occurs when your hair falls out without completing this three-stage cycle. The hair loss becomes permanent when the follicle stops producing hair, leading to balding. There are two types of hair fall that can lead to balding. Keep reading to find out what they are.

Types of alopecia:

There are many types of hair loss, also called alopecia:

  • Involutional alopecia is a natural condition in which the hair gradually thins with age. More hair follicles go into the resting phase, and the remaining hairs become shorter and fewer in number.

Androgenic alopecia is a genetic condition that can affect both men and women. Men with this condition, called male pattern baldness, can begin suffering hair loss as early as their teens or early 20s. It’s characterized by a receding hairline and gradual disappearance of hair from the crown and frontal scalp. Women with this condition, called female pattern baldness, don’t experience noticeable thinning until their 40s or later. Women experience a general thinning over the entire scalp, with the most extensive hair loss at the crown.

Anagen effluvium:

Anagen effluvium causes large amounts of hair to fall out rapidly during the anagen (growth) phase of the hair cycle.

The condition may cause hair to fall out from the head, as well as from other parts of the body, including eyebrows and eyelashes.

Causes of anagen effluvium include:

Treatment for this condition depends on the cause but can include a topical solution of minoxidil.

If a person has anagen effluvium as a result of undergoing chemotherapy, cooling the scalp during the procedure may help. Hair will often grow back 3–6 months after stopping the chemotherapy.

Alopecia areata:

Alopecia areata is an autoimmune condition that causes hair to fall out suddenly. The immune system attacks hair follicles, along with other healthy parts of the body.

Hair from the scalp, as well as eyebrows and eyelashes, may fall out in small chunks. But in about 90% of people with the condition, the hair returns within a few years without any treatment.

In severe conditions, the treatments for alopecia areata include injecting small amounts of steroids like triamcinolone into affected patches to stimulate hair growth. Although localized injections may not be practical for large areas, often this is a very effective treatment in helping the hairs return sooner. Other treatments, such as oral steroids, other immunosuppressives, or ultraviolet light therapy, are available for more widespread or severe cases but may be impractical for most patients because of potential side effects or risks.

Telogen effluvium 

Telogen effluvium is a condition where the hair remains in the telogen (natural shedding) phase of the growth cycle. This causes more hair to fall out, sometimes in handfuls.

Telogen effluvium is usually a temporary condition that resolves over time. It is advisable to see a doctor find out the cause.

Some possible causes include:

  • Health triggers: Malaria, typhoid, tuberculosis, thyroid issues, organ dysfunctions, HIV, malnutrition, syphilis, autoimmune diseases, rapid weight loss, childbirth, and nutrient deficiencies.
  • Stress Triggers: Emotional trauma, heavy labor, starvation, crash diets, serious injuries, and surgeries.
  • Drug Triggers: Oral retinoids, oral contraceptives, antithyroid drugs, anticonvulsants, hypolipidemic drugs, beta-blockers, amphetamines, Captopril, and heavy metals.
  • Local Triggers: Hair dye allergies

A doctor will need to treat any underlying causes of telogen effluvium.

Traction alopecia

Traction alopecia is a small or localized hair loss due to pulling hair into tight hairstyles, which causes it to break and come loose. Hairstyles associated with this condition include:

  • tight buns or ponytails
  • braids
  • cornrows
  • extensions

If traction alopecia continues, a person may develop bald spots and thinness of the hair.

In terms of self-care, avoiding tight hairstyles will usually prevent further damage.

Scarring alopecias

Scarring alopecias result in permanent loss of hair. Inflammatory skin conditions  (cellulitis, folliculitis, acne), and other skin disorders (such as some forms of lupus and lichen planus) often result in scars that destroy the ability of the hair to regenerate. Hot combs and hair too tightly woven and pulled can also result in permanent hair loss.

Trichotillomania, seen most frequently in children, is a psychological disorder in which a person pulls out or twists one’s own hair.

Treatment is often entirely behavioral. One has to notice the behavior and then consciously stop. Severe or resistant cases may require stress counseling with a therapist or psychologist or medical treatment with a psychiatrist. Several antidepressant or anti-anxiety medications have been shown to help with this condition.

Tinea capitis

Tinea is the medical word for fungal infection, and capitis means head. Tinea capitis is a fungal infection of the scalp that for the most part affects school-age children. Tinea capitis is more common in black African or African-American scalps. This condition is rare in healthy adults. Bald spots usually show broken-off hairs and are accompanied by dermatitis. Oral antifungals can penetrate the hair roots and cure the infection, after which hair grows back. Sharing hats or combs and brushes may transmit tinea capitis.

How do physicians diagnose hair loss?

Your doctor may suggest one or more of the following tests find out the cause of your condition:

  • Blood test
  • Pull test that includes pulling several strands of your hair by the doctor to determine the stage of the shedding process.
  • Scalp biopsy, where the sample from your scalp or hair plucked from the scalp is tested.
  • Light microscopy to examine hairs that are trimmed at their bases.

Once the cause of your hair loss is determined, you can discuss the treatment options with your doctor.

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