WHAT IS HAIR LOSS?
Hair loss or alopecia is a problem of great concern to all those who experience it. In many women, a gradual but slight widespread thinning of the hair starts in adult life. It is basically a natural process and should not be regarded as abnormal. About 50% of women have significant hair loss by the age of 60. This is male pattern baldness called androgenetic alopecia because it is under the influence of male hormones (androgens).
FACTS ABOUT NORMAL HAIR GROWTH AND LOSS
Hair is continually produced and shed at the same time.
About 50 to 100 hairs are shed daily without a reduction in hair thickness.
Every hair on the scalp is shed and replaced every 3 to 5 years.
At least 25% of hair must be shed before there is a noticeable loss of thickness.
Significant hair loss tends to block the shower drain or be visible all over the pillow.
WHAT ARE CAUSES OF ABNORMAL HAIR LOSS?
In general terms, the basic causes are genetic (hereditary) factors, hormonal factors, stress, illness, and drugs. SPECIFIC CAUSES ARE:
androgenetic alopecia (common baldness)
alopecia areata
chronic traction alopecia—due to an overtight hairstyle
diffuse alopecia, due to telogen effluvium, or drugs.
ANDROGENIC ALOPECIA IN WOMEN
Women also produce androgens but the hair loss pattern is slower and different from that of men. Diffuse thinning occurs, usually on the top of the head (the crown). The front hairline usually remains but in some women, this can recede. Although hair loss can appear in men and women as early as their twenties, it may not appear before the age of 50 in women. Some women notice a short period of considerable hair loss but this may settle down to a long period of no loss. Androgenetic alopecia may be unmasked after an episode of diffuse loss such as occurs after childbirth or a severe illness. Total loss of hair rarely occurs in women.
Treatment is somewhat controversial and needs to be discussed with your doctor.
ALOPECIA AREATA
This is a disorder of the hair follicle that causes complete hair loss in patches leaving a smooth, clean, normal scalp, or other areas normally covered in hair. A smaller localized patch will usually recover spontaneously within 12 months, though some may not. Alopecia areata can cover an extensive area and rarely it may cover the whole scalp (alopecia totalis), even the eyelids or eyebrows when recovery is unlikely
DIFFUSE ALOPECIA
TELOGEN EFFLUVIUM
This complex term refers to diffuse shedding of hair. It can be triggered by a variety of stressful conditions after which it takes about 2 to 4 months for the hair loss to occur. In this disorder up to 50% loss is common so perceptible thinning will be noticed. Patients usually complain of large clumps of hairs with white bulbs coming out with gentle tugging on combing or shampooing—this can exceed 150 hairs a day compared with the normal average of 50 to 100 hairs.
The classic precipitating event is childbirth when the hair thins about 3 months later. Others include any severe stress, high fever, weight loss especially crash dieting, trauma from surgery or an accident, malnutrition, ceasing the pill, and certain illnesses.
People can be reassured that spontaneous recovery is usually expected in about 6 months. If stress factors are corrected and recovery is poor, topical minoxidil for a minimum of 4 months can be used.
CHRONIC TELOGEN EFFLUVIUM
This condition occurs usually in menopausal and postmenopausal women. There may be an episode of dramatic hair shedding that recovers but recurs weeks to months later and lasts up to several days. Fortunately, it does not result in obvious balding—it is self-limiting and does not need treatment.
DRUG INDUCED ALOPECIA
Drugs are a very important cause of alopecia. Those that cause telogen effluvium include cytotoxics (cancer chemotherapy), anticoagulants (warfarin, heparin), antithyroid drugs, antiepileptic, and various hormones.
GENERAL COMMENTS ON TREATMENT
MEDICATIONS
There are several drugs available that can slow down or prevent further hair loss. With these treatments, most women will notice a reduction in hair loss and some will notice hair regrowth but normal regrowth is exceptional. The medications are expensive and need to be used for the rest of one’s life if a good response occurs. You can discuss these medications with your doctor.
PHYSICAL TREATMENT
Other treatments include the use of wigs, hair transplantation, and camouflage. Wigs can be worn on the whole head or on a bald spot, or fibers can be interwoven with the remaining hairs. You can consult hairdressing experts about camouflage.