Correctly diagnosing hair loss

Your "crowning glory" serves a significant function in your well-being. It protests your scalp from the scorching heat of the sun, and in colder climates it helps control heat loss.

Society has placed a great deal of social and cultural importance on hair and hairstyles. Unfortunately, many conditions, diseases, and improper hair care results in excessive hair loss. People who notice their hair shedding in large amounts after combing or brushing, or whose hair becomes thinner or falls out, should consult a dermatologist. With correct diagnosis, many people with hair loss can be helped.

Dermatologists, physicians who specialize in treating diseases of the hair and skin, will evaluate a patient’s hair problem by asking questions about diet; medications, including vitamins and health food taken in the last six months; family history of hair loss, recent illness and hair care habits.

Hormonal effects may be evaluated in women by asking about the menstrual cycles, pregnancy and menopause.

After examining the scalp and hair, the dermatologist may pluck a few hairs and examine them under the microscope.

Sometimes various blood tests and scalp biopsy may be performed for an accurate diagnosis. It’s important to find the cause and whether or not the problem will respond to medical treatment.

Normal hair growth

About 90 percent of the hair on a person’s scalp is growing at any one time. The growth phase lasts between two and six years.

Ten percent of the hair is in resting phase that lasts two to three months. At the end of its resting stage, the hair is shed.

When a hair is shed, a new hair from the same follicle replaces it and the growth cycle stars again. Scalp hair grows about one-half inch a month.

As people age, their rate of hair growth slows. More hair shedding its due to the normal hair cycle, and losing 50 to 100 hairs per day is no cause for alarm. However, if you are concerned about excessive hair loss or dramatic thinning, consult your dermatologist.

Causes of excessive hair loss

Improper hair cosmetic use/improper hair care – Many men and women use chemical treatments on their hair, including dyes, tints, bleaches, straighteners and permanent waves.

These treatments rarely damage hair if they are done correctly. However, the hair can become weak and break if any of these chemicals are used too often.

Hair can also break if the solution is left on too long, if two procedures are done on the same day, or if bleach is applied to previously bleached hair. If hair becomes brittle from chemical treatments, it’s best to stop until the hair has grown out.

Hairstyles that pull on the hair, like ponytails and braids, should not be pulled tightly and should be alternated with looser hairstyles. The constant pull causes some hair loss, especially on the sides of the scalp (called traction alopecia).

Shampooing, combing and brushing too often may also damage hair, causing it to break. When hair is wet, it is more fragile, so vigorous rubbing with a towel, and rough combing and brushing should be avoided.

Don’t follow the old rule of 100 brush strokes a day – that damages the hair. Instead use a wide-toothed comb, a cream rinse after shampooing helps detangle hair.

Hereditary thinning or balding (Androgenetic alopecia) – Hereditary balding or thinning is the most common cause of hair loss. The tendency can be inherited either from the mother’s or father’s side of the family.

Women with this trait develop thinning hair, but do not become completely bald. The condition is called androgenetic alopecia or male-pattern baldness. It can start in the teens, 20s or 30s.

There is no cure, although medical treatment has recently been available that may help some people. One treatment involves applying a solution, minoxidil, to the scalp twice a day.

Another treatment for men is a daily pill containing finasteride, a drug that blocks the formation of active male hormone in the hair follicle.

When confronted with thinning hair or baldness, men and some women consider hair transplantation, which is a permanent form of hair replacement. Anyone who has suffered permanent hair loss may be a candidate for hair transplantation.

The procedure of hair transplantation involves moving some hair from hair-bearing portions (donor sites) of the head to bald or thinning portions (recipient sites) and/or removing bald skin. Because the procedures involve surgery as well as time and money, they should not be undertaken lightly.

Your dermatologist will help decide which method or combination of methods is right for you.

Alopecia areata – In this type of hair loss, hair usually falls out, resulting in totally smooth, round patches about the size of a coin or larger. It can, rarely, result in complete loss of scalp and body hair. The disease may affect children or adults of any age.

The cause of alopecia areata is unknown; apart from hair loss, affected persons are generally in excellent health. In most cases, the hair regrows by itself.

Dermatologists can treat many people with this condition. Treatment includes topical medications, a special kind of light treatment, or in some cases with injection.

Childbirth – When a woman is pregnant, more of her hair will be growing. However, after a woman delivers, many hairs enter the resting phase of the hair cycle. Within two to three months, some women will notice large amount of hair coming out in their brushes and combs. This can last for one to six months, but resolves completely in most cases.

High fever, severe infection, severe flu, chronic illness – Illnesses may cause hairs to enter the resting phase. Four weeks to three months after a high fever, severe illness or infection, a person may see a lot of hair falling out. This shedding usually corrects itself.

Thyroid disease – Both an overactive thyroid and an underactive thyroid can cause hair loss. Your physician can diagnose this with laboratory tests. Hair loss associated with thyroid disease can be reversed once the thyroid problem is treated.

Inadequate protein in diet – Crash dieting, diet low in protein or malnutrition can cause hair loss. Massive hair shedding can occur two to three months later. This condition is reversible once proper amount of protein is incorporated in the diet.

Medications – Some prescription drugs can cause hair cells to stop dividing. Hair becomes thin and breaks off as they exit the scalp. This occurs one to three weeks after the treatment. Patients can lose up to 90 percent of their scalp hair. The hair will regrow after treatment ends.

Low serum iron – Iron deficiency occasionally causes hair loss. Some people do not have enough iron in their diet or many not fully absorb iron. Heavy menstruation may cause iron deficiency. Low iron can be corrected by taking iron pills.

Infection of the scalp – Certain fungal infections of the scalp, syphilis and some bacterial infections may cause patchy, scaly hair loss. The dermatologist can correctly diagnose the cause of infection and treat accordingly.

Hair pulling (Trichotillomania) – Children and sometimes adults twist and pull their hair until they come out. In children especially, this is often just a bad habit that gets better when the harmful effects of the habits are explained. Often hair pulling can be a coping response to unpleasant stresses and is occasionally a sign of a serious problem needing the help of a mental health professional.

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The author is a fellow of the Philippine Dermatological Society, which is the only recognized affiliate society for dermatology of the Philippine Medical Association and the Philippine College of Physicians. The PDS Secretariat is at Room 1015, Front Tower, Cathedral Heights Building Complex, St. Luke’s Medical Center, E. Rodriguez Avenue, Quezon City; tel. no. 727-7309, website www.pds.org.ph.