Understanding hair loss

By Dr Arusha Campbell-Chambers

Alopecia (hair loss) refers to excessive shedding, thinning and/or breakage of hair. There are many causes of hair loss which can occur in different patterns. These patterns include generalised hair thinning, hair breakage and bald patches.

Generalised hair thinning is usually associated with a smooth clean scalp, free of bumps or scars (non-scarring alopecia). Its causes include: hereditary thinning (androgenetic alopecia), post-pregnancy (about three months after delivery, women may have excessive hair loss which can last for up to six months but usually goes away completely), severe illness, high fever, major surgery, anorexia, crash dieting (low protein intake), medical conditions like iron-deficiency anaemia, thyroid disease, systemic lupus erythematosus and some medications.

These medications may cause temporary hair loss e.g. some anti-depressants, anti-hypertensives, oral contraceptives and high doses of vitamin A. Other medications can cause massive amounts of hair loss, like some anti-cancer drugs. The hair tends to regrow after treatment is discontinued.

Improper hair care

Some individuals can be born with genetic defects causing weak hair shafts and hair breakage. However, more commonly, hair breakage occurs as a result of improper hair care. Some examples of this include chemical treatments - dyes, bleaches, relaxers, permanent waves which are left on the scalp too long, used too often or when a mixture of procedures is done. Frequent use of harsh heating and drying implements e.g. flat irons, hair dryers, curling irons can also damage hair. Frequent use of hair styles that pull on hair too tightly, e.g. braids, weaves, ponytails, can cause breakage, thinning or bald patches especially along the hair line (traction alopecia). Shampooing and combing too often can also cause hair breakage.

There are many causes of bald patches which can be subdivided into those that cause scarring and those that don't scar (non-scarring). Causes of non-scarring alopecia include hereditary balding, alopecia areata and hair pulling. Alopecia areata causes smooth bald patches on the scalp. It can also result in loss of all body hair in extreme cases. Hair pulling (trichotillomania) can cause hair breakage as well as bald patches. Children and adults can engage in this practice which may be due to a psychological problem.

Fungal infection

Other medical conditions can cause scarring alopecia. These include fungal infection of the scalp (ringworm) which can lead to broken hair, redness, swelling, tenderness and oozing. Other causes of scarring alopecia include chronic folliculitis, folliculitis decalvans and dissecting cellulitis of the scalp. These conditions involve recurrent inflammation of the hair follicle and are more common in individuals of African descent. Discoid lupus erythematosus (DLE) is an autoimmune disease (where the individual's immune system attacks their own cells) resulting in destruction of the hair follicle and scarring. It can affect the scalp as well as other parts, usually of the upper body.

Hair loss is a very common problem with a vast number of causes. It can lead to significant emotional distress. Your dermatologist can advise you on the best treatment options for you based on the underlying cause.

Dr Arusha Campbell-Chambers is a dermatologist and founder of Dermatology Solutions Skin Clinics & Medi-Spas; email: yourhealth@gleanerjm.com.