HEALTH TIPS: HAIR LOSS- ALOPECIA

Dr Tariq Jagnarine
Family Medicine, Endocrinology / Diabetes

For many people losing their hair, the psychological costs are acute. When looking around, it is easy to feel like everyone else has their hair and they don’t. For some, it diminishes their confidence in who they are and how they feel. While this reaction may be perfectly natural, the truth is that millions of men and women suffer from hair loss.
It can affect just the hair on the scalp or the entire body. Although alopecia is more prevalent in older adults, excessive hair loss can occur in children and young adults as well.
It’s normal to lose between 50 and 100 hairs a day. With about 100,000 hairs on our head, that small loss isn’t noticeable.
New hair normally replaces the loss hair, but this doesn’t always happen. Hair loss can develop gradually over years or happen abruptly. Hair loss can be permanent or temporary.
It’s impossible to count the amount of hair loss on a given day. Persons may be losing more hair than is normal if they notice a large amount of hair in the drain after washing their hair or clumps of hair in their brush. They might also notice thinning patches of hair or baldness.

CAUSES OF HAIR LOSS
The most common cause of hair loss is hereditary male- or female-pattern baldness. If one’s family has a history of baldness, they may have this type of hair loss. Certain sex hormones can trigger hereditary hair loss. It may begin as early as puberty.
In some cases, hair loss may occur with a simple halt in the cycle of hair growth. Major illnesses, surgeries, or traumatic events can trigger hair loss. However, hair will usually start growing back without treatment.
Hormonal changes can cause temporary hair loss. Examples include:
• Pregnancy
• Childbirth
• Discontinuing the use of birth control pills
• Menopause
Medical conditions that can cause hair loss include:
• Thyroid disease
• PCOS
• Alopecia areata (an autoimmune disease that attacks hair follicles)
• Scalp infections like ringworm (fungal infection)
Diseases that cause scarring, such as lichen planus and some types of lupus, can result in permanent hair loss because of the scarring.
Hair loss can also be due to medications used to treat:
• Cancer
• High blood pressure
• Arthritis
• Depression
• Heart problems
A physical or emotional shock may trigger noticeable hair loss. Examples of this type of shock include:
• Death in the family
• Extreme weight loss
• High fever
People with trichotillomania (hair-pulling disorder) have a need to pull out their hair, usually from their head, eyebrows, or eyelashes.
Traction hair loss can be due to hairstyles that put pressure on the follicles by pulling the hair back very tightly.
A diet lacking in protein, iron, and other nutrients can also lead to thinning hair.

DIAGNOSIS
Persistent hair loss often indicates an underlying health issue. A clinician can determine the cause of the hair loss based on a physical examination and a health history. In some cases, simple dietary changes can help with changes in prescription medications.
If an autoimmune or skin disease is suspected a biopsy of the skin on the scalp is taken to confirm the cause. This will involve carefully removing a small section of skin for laboratory testing. It’s important to keep in mind that hair growth is a complex process. It may take time to determine the exact cause of your hair loss.

TREATMENT OPTIONS
• Medication
Medications will likely be the first course of treatment for hair loss. Over-the-counter (OTC) medications generally consist of topical creams and gels that is applied directly to the scalp. The most common products contain an ingredient called minoxidil (Rogaine). Minoxidil is recommended in conjunction with other hair loss treatments. Side effects of minoxidil include scalp irritation and hair growth in adjacent areas, such as the forehead or face.
Prescription medications may also treat hair loss. The oral medication finasteride (Propecia) for male-pattern baldness. This medication is used daily to slow hair loss. Some men experience new hair growth when taking finasteride.
Rare side effects of finasteride include diminished sex drive and impaired sexual function. There may be a link between the use of finasteride and a more serious type (high-grade) of prostate cancer, according to the Mayo Clinic.
Also, corticosteroids like prednisone can be used. Individuals with alopecia areata can use this to reduce inflammation and suppress the immune system. Corticosteroids mimic the hormones made by the adrenal glands.
A high amount of corticosteroid in the body reduces inflammation and suppresses the immune system.
• Medical Procedures
Sometimes, medications aren’t enough to stop hair loss. There are surgical procedures to treat baldness.
• Hair Transplant Surgery
Hair transplant surgery involves moving small plugs of skin, each with a few hairs, to bald parts of the scalp. This works well for people with inherited baldness since they typically lose hair on the top of the head. Because this type of hair loss is progressive, they would need multiple surgeries over time.
• Scalp Reduction
In a scalp reduction, a surgeon removes part of the scalp that lacks hair. The surgeon then closes the area with a piece of one scalp that has hair. Another option is a flap, in which a surgeon folds a scalp that has hair over a bald patch. This is a type of scalp reduction.
Tissue expansion can also cover bald spots. It requires two surgeries. In the first surgery, a surgeon places a tissue expander under a part of the scalp that has hair and is next to the bald spot. After several weeks, the expander stretches out the part of the scalp that has hair.
In the second surgery, the surgeon removes the expander and pulls the expanded area of the scalp with hair over the bald spot.
These surgical remedies for baldness tend to be expensive, and they carry risks. These include:
• Patchy hair growth
• Bleeding
• Wide scars
• Infection
PREVENTING HAIR LOSS
There are things people can do to prevent further hair loss. Don’t wear tight hairstyles like braids, ponytails, or buns that put too much pressure on one’s hair. Over time, those styles permanently damage the hair follicles.
Try not to pull, twist, or rub the hair. Eating a balanced diet that includes adequate amounts of iron and protein.
Certain beauty regimens can worsen or cause hair loss.
If Someone is currently losing hair, use a gentle baby shampoo to wash the hair. Unless they have extremely oily hair, consider washing the hair only every other day. Always pat the hair dry and avoid rubbing the hair.
Styling products and tools are also common culprits in hair loss. Examples of products or tools that can affect hair loss include:
• Blow dryers
• Heated combs
• Hair straighteners
• Coloring products
• Bleaching agents
• Perms
• Relaxers
When choosing to style the hair with heated tools, only do so when the hair is dry. Also, use the lowest settings possible. Hair loss can be stopped or even reversed with aggressive treatment, especially if it’s due to an underlying medical condition. Hereditary hair loss may be more difficult to treat. However, certain procedures such as hair transplants can help reduce the appearance of baldness.