Types of Hair Loss

Hair Loss affects a large number of people in today’s society but not everyone suffers from the same ‘type’ of hair loss. Hair loss comes in many forms and degrees of severity such as androgenetic alopecia, elogen effluvium, alopecia areata, ringworm, scarring alopecia, and hair loss due to cosmetic over processing. Alopecia is the general medical term for hair loss which can be caused by a wide range of factors ranging from genetics to environmental/psychological influences. While androgenetic alopecia is the most common form of hair loss, this article will also explore the other main forms of hair loss that dermatologists have recognised over the years. Although dermatologists have made much advancement in this area in the last few years, research into hair biology and hair diseases is still limited and so the level of research and the subsequent findings is sure to increase in the future.

Telogen Effluvium
Some forms of hair loss are known as ‘effluvium’ which means ‘outflow’. Effluviums affect different phases of the hair growth cycle. Telogen Effluvium is one of the most common forms of hair loss and so it is surprising how little research has been done to understand this condition. Telogen Effluvium happens when there is a change in the number of growing hair follicles. If the number of hair follicles producing hair drops significantly during the resting, or telogen phase, there will be a significant increase in dormant, telogen stage hair follicles. This results in Telogen Effluvium hair loss. Telogen Effluvium is often characterised by the thinning of hair on the top of the scalp. There is usually no hair line recession. People who suffer from Telogen Effluvium rarely lose all of their hair apart from in extreme cases in which the individual also often loses hair from their eyebrows and pubic region. However, the Telogen Effluvium form of hair loss is usually relatively easy to reverse and cure as the hair follicles are not permanently affected. As a result, by taking various medications, this form of hair loss can be cured.

Telogen Effluvium can develop in numerous ways. An environmental force is one of the most common forces that causes Telogen Effluvium. In this case, an environmental force “shocks” the growing hair follicles so that they go into a resting state for a while. This results in thinning hair/an increase in hair shedding. If the trigger is short lived, then the damage is easily reversible by eliminating the environmental force. Once it is eliminated, the hair follicles will return to their growing state and start producing new hair fibres resulting in a full head of hair within a year.
How one treats Telogen Effluvium depends on how it was caused and the severity of the situation. If its stress, treatment can be as simple as taking natural supplements and undertaking activities for stress control such as a diet plan and an exercise program (running and yoga). However, when a particular cause can’t be found, most dermatologists will prescribe ‘common’ hair loss medications such as Minoxidil.

Anagen Effluvium
Unlike Telogen Effluvium, Anagen Effluvium develops at a faster rate and is most commonly seen in people taking cytostatic drugs for cancer or those who have ingested certain toxins which inhibits cell proliferation. Hair fibre grows at up to 0.4mm a day and thus requires a lot of cell proliferation. Cytostatic cancer drugs and various toxins and poisons inhibit rapid cell growth thus inhibiting hair fibre production. When the hair fibres fall out they are mostly dystrophic Anagen hairs with a tapered root end. Some patients who receive cancer treatment choose to use cold therapy – a cap with ice packs and cold water which is placed on the patients head while the anti-cancer drugs are given. This sends the hair follicles into suspended animation prior to contact with the drug thus minimising the damage to the hair follicles. However, some patients find the process too uncomfortable and decide that it’s not worth it as the recovery from anagen effluvium is quite rapid (many patients noting new hair growth within one month). As the follicles are just frozen in time, they are ready to grow once the factor causing the anagen effluvium has been removed. Nevertheless, some people find that their hair changes in colour or texture after treatment and these changes can be permanent.

Alopecia Areata
Alopecia Areata(AA) is probably the third most common form of hair loss as nearly 2% of people will experience this form of hair loss in their lifetime. Again, there is insufficient research on Alopecia Areata however what we do know is that it is caused when the person’s immune system is inappropriately activated and attacks hair follicles, thinking that they are a threat to the rest of the body. AA can affect men, women, and children. It often appears as well-defined circular bald patches on the scalp. Alopecia totalis is the name given to hair loss when it is spread over the entire scalp and Alopecia universalis is the term given to hair loss when it also affects a person’s eyebrows, lashes, beard and pubic hair. If the alopecia is just limited to the beard area, it is called alopecia barbae. Unlike other autoimmune diseases, the hair follicles are not completely destroyed and can re-grow if the inflammation subsides. However, about 30% of individuals find the condition is permanent/semi-permanent and becomes more extensive as time passes. Traditionally, AA has been regarded as a stress-induced disease however dermatologists now believe that AA is much more complicated than that as genes, hormones, allergies, viruses and toxins have now become part of the equation.

The most common AA treatment involves the use of corticosteroids which can be applied to the bald patches. In extreme cases, systemic corticosteroids (those taken in pill or other form to affect your body), “pulse therapy” or more specialized treatments that involve applying sensitizing chemicals to the skin may be used. These cause an allergic reaction that can help promote hair growth. However, not all medications work everyone and for those unlucky individuals, the only answer may be hair grafts or wigs.

Scarring alopecia
Scarring alopecia, also known as cicatricial alopecia and includes dissecting cellulitis, eosinophilic pustular folliculitis, follicular degeneration syndrome (previously called “hot comb” alopecia), folliculitis decalvans, lichen planopilaris, and pseudopelade of Brocq, to name a few. Scarring alopecia may also be part of a much larger condition such as chronic lupus erythematosus. While there are many forms of scarring alopecia, most forms lead to permanent destruction of hair follicles thus causing permanent hair loss. Unfortunately, although most forms of scarring alopecia first occur as small patches of hair loss they often expand with time and are sometimes associated with severe itching, burning, and pain. If the dermatologist suspects scarring alopecia he or she will often conduct a skin biopsy to confirm the diagnosis. When confirmed they are generally treated with corticosteroids in topical creams and by injection into the affected area. In severe cases, antimalarial and isotretinoin drugs may also be used.

Hypotrichosis
Hypotrichosis is the condition in which someone can’t grow hair. Unlike alopecia, which describes hair loss, hypotrichosis describes a situation where hair loss can’t occur as there wasn’t any hair growth in the first place. People are born with hypotrichosis due to genetic aberrations or defects of embryonic development. There are hundreds of different types of hypotrichosis and unfortunately, most of these conditions involving hypotrichosis have no known treatment. A few forms of hypotrichosis are as follows:

Congenital Aplasia – A developmental defect in which the skin does not fully form as an embryo develops. A baby may be born with a patch of skin that is like an open wound or an ulcer. Often this defect occurs at the back of the scalp and if the defect is small, the skin will scab over and the baby is left with a scar. However, if a baby is born with a large congenital aplasia, it usually requires an operation to close up the skin.

Triangular Alopecia – Triangular alopecia (alopecia triangularis) is similar to congenital aplasia as it is a condition which affects a triangular patch of skin and hair above the temples. Hair follicles are unable to grow in this area and so the only cure is to surgically remove the area or implant hair follicles taken from somewhere else.

Congenital Atrichia – Congenital atrichia is caused by a single gene defect even when the parents don’t have the condition. People with congenital atrichia are born with a full head of hair but lose this hair as a child, hair which never grows back. This happens when the hair follicles enter their first resting state (telogen phase) in early childhood. For hair to grow, the dermal papilla cells and the epithelial cells have to communicate with each other. However, in this case, the dermal papilla cells get left behind deep in the skin and are thus unable to communicate with the epithelial cells which means that the anagen growth phase cannot commence and thus hair will never grow again.

Seborrheic dermatitis – Seborrheic dermatitis is classified as a skin condition but it can also lead to temporary hair loss if the dermatitis is on the scalp. Dermatitis is often oily and inflamed in appearance and can be itchy or painful to touch. Seborrheic dermatitis occurs when the sebaveous glands attached to the hair follicles begin to produce a very rich sebum- fatty acids and increased amounts of triglycerides and cholesterol. The excess, rich sebum production in seborrheic dermatitis can trigger the proliferation of skin flora. Yeast Pityrosporon ovale has been shown to increase in numbers with the intensity of seborrheic dermatitis. This often occurs when hormones are fluctuating e.g. during puberty. Seborrheic dermatitis can also be caused by Parkinson’s disease, head injury and a stroke and stress, a lack of essential nutrients and chronic fatigue can make it worse. Although it first and foremost affects the skin, if the follicles are close to the inflammatory cells, the follicles can be adversely affected as it becomes a dangerous environment in which to grow. There are several methods in which to treat seborrheic dermatitis including the use of anti-dandruff shampoo and other medicated shampoos. Additionally, the inflammation can be treated using a corticosteroid cream and although Seborrheic dermatitis may vanish quickly, a preventative treatment should be used even when the symptoms have gone.

Loose anagen syndrome – As the name suggests, loose anagen syndrome is when people grow ‘weak’ hair that is loose and easily pulled out of the hair follicle. Loose anagen syndrome is often diagnosed in young children (most common in blonde haired children) and the back of the head is usually most affected. At night, the friction between the pillow and one’s hair can cause substantial hair loss and even the remaining hair usually doesn’t grow very long. Loose anagen syndrome occurs when the root sheaths that protect the hair shaft in the skin are not fully developed. Because the root sheaths are not fully formed there is a lack of adhesion between the hair shaft and the root sheath and the hair fibre is poorly anchored in the hair follicle. Unfortunately for sufferers of loose anagen syndrome, there are no known effective treatment.

Traction alopecia – Traction alopecia occurs when an individual wears a tight hat, has a cornrow hair style, braids the hair or pulls the hair into a tight pony tail/ bun. Due to the tight pulling action, hair loss occurs, leaving clear bald patches or diffuse, thin hair. If traction alopecia continues for a long time and the same hair is repeatedly pulled out then the hair follicles in the skin can become so damaged that they stop growing hair permanently.

Overprocessing and cuticle stripping – Overprocessing the hair is the most common cause of physical hair damage by far. Perming, bleaching, straightening and hair dyeing all involve quite harsh chemicals that can significantly affect the integrity of hair fibre. For perms, straighteners, bleaches, and dyes to work the cuticle has to be opened up so that other chemicals can get to the hair cortex and rearrange the chemical bonds in the hair structure. If the chemicals are extremely harsh or are used too often, the cuticle can be permanently damaged thus leading to hair loss or the appearance of dull, “dry” and frizzy hair which often ‘breaks’ in time. Aggressive brushing, back combing, and other grooming techniques can also cause hair loss or breakage as it exerts a high level of stress on the hair fibre. To ‘fix’ the damage cause, the best approach is to cut off as much damaged hair as possible and to be gentle until new, undamaged hair grows. While there are cosmetic treatments to help “glue” damaged hair back together, they only work for a short time and have to be reapplied regularly so patience, in this case, is the best cure.