Hair loss or hair thinning affects both males and females of any age and can be characterized by general hair thinning or patches of baldness. This hair loss can occur anywhere hair grows on the skin, commonly on one’s scalp, eyebrows, and facial hair. Both thinning of the hair and balding can cause great distress and anxiety for the patient.
There are three stages of hair growth. Anagen phase lasts between 2-6 years. This is the phase of active hair growth. These hairs are targeted when one is receiving chemotherapy. It is estimated that 85%-90% of scalp hairs are in the anagen phase. Catagen phase are the hairs that are in a transitional state from the growing phase to a resting phase. This phase lasts between 1-2 weeks. Catagen hairs comprise less than 1% of the scalp hair. Telogen phase are hairs that are in a resting state and are about to shed. This phase can last between 3-5 months before they fall out. These hairs are targeted with hair loss after labor or a serious illness. It is estimated that 10-15% of scalp hairs are in the telogen phase. Based on genetics, hair growth rate can range from one-half inch to one inch per month.
There are many causes for hair loss including nutritional deficiencies, mechanical trauma to the hair, immune disorders, fungal infections, family history, stress and drugs. While it is normal to shed between 100-150 hairs daily, patients usually notice an increase loss while showering, brushing or combing the hair.
Alopecia areata is the term used when hair loss results in patches of baldness on the skin in which the immune system attacks the hair follicles. Alopecia totalis is loss of all hair located on one’s head, while alopecia universalis is the loss of both head and body hair. Traction alopecia is due to continual and excessive pull on the hair due to tight ponytails, sleeping in curlers, or having the hair styled with cornrows, weaves or having extensions. Trichotillomania is a compulsive disorder where the patient feels the need to pull out strands of hair. Stress to the body due to a high fever, major surgery, or pregnancy can also cause hair loss within three months of the inciting focus. This is known as Telogen Effluvium.
Alopecia is generally divided into two categories; scarring (cicatricial) or non-scarring (non cicatrical). A diagnosis is made by examining the skin and hair with a pull or pluck test to identify areas of disease. Your Dermatologist may also order blood work to further determine other causes, such as thyroid, hematologic abnormalities, or immune disorders. A skin biopsy can further evaluate the hair follicle at the microscopic level and determine whether your condition is scarring or non-scarring. Unfortunately, scarring alopecia results in permanent hair loss. Non scarring alopecia offers hope of resolution. There are various treatment options depending on the type of hair loss including oral and topical medications, intralesional injections, and surgical procedures. Your Dermatologist can establish the diagnosis and decide the best treatment options available.
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