Hair Loss Disorder Causes & Symptoms

Hair loss also known as Alopecia affects men and women of all ages. Hair loss occurs when the cycle of hair growth and  shedding is disrupted or when the hair follicle is destroyed and replaced with scar tissue. This happens due to many disorders like; Alopecia areata, trichotillomania, traction alopecia, and tinea capitis that occur due to many causes.

What Causes Hair Loss?

Hair loss is often caused by genetics, that is, it runs in families. In general it is not a symptom of disease. However, thyroid disease, anemia, ringworm of the scalp, and anorexia can cause hair loss. In addition, some medications such as cancer chemotherapy, may cause temporary hair loss. Hair growth usually returns to normal when the medications are stopped. In some cases, hormones after giving birth or during menopause can cause thinning hair.

Hair Loss Disorder

Androgenetic alopecia, one of the most common forms of hair loss, usually has a specific pattern of temporal-frontal loss in men and central thinning in women. Minoxidil is the most prescribed medication to treat men and women, with the addition of finasteride for men. 

Alopecia areata, trichotillomania, traction alopecia, and tinea capitis have unique features on examination that aid in diagnosis. To treat these disorders it is a must to focus on curing the underlying causes.

Alopecia areata

Alopecia areata (A.A) is a common form of hair loss. It is an autoimmune condition where circular bald patches appear on the scalp and other hair-bearing areas. It usually starts with one or more small, round, smooth patches on the scalp and can progress to total scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis).

A.A is probably secondary to an autoimmune reaction involving antibody, T-cell, and cytokine-mediated losses. The trait appears to be polygenic, affecting men and women equally. 

The hair loss may occur spontaneously, and the hair may regrow if the inflammation subsides. If the alopecia covers the entire scalp it is called alopecia totalis. If it spreads to the rest of the body including eyebrows, lashes, beard, and pubic hair it is called alopecia universalis. In men, if the alopecia appears only in the area of the beard it is called alopecia barbae. 

What Happens In Alopecia Areata?

 

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Alopecia areata  is a highly unpredictable and cyclical condition. The affected hair follicles become very small and produce no visible hair above the skin’s surface. 

This hair loss disorder usually begins when clumps of hair fall out, resulting in totally smooth, round hairless patches on the scalp. In some cases the hair may become thinner without noticeable patches of baldness, or it may grow and break off, leaving short stubs. In rare cases, complete loss of scalp and body hair occurs. Even if hair grows back  in one area, it will fall out in another area.

Causes Of Alopecia Areata (A.A)

The condition occurs when white blood cells attack the cells in hair follicles, causing them to shrink and dramatically slow down hair production. It is unknown precisely what causes the body’s immune system to target hair follicles in this way. A.A is more likely to occur in a person who has a close family member with the disease.

Symptoms of A.A

The typical pattern is for one or more –large coin shaped– bald patches to appear on the scalp. They develop quite quickly.

The scalp usually looks healthy and there is no scarring. Occasionally, there is some mild redness, mild scaling, mild burning or a slightly itchy feeling on the bald patches. 

Treatments For Alopecia Areata

Unfortunately, there is currently no cure for alopecia areata. Although there are some forms of treatment that  doctors suggest to help hair re-grow more quickly. The most common form of alopecia areata treatment is the use of corticosteroids, powerful anti-inflammatory drugs that can suppress the immune system. Other medications that can be prescribed that either promote hair growth or affect the immune system include Minoxidil, Anthralin, SADBE, and DPCP. However, they cannot prevent the formation of new bald patches. Other alternative treatment methods such as acupuncture and aromatherapy, can help treat this condition. However, there is little evidence to support these treatments. 

Trichotillomania
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Trichotillomania is a psychiatric impulse-control disorder. It’s a condition that gives some people strong urges to pull out their own hair. It can affect people of any age. However, it’s a most common condition among children between 8 to 15 years old. And it is the most common cause of childhood alopecia.

What Happens In Trichotillomania?

People with trichotillomania pull hair out at the root from different places of the body. However, the scalp is the most common part. Patients also may eat the plucked hairs, causing internal complications such as bowel obstruction.

Some people with the condition pull large handfuls of hair, which can leave bald patches on the scalp or eyebrows. Others pull out their hair one strand at a time. They might inspect or play with the strand after pulling it out.

Some people are very aware of their pulling. Others seem to do it in a very absent-minded way, without noticing what they’re doing. For people with trichotillomania, resisting the urge to pull out their hair feels as hard as resisting the urge to scratch a very itchy itch.  

This disorder can affect how people feel about themselves. Some are self-conscious about how this affects their appearance.

 Trichotillomania Factors

Some experts think that this disorder is close to obsessive compulsive disorder (OCD). 

The cause of trichotillomania is unclear. But like other disorders, it probably results from a combination of many factors. 

  • Family history: The disorder may occur in those who have a close relative with the disorder.
  • Age: This disorder usually develops just before or during the early teens. And is often a lifelong problem.
  • Negative emotions: For many people hair pulling is a way of dealing with negative or uncomfortable feelings. Specially stress, anxiety, tension, loneliness & other emotional disorders. 
  • Positive reinforcement: Patients often find that pulling out hair feels satisfying and provides a measure of relief. As a result, they continue to pull their hair to maintain these positive feelings.

Although far more women than men get treatment for trichotillomania, this may be because women are more likely to seek medical advice. 

Treatment And Therapy

People with this disorder usually need help from medical and behavioral specialists in order to stop. With the right help, most people overcome their hair-pulling urges. When someone is able to stop pulling, hair usually grows back. 

The treatment may involve a type of behavioral therapy called habit substitution, taking medicine, or a combination of therapy and medicine. 

  • Therapy: Therapists teach patients how to plan a replacement habit when they feel a strong urge to pull hair.
  • Medicine: Can help the brain deal better with urges, making them easier to resist.

What’s Traction Alopecia An What Causes It?
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This condition occurs due to constant pulling on hair roots. Hairstyles that cause tension on the hair follicles such as tight braids, or “corn rows,” often cause this condition. It’s a common condition in females who pull their hair tightly in ponytails. The hair loss usually occurs in the frontal and temporal areas but depends on the hairstyle used. It may also be due to use of chemical straightening or weaving.

Treatment Of Traction Alopecia

The sooner this condition is diagnosed the easier it is to treat. Leaving hair untreated over a long period of time may cause permanent hair loss. Wearing hair in styles that are looser and do not pull on the roots is often the best way to prevent this type of hair loss.

Tinea Capitis Definition And Factorshair-loss-disorder-causes-and-symptoms

Tinea capitis (T.C), or ringworm of the scalp, is a fungal infection that tends to attack hair shafts and follicles leading to hair loss. It appears as bald spots with black dots where the hair has broken off. It most commonly affects children, but can affect adults as well.

T.C usually occurs in prepubertal patients. The most severe form of it is a kerion, a fluctuant, boggy lesion with overlying hair loss. 

This condition can result in widespread hair loss with increased fragility of the hairs and frequent breakage. In most cases, the disease is transferred by way of contact with animals (dogs, cats, cows, hamsters and guinea pigs). 

There are two common types of symptoms:

  • One or more sections of the scalp will show hair loss or give a stubbly appearance. The skin will be slightly scaly but with little or no irritation. In addition to these symptoms, ringworm may be present on the face or other parts of the body.
  • In severe cases, a kerion (a swollen mass discharging pus) will appear on the scalp. The kerion may become inflamed and fill with fluid or pus, and may also be quite painful.

Severe alopecia may develop and at this stage. The scalp will often become infected further with bacteria. 

The lymph nodes of the neck can also become swollen and tender. In rare cases, there may also be a fever.

Treatments And Cures

Treatment usually includes Anti-fungal antibiotics.:

  • Griseofulvin (Grifulvin).
  • Itraconazole (Sporanox).
  • Terbinafine (Lamisil).
  • Fluconazole (Diflucan).

20 Oral steroids may be necessary if a patient has a kerion, to decrease inflammation and potential scarring. All these treatments have fewer side effects. 

Cicatricial Alopecia Causes And Treatments

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Cicatricial alopecia (C.A) refers to a diverse group of rare disorders that destroy the hair follicle andreplace it with scar tissue. These disorders destroy hair follicles without regrowth and follow an irreversible course. Fortunately, hair loss becomes permanent. 

C.A is not contagious. It occurs worldwide in otherwise healthy men and women. This condition affects all ages, but is not common in children. Most commonly affects women of African ancestry, and may occur in more than one family member.

It is likely that these disorders involve stem-cell failure at the base of the follicles. Which inhibits follicular recovery from the telogen phase. Inflammatory processes, including repetitive trauma also may lead to stem-cell failure.

Causes

The cause of cicatricial alopecia is not well understood. What is known is that redness, heat, pain, or swelling occurs at the upper part of the hair follicle. That is the place where stem cells and sebaceous (oil) glands are located. Stem cells are cells that can develop into different kinds of cells. If the stem cells and oil glands are destroyed, the hair follicle cannot regrow.

Treatment

Because hair loss in cicatricial alopecia is permanent and the hair does not grow back, it is important to begin aggressive treatment early before extensive hair is lost.

The treatment depends largely on whether lymphocytes, neutrophils, or both are predominantly responsible for the hair follicle destruction.

  • Lymphocytes: The treatment is usually with medicines to remove the inflammatory cells. Oral treatments may include antimalarials, antibiotics, immunosuppressive drugs, and a class of diabetes medications. medications are applied directly to the skin include corticosteroids, topical tacrolimus, and other agents that suppress or modulate the immune system.
  • Neutrophils: This kind is treated with oral and topical antibiotics and anti-inflammatory medications. 
  • Neutrophils and Lymphocytes: In this case, treatment may include antimicrobials, anti-inflammatory medications, and retinoids.

 

Androgenetic alopecia

 

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Androgenetic alopecia (A.G.A) is a common form of hair loss in both men and women. In men, this condition is also known as male-pattern baldness. Hair is lost in a well-defined pattern, beginning above both temples. Over time, the hairline recedes to form a characteristic “M” shape. Hair also thins at the crown (near the top of the head), often progressing to partial or complete baldness.

The pattern of hair loss in women differs from male-pattern baldness. In women, the hair becomes thinner all over the head, and the hairline does not recede. This condition in women rarely leads to total baldness.

Androgenetic alopecia can start as early as a person’s teens and risk increases with age. More than 50 % of men over 50 have some degree of hair loss. In women, hair loss is most likely after menopause. 

Causes And Factors

A variety of genetic and environmental factors likely play a role in causing A.G.A. Despite researches, most of these factors remain unknown.

Studies have determined that this form of hair loss is related to male sex hormones called androgens, particularly an androgen called Dihydrotestosterone. Starting at puberty, androgens shorten the anagen phase and promote follicular miniaturization. This leads to vellus-like hair formation and gradual hair thinning. 

Women also may experience AGA, often with thinning in the central and frontal scalp area but usually without frontal–temporal recession. 

Laboratory tests are of little value in women with AGA who do not have characteristics of Dyperandrogenism. 

Treatment Options For AGA

In those who respond, the benefit is only maintained for as long as the treatment is used. Only 2 drugs currently have US Food and Drug Administration (FDA)–approved indications for treatment of AGA:

  • Minoxidil :

This medicine is available without a prescription as a 2-percent topical solution that can treat both men and women. And as a 5-percent solution (Rogaine Extra Strength) for men only. Minoxidil is an effective treatment for male and female AGA. 

It’s the first treatment that the American Academy of Dermatology guidelines recommends.

Applying Minoxidil to the scalp twice a day for one year will show good results. In men, minoxidil may work better in areas with higher concentrations of miniaturized hairs. However, this medicine does not work on completely bald areas and has relatively few side effects.

  • Finasteride: 

This one  is given orally and is a 5-alpha reductase type 2 inhibitor. It is not an Anti-androgen. The drug can treat only men because it can produce ambiguous genitalia in a developing male fetus. It diminishes the progression of AGA in males and stimulates new regrowth.

A study in postmenopausal women indicated no beneficial effect of the medication in treating female AGA. Women who could be pregnant should not handle finasteride, because it may cause birth defects in a male fetus.

This drug has relatively few side effects, and a dosage of 1 mg per day costs about $49.50 per month. Which is expensive for most people. 

 

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