Hair loss (alopecias) are often observed, but little discussed. As a visible sign of the state of health and beauty, our culture places an extraordinary emphasis - especially for women - not only on hair styling but also hair luster and quantity. Inherited disorders such as alopecia areata can lead to total baldness. These disorders can be mistaken as being due to cancer therapy, and are very stressful to those affected.
Alopecia is generally classified in two forms: scarring and non-scarring.
It is critical to establish whether or not your hair loss is due to a scarring, permanent hair loss condition or is due to a non-scarring, potentially reversible form of hair loss. Some types of scarring alopecias are due to serious diseases affecting other organs that can be identified by scalp examinations.
Information on Research and Causes of Alopecias
In the past 20 years, medical research has made significant advances in determining the genetic and environmental causes of a number of human diseases including some causing hair loss. The US National Institute of Health (NIH) in particular has freely available sites to educate the public about medical advances for the diagnosis and treatment of common and rare diseases. The National Organization for Rare diseases (NORD) (www.rarediseases.org) is a helpful source of information. Since medical research on alopecias and hair disorders may be very difficult to understand, there are a number of websites created by hair disorder associated support groups.
Alopecia areata is one of more than 80 autoimmune diseases including rheumatoid arthritis, celiac disease, thyroiditis, early onset insulin dependent diabetes mellitus and lupus erythematosus. The National Alopecia Areata Foundation (NAAF) (www.naaf.org) is a non-profit support group that provides information about and research support for patients with alopecia areata.
NAAF and NIH supported an Alopecia Areata Registry research grant to identify families and individuals with alopecia areata to enable medical researchers to identify specific genetic changes that will lead to better diagnoses and therapies. The impact on these and other medical conditions by studying alopecia areata, a distinctive and visible condition, is easy to understand but not rarely appreciated by the general public.
A similar non-profit support group, Cicatricial Alopecia Research Foundation (CARF) (www.carfintl.org) provides information and raises funds to support research on permanent scarring forms of alopecia.
Normal progression of pattern hair loss in men and women without treatment.
A Closer Look at Pattern Hair Loss
Dihydrotestosterone (DHT) is an androgen. The following is the effect it has on your hair:
Although the art of hair styling and wigs continues to evolve and are cosmetically helpful, insuring the correct diagnosis and treatment(s) is needed to avoid long term consequences. Avoiding increased hair loss is also possible, and not always difficult. No matter the cause, if you are experiencing any form of hair loss, you should set up an appointment for evaluation with The Hair & Scalp Institute.
Common Non-Scarring Alopecias (often reversible)
• Male Pattern Hair Loss (Androgenetic) – Thinning caused by any number of hormonal or genetic factors, usually starting above the temples or on the crown of the head.
• Female Pattern Hair Loss – Similar to Male Pattern, although in females the hair generally becomes thinner around the entire scalp, and the hairline does not recede.
See below for more information on Pattern Hair Loss
• Anagen Effluvium – The chronic loss of hair in the growth phase. Typically this is caused by radiation therapy or chemotherapy.
• Traction Alopecia – Results from the pulling force being applied to the hair due to certain kinds of hair care and styling.
• Trauma-Induced (Trichollomania) – A psychiatric disorder resulting in the compulsive urge to pull out one's own hair.
• Acute Infections – Certain bacterial infections may lead to hair loss.
• Tinea Capitis – A fungal infection commonly known as "Ringworm."
• Telogen Effluvium – Aside from pattern thinning, this is the most common form of hair loss resulting from stress
or prescription drugs.
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Common Scarring Alopecias (not reversible)
• Systemic Lupus Erythematosus (SLE) – Lupus, an autoimmune disease that results in scarring hair loss.
• Discoid Lupus Erthematosus (DLE) - a chronic skin condition resulting in sores with a red, inflamed patch and a scaling, crusty appearance.
• Lichen Planopilaris (LPP) – The follicular (relating to the hair follicles) form of Lichen Planus, an autoimmune disease, presenting as papules, lesions, or rashes.
• Frontal Fibrosing Alopecia (FFA) – Hairline recession and sometimes eyebrow loss, common in postmenopausal women.
• Central Centrifugal Cicatricial Alopecia (CCCA) – Classification of hair loss that starts at a central point and begins to move.
• Dissecting Cellulitis – Inflamed lumps caused by bacteria that begin to connect.
Pattern Hair Loss
- Testosterone is converted to Dihydrotestosterone (DHT) by 5 Alpha Reductase (5AR) enzyme.
- DHT then attaches to the Androgen Receptors on the hair follicle.
- DHT causes the hair follicle to gradually miniaturize during each hair growth cycle.
- The ever smaller hair follicle, hampered in its development, draws closer to the surface of the scalp.
- The combination of DHT, decreased blood flow and vital nutrients all damage the hair rooting system (dermal papillae) allowing the hair to be pulled more easily from the scalp, accelerating excessive hair loss.
After multiple hair growth cycles the rooting system dies, at which point the hair is permanently lost.
