Hair Loss

What is hair loss?

Hair loss or alopecia is a fairly common occurrence. While it is more prevalent in older adults, anyone can experience it, including children. It is typical to lose between 50 and 100 hairs a day, with about 100,00 hairs on a head, that small loss isn’t noticeable. New hair normally replaces the lost hair, but this doesn’t always happen. Hair loss can develop gradually over years or happen abruptly. Depending on the underlying cause, it may be temporary or permanent.

Hair loss has many causes and the cause can determine whether your hair:

• Falls out gradually or abruptly
• Thins at the sides or center
• Requires treatment or medications to grow
• Needs urgent care to prevent permanent hair loss

What causes hair loss?

There are several causes of hair loss, some being commoner than others. Here are a few different types of hair loss:

Hereditary hair loss or androgenic alopecia

This is the most common cause of hair loss, affecting up to 50% of people worldwide. It is as a result of inherited genes that cause hair follicles to shrink and eventually stop growing hair. Hair loss related to androgenic alopecia tends to happen gradually. While some people might experience hair loss as early as puberty, others might not notice symptoms until their middle ages.

Female pattern baldness often results in thinning all over the scalp and might look like widening or thinning around the part. It typically occurs after age 65 but, for some females, it can begin early in their lives. Male pattern baldness typically involves progressive hair loss above the temples and thinning at the crown of the head, creating an “M” shape.

Alopecia areata

Alopecia areata is a disease condition that causes your immune system to attack hair follicles (what holds the hair in place), resulting in bald patches that can range from small to large. In some cases, it might lead to total hair loss. In addition to losing hair on the scalp, some people with alopecia areata lose hair from their eyebrows, eyelashes, or other parts of the body.

Anagen effluvium/ Cancer treatment

Anagen effluvium involves a rapid loss of hair. This usually happens because of radiation treatment or chemotherapy. Wearing a cooling cap before, during, and after each chemotherapy session may prevent hair loss. Hair will usually regrow after the treatment stops.

Telogen effluvium

Telogen effluvium is a type of sudden hair loss that results from emotional or physical shock, like a traumatic event, period of extreme stress, or a serious illness. It can also happen because of hormonal changes, like those that happen in:

• Childbirth
• Postpartum
• Menopause
• Polycystic Ovary Syndrome (PCOS)

Other potential causes of telogen effluvium include:

• Mmalnutrition including vitamin or mineral deficiency
• Certain endocrine disorders
• Starting or stopping hormonal birth control
• Post surgery as a result of the anesthesia
• Acute illnesses or severe infections like COVID-19

Several types of medications can also cause it, including:

• Anticoagulants
• Anticonvulsants
• Oral retinoids
• Beta-blockers
• Thyroid medications

This type of hair loss typically resolves on its own once the underlying cause is addressed. When the shedding stops , most people see their hair regain its normal fullness within 6 to 9 months.

Tinea capitis/ ‘kakawerewere’

Tinea capitis, also called ringworm of the scalp, is a fungal infection that can affect the scalp and hair shaft. It causes small bald patches that are scaly and itchy. Over time, if not treated early, the size of the patch or patches will increase and fill with pus. These patches, sometimes called a kerion, can cause scarring as well.

Other symptoms include:

• Brittle hair that breaks easily
• Scalp tenderness
• Scaly patches of skin that look grey or red

It’s treatable with antifungal medication.

Traction alopecia

Traction alopecia results from too much pressure and tension on the hair, often from wearing it in tight styles, like braids, ponytails, or buns. You can prevent hair loss by laying back on these tension styles which pulls at the edges.

Medication

Hair loss is a possible side effect of some medications. Speak to your prescriber if you think your medication is a possible cause of hair loss. It is essential to speak to your doctor before stopping any prescribed medications. Regrowth is possible after the medication course.

Sexually transmitted infection

Left untreated some STI, notably syphilis can cause hair loss on the scalp, eyebrows, beard and elsewhere. Other STIs can also cause hair loss. Regrowth is often possible after the STI is treated.

How can you prevent hair loss?

There are a few things you can do to minimize hair loss:

• Keep hairstyles loose. If you regularly style your hair into braids, buns, or ponytails, try to keep them loose so they don’t put too much pressure on your hair.
• Avoid touching your hair. As much as possible, try not to pull, twist, or rub your hair.
• Pat hair dry. After washing, use a towel to gently pat your hair dry. Avoid rubbing your hair with the towel or twisting it within the towel.
• Aim for a nutrient-rich balanced diet. Try to incorporate plenty of iron and protein into snacks and meals. Vitamins to incorporate into your nutrition plan that may promote hair growth include: B vitamins, specifically riboflavin, biotin, folate, and vitamin B12, iron, vitamin C, vitamin D.

Styling products and tools are also common culprits in hair loss. Examples of products or tools that can affect hair loss include: blow dryers, heated combs, hair straighteners, coloring products ‘yomo’, bleaching agents, perms and relaxers. If you decide to style your hair with heated tools, only do so when your hair is dry and use the lowest settings possible.

How is hair loss diagnosed?

Because so many things can cause hair loss, it’s best to schedule an appointment with a medical professional if you notice any changes in your hair. A combination of your health history — including any recent illnesses, surgeries, life stressors, and family history — and a physical exam to help narrow down the causes.

It’s important to keep in mind that hair growth is a complex process and multiple tests may be needed to understand what is causing your hair loss. A biopsy may also be taken if it is initially very unclear what the root causes may be. They may also order blood tests to check for any nutrient deficiencies or signs of an underlying condition.

What are the treatment options for hair loss?

There is a range of treatment options for hair loss, but the best option for you will depend on what’s causing your hair loss. Typically, the most common types of hair loss are treated with topical or oral medications, which will likely be the first course of treatment. The most common products contain an ingredient called minoxidil.

Prescription medications, like finasteride, may help prevent further androgenetic hair loss, especially for male pattern baldness. You take this medication daily to slow hair loss, though some experience new hair growth when taking finasteride. Your clinician might prescribe anti-inflammatory medications, like corticosteroids, if hair loss seems related to an autoimmune condition.

Hair transplant surgery

Hair transplant surgery involves moving small plugs of skin, each with a few hairs, to bald parts of your scalp. This works well for people with inherited baldness since they typically lose hair on the top of the head. Because some hair loss can be progressive, you may need multiple procedures over time. It is worth noting that this method is unlikely to benefit or help people with scarring alopecias. Where regrowth is not possible or treatment too costly you can consider the option of wearing a bald look or wearing wigs.