Normal Hair growth
There are 100 thousand hairs on the average scalp and each hair grows for between 3 to 7 years before growth stops and the hair bulb enters the resting (Telogen) phase. The hair is then retained in the follicle for between two to four months, before a new hair grows from the base of the follicle. We normally lose about 60 to 100 hair daily in this way often without noticing it.
Diffuse Hair Loss
Diffuse thinning is a condition which causes a fairly even amount of hair thinning across the scalp. Although this condition can make the hair look thinner (almost bald in some places) it is a temporary condition. Diffuse thinning usually lasts no more than six months and it can be aided with different treatments
The signs of Telogen effluvium are: sudden drastic diffuse hair shedding throughout scalp. Shed hair is noticed in comb, brush, basin and shower with anything up to 50% of the density being lost within a short period.
The good news with this type of hair loss is that new hairs push out the old hairs and many new tapered re-growing hair can be seen through the scalp at the same length.
This drastic hair loss follows 2 to 4 months after a trauma
Acute Telogen Effluvium is caused by many different traumas, which include:
Chronic Telogen Effluvium (C.T.E.): the signs of CTE are long term hair shredding which can last for as long as the cause is not removed. The re-growth is still present but at different lengths. Because the growing length is shortened, the hair will not seem to grow and if no explanation is given, the worry can prolong the loss.
Whatever the original causative factor, stress can cause hair loss; hair loss can cause stress therefore perpetuating the problem sometimes for many years until the vicious circle is broken.
The symptoms listed above can cause an interruption in the hair growth cycle, causing up to four times the normal amount suddenly to enter the Telogen phase together. This can be up to 400 hairs daily. As the shedding phase is two to four months later, the hair loss is not linked to the original cause.
As each hair is shed, a new hair grows from the same follicle replacing the previous hair.
Treatment for long term Telogen effluvium
Androgenetic hair loss in women presents a diffuse thinning to the front and crown area of the scalp and never at the sides and back. Partings seem wider and the scalp seems more noticeable at the front and the top of the head
This is a slow, gradual process and rarely does it completely denude the area.
Androgenetic hair loss in women usually begins with the hormone changes after puberty, pregnancy or menopause. There is no increased hair shedding noticed with this type of loss.
Ladies with Androgenetic hair loss can also suffer from a greasy scalp and male type body hair growth.
Androgenetic hair loss has three causative factors, age, inheritance and the presence of the hormone testosterone.
Androgenetic hair loss can start from puberty, childbirth, after the menopause and in old age.
It is commonly inherited from the maternal grandmother.
3. Testosterone: F.P.A. results from the normal amount of testosterone present in a female. Postmenopausal thinning is related to estrogen's reduction. With the effect of a normal increase in testosterone at puberty, each succeeding hair growth cycle is shortened, and the hair (thinner) Sensitivity of the hair bulb to the hormone testosterone.
Although all Alopecia areata cases are extremely unpredictable they can be very broadly placed into short and long-term types. It can also be diffuse, sometimes leading to Totalism (lack of all scalp hair), or Universalis, (lack of all scalp and body hair). If it starts before puberty then the prognosis is not good, particularly if in the ophiasic (circular hair loss) or marginal pattern.
Short term areata: The first signs of short term Alopecia areata are one to four circular, completely bald patches. The hair follicles are clearly visible and the earliest patch will often be re-growing vellus, often unpigmented hair from the center of the patch, while the latest patches show extension by having short broken hairs called exclamation hairs, narrowing towards the scalp, at the margins. Short-term areata can last from between 6 months to a year. Sometimes it never returns but occasional relapses are possible.
Longer term areata: Can start the same way as the short term type but the patches soon join together into larger more irregularly shaped patches extending into different areas. This can improve spontaneously or last for many years, coming and going with complete recovery taking place before it starts all over again, or not! Pregnancy can sometimes cause temporary regrowth of areata.
Diffuse areata: As it can mimic reflective diffuse hair loss, thorough examination of the whole scalp should be made. The patient will notice hair falling diffusely throughout the scalp, which is covered with hundreds of exclamation hairs and tiny areas of hair loss. Unlike Telogen effluvium there is no spontaneous regrowth. Diffuse areata is often the first sign of Areata Totalis or complete loss of hair all over the scalp and can fall rapidly. Slight itching sometimes precedes of the area
Brittle nails, thimble pitting and other nail malformations can co-exist with areata. Vitiligo can some times coexists with areata and is also said to be an autoimmune disease.
Causes: Although the actual causes and mechanism of areata are unknown, it is considered to be an autoimmune disease, where the body’s defence mechanism is destroying the hair in the same way as it would defend the body against invading pathogens. White cells in the blood (leucocytes) are more abundant in extending patches and it would seem that it attacks persons whose immunity is lowered after illness or trauma. Where sepsis has occurred as from tooth abscess, tonsillitis, ulcerative colitis, or other infection, then toxins circulate in the bloodstream and, it would seem that they can sometimes upset the immune system elsewhere in the body. ’High fever“can create a similar problem.
Areata is considered to be multi-aetiological and many possible causes have been suggested. Bereavement is at the top of the list, as is acute stress or sudden shock. Accident, Whiplash, Displaced vertebrae, Eyestrain, Cataracts, impaired vision. Thyroid dysfunctions and coeliac disease are said to be associated with areata. There is often a familial trait to inherit areata and it also seems to attack those who suffer from eczema, asthma and hay fever.
Sickle cell anaemia in some people can sometimes cause ophiasic (marginal) areata. Sufferers of Down syndrome are more prone to areata.
Alopecia areata must be differentiated from other alopecias, which can look similar. When no hair follicle openings can be seen, then the hair loss is considered to be cicatricial (scaring) as in autoimmune scarring alopecias as well as those of known cause. Ringworm can cause similar patchy hair loss but is usually scaly and often itchy. Traumatic alopecia of outside origin (scratching, pulling, and hairdressing) can sometimes mimic areata but questioning will reveal the real cause. AIDS or Syphilis can cause patchy hair loss.
Treatment is supportive and cannot be guaranteed, but elimination of possible causative factors is essential while vitamin and mineral supplements can be of help. Electrotherapy stimulates and irritates the area giving perhaps a better chance of recovery, particularly in the shorter-term cases.
Six weekly electrotherapy sessions can be performed and prolonged if regrowth is seen. Electrotherapy consists of High frequency, Infra-red and scalp stimulation.
Doctors may prescribe corticosteroids, irritants, retinoids or Minoxidil, these may help, but none of these are cures.