How to Treat Recurrent Patchy Hair Loss or Alopecia Areata

 

Part 2: Treatment Tips on Patchy Hair Loss

Extensive Alopecia Areata
Extensive Alopecia Areata

Depending upon the extend of involvement, alopecia areata is divided into:

  1. Localized alopecia areata
  2. Alopecia totalis: involve the whole scalp, eyebrows, beard
  3. Alopecia Universalis: Total loss of body hair

At times, alopecia areata can be quite stubborn in its response to treatment. Many patients continue to get recurrences despite the therapeutic interventions. This definitely calls for further investigations to rule out or confirm causes like unmanaged stress, direct pressure or untreated caries teeth.

 Tips on dealing with Alopecia Areata:

  1. In many cases hair growth occurs spontaneously in a few months without any medical treatment. A wait and watch approach is indeed a non expensive, safer alternative for a limited number of patients.

But if the patches are getting wider and the hair pulling test is positive, it is wiser to consult your dermatologist.

Hair pulling test: Try pulling out the hairs at the periphery of the patches. If they come out very easily without any resistance, the test is positive. Also these hairs will look like “exclamation marks” with loss of pigment and thinning just above the hair roots.

  1. The first hair re growth after treatment or spontaneous regrowth will show fine, non pigmented or grey hairs. There is no need to worry as normal, pigmented hair will come out sooner or later.
  2. Do not apply contact irritants from “helpful” friendly advices or home remedy tips! This may cause further worsening of the lesions and sometimes even cause permanent scarring if the irritant reaction is severe. It is to be noted that mild counter irritant effect does actually produce hair growth in some patients of alopecia areata. Possibly new inflammatory cells attracted to the area may be flushing out the auto antibodies and releasing the hair roots from their inhibitory effects.
  3. Intradermal injection with corticosteroids is a very effective treatment for alopecia areata. This procedure should only be done by an experienced dermatologist as proper dilution, quantity and depth are necessary to produce optimum results. I have come across quite a number of patients scarred for life with skin atrophy and leucoderma following undiluted steroid injections given by pharmacists and non dermatologists. This is very unfortunate and should be avoided by all means.

    Alopecia Areata: Treatment Tips
    Alopecia Areata: Treatment Tips
  4. Like wise, application of topical steroids should be done only under medical supervision. Super potent steroids applied on face can cause permanent damage to the facial skin.
  5. If you are getting new patches of hair loss despite treatment, look for hidden infections in the teeth. Get a dental consultation.
  6. Review whether you are causing undue pressure on the area with tight fitting helmets or scarves, improper shaving techniques etc. Also correct your posture while sleeping or watching TV.
  7. Use hands free sets or blue tooth for your cell phones. This will reduce the damaging effects of the radio waves emitted by the sets.
  8. Take a stress test. If your stress level is high, learn how to manage the stress. A sense of perceived loss of affection from the near and dear may be the underlying problem in the causation of patchy loss of hair. I have seen young children of 2-5 years age getting alopecia areata within a few months after their younger siblings are born. It is clearly the imagined or real loss of attention and affection from the parents that is the culprit in such cases. Parents have to take extra care to convey the message that the newcomer in no way interferes with their affection for the elder one.
  9. Once the hair loss has stopped and new patches stop appearing, you can boost the hair growth with medications like minoxidil and vitamin supplements. This will hasten the growth and also provide additional nourishment for the newly sprouting hair roots.

Also Read Tips on Dealing with Recurrent Patchy Hair Loss- Part 1.

Also Read other Articles on Hair

Published by Dr Hanish Babu, MD on 10th June, 2018

Click here to book an appointment with Dermatologist Dr Hanish Babu, MD

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

Tips on Dealing with Recurrent Patchy Hair Loss or Alopecia Areata

Part 1: The Causes of alopecia areata

Alopecia areata Causes
Alopecia areata may be caused by many factors like stress, direct pressure and autoimmunity

 Alopecia areata is a localized, patchy, non scarring type of hair loss, characterized by the presence of one or more round or oval hairless patches. The affected skin appears normal and smooth, unlike the fungal infections, where there is crusting of the skin and uneven breaking of hairs. On the periphery of the patches, a few short hairs, which taper and loss pigment as they approach the skin, may be seen. These are called “exclamation mark” hairs due to their resemblance to the mark.

Alopecia areata usually affects the scalp. Other hair bearing areas, especially the beard are also affected. Any age can be affected in alopecia areata; though the common age group is 15-30. The youngest alopecia areata patient I have seen was a 2 year old girl.

Causes of alopecia areata:

  1. Autoimmune theory of Alopecia Areata
    Autoimmune theory of Alopecia Areata

    Autoimmune theory: Alopecia areata is thought to be an autoimmune disease where the body produces antibodies (‘auto’antibodies) against the hair germinal cells and cause their destruction in localised areas. The localisation of lesions also point towards a neural pathway involvement. In patients with graying hairs, it is common to see that only the black hairs fall off in the patches. Sparing of the grey hairs in alopecia areata indicates that normal nerve supply and melanin pigment is necessary for the alopecia areata to occur.

  2. Direct pressure: Many patients get patchy hair loss following direct pressure on hair bearing areas, e.g., from a tight fitting helmet, pressing the head against bed rails for prolonged duration while watching TV etc.
  3. Mobile phones and alopecia areata: Another complication of the modern device! Before the hands free sets became common, a number of patients, especially those using cheaper brands of cell phones, presented with alopecia areata on their beards. Possibly the radio waves emitted by the mobile phone damaged the hair follicles and triggered an autoimmune inflammatory reaction in the area. Most of them also had dull aching pains in their ear on the same side.
  4. Caries tooth: This is a very important factor usually ignored by patients and their doctors alike. In the Middle East where I practice, there is a very high incidence of alopecia areata. In my practice, I come across almost 6-7% alopecia cases among the total skin diseases. In addition to stress, one common factor that I noticed was the presence of caries tooth in almost all cases with recurrent patchy hair loss, especially on the beard. Research showed that alopecia areata of dental origin has indeed been mentioned in scientific journals.

    Alopecia of Dental Origin
    Caries tooth may be a cause for recurrent patchy hair loss

Personally I make a habit of referring all my alopecia areata patients who come with recurring patchy loss of hair, especially resistant to treatment, to a dental surgeon. Most such patients stop getting recurrences after their teeth infection is taken care of.

Possible explanation of the relationship between caries tooth and alopecia areata: Tooth germinal cells and hair germinal cells have embryological and histological similarities. Hence, the antibodies forming against damaged tooth germinal cells and the bacteria attacking them must be affecting the hair follicles as well. This is only a hypothesis and need to be studied further. The involvement of nail (nail pits) in alopecia areata supports this hypothesis, as nail is another integument of the skin that is similar to the tooth and hair!

  1. Stress: Most patients who come with recurrent episodes of alopecia areata also report a preceding period of intense stress in their life. How the stress causes hair loss only in localized patches, is however, not known. Hypothetically the nerve supply and altered immune responses in stress may be playing a role in the causation of alopecia areata. Corroborative studies where cure has been affected following implementation of stress management techniques in non responsive patients point to a positive role of stress in the causation of alopecia areata.

Part 2: Tips on Treating Alopecia areata.

Other Articles on Hair Loss

Published by Dr Hanish Babu, MD on 10th June, 2018

Click here to book an appointment with Dermatologist Dr Hanish Babu, MD

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

How to Manage Hair Loss in Females

 

In males, usually generalized hair loss is due to male pattern common baldness. In females, though, the hair loss could be due to many causes.

The main causes of male type baldness in females is due to excessive production of circulating androgens, resulting from diseases of various endocrine glands, like polycystic ovarian disease, adrenal hyperplasia, cushing’s syndrome and adrenal and ovarian tumors.

As we have already discussed, hair fall can also have many other causes, usually due to abnormalities in hair cycling. (hair has got growth, resting and falling cycles, any abnormality of these will cause hair to fall)

Normal causes for hair loss or alopecia in females are:

  1. Following delivery: hormonal changes.
  2. Stress
  3. Prolonged illness
  4. Nutritional deficiencies.
  5. Anemia: an important cause
  6. Local causes in the scalp: dandruff, too much chlorine in water and contact allergy.

Tests for Hair Loss in Women

  • Hormone levels (DHEA, testosterone, androstenedione, prolactin, follicular stimulating hormone, and leutinizing hormone)
  • Serum iron, serum ferritin, and total iron binding capacity (TIBC)
  • Thyroid levels (T3, T4, TSH)
  • VDRL (a screening test for syphilis)
  • Complete blood count (CBC)
  • Vitamin D3 levels
  • Scalp biopsy — A small section of scalp, usually 4 mm in diameter, is removed and examined under a microscope to help determine the cause of hair loss.
  • Hair pull – Your dermatologist lightly pulls a small amount of hair (about 50-60 strands) to determine if there is excessive loss. If more that 5-6 hairs come out, then the patient is likely suffering from excess hair loss. Normal range is one to three hairs per pull.
  • Densitometry — The densitometer is a handheld magnification device used to check for miniaturization of the hair shaft.
  • Trichoscopy

Here is what to do if you are a female suffering from hair loss:

  1. If you have any of the above triggers, try to correct them
  2. Check your Hemoglobin level. If it is lower than 11 gms/dl, you should take an iron-folic acid supplement.
  3. Do not use hot water to wash your hair. Do not put on tight clips.
  4. Take a balanced diet
  5. Practice relaxation techniques.

Specific treatments, along with the above:

  1. Topical hair tonics, with or without 2% minoxidil
  2. Multivitamin for hair
  3. Treatment for specific causes as determined through the lab investigations.

Also read:

Published by Dr Hanish Babu, MD on 9th June, 2018

Click here to book an appointment with Dermatologist Dr Hanish Babu, MD



Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

 

How to Treat Hair Loss?

Hair Loss Causes

Treatment of hair loss depends upon finding the cause and treating it. It is not as simple as it sounds, though!

Proper diagnosis, as was discussed earlier depends upon detailed history, clinical examination including hair pull test and trichoscopy and relevant lab investigations.

Once these are done, we are ready to deal with the enigma of hair loss or alopecia!

The first step would be to differentiate scarring from non-scarring alopecia.

How to Differentiate Scarring from Non-Scarring Hair Loss?

Close examination of the skin is enough to differentiate the scarring from non scarring alopecia. In scarring alopecia, there is absence of hair follicle opening and increased wrinkling of the involved skin. The skin surface is thin, shiny and dry. Underlying small blood vessels may be visible through the atrophic skin. Towards the periphery of the bald patch, hairs will be twisted because of the pull of the scar tissue.

Treatment of Common Baldness

Treatment of common baldness could be medical or surgical.

Medical Treatment of common  baldness: Topical Minoxidil is THE treatment for baldness. Most so called herbal and other miraculous cures are ineffective, or a concoction containing minoxidil itself.

Finasteride is an oral medication used for extensive male pattern baldness. It works by binding the enzyme which converts free testosterone to Dehydrotestosterone (DHT). This is a prescription medication and should only be used under the supervision of a dermatologist.

Salient features of Minoxidil therapy:

  • Life long treatment
  • Limited improvement
  • Arrest progress of hair loss
  • Expensive
  • Response is seen typically after 3-4 months
  • Hair fall restarts after stopping medication
  • Should be used carefully in those with fluctuant blood pressure and heart diseases
  • Irritation and allergic contact dermatitis may occur to the application.
  • Application 1 ml twice daily after wash with minimal rubbing

PRP Treatment and Mesotherapy for Common Baldness and Hair Loss 

Platelet Rich Plasma injections and Mesotherapy with hairtonics and vitamins are becoming increasingly popular in treatment of hairloss including common baldness.

Surgical Treatment of Common Baldness: 

Before contemplating surgery like hair transplantation, the subsequent risks and cost of such surgeries should be considered. In milder cases, a change of hair style or later, a wig would suffice. Flap and strip grafts, scalp reduction operations are also available as alternatives to hair transplantation . Hair weaving is a new technique that is gaining popularity.

When to Consult a Dermatologist

  1. Sudden , generalized hair fall should be reported at once
  2. If associated with other systemic symptoms like generalized weakness, palor, in females, menstrual iirregularities et

Generalized Hair Loss Treatment Tips

  1. Do not pour hot water on the scalp
  2. Do not use harsh shampoos
  3. Hair fall is common after delivery or after a prolonged illness, take nutritious food and use mild shampoos.
  4. Vitamin supplements are beneficial, especially biotin and zinc containing vitamins help hair growth.
  5. Check haemoglobin level for anaemia, and, if present, correct it.
  6. Rule out thyroid and other endocrinological causes.
  7. Learn to manage stress properly, here is an appropriate program which gives a practical program to manage your stress for life.

Localized Non Scarring Hair Loss:

Recurrent Patchy Hair Loss (Alopecia Areata) is the commonest type of localized hair loss : Learn more about alopecia areata.

Also Read:

 

Published by Dr Hanish Babu, MD on 9th June, 2018

Click here to book an appointment with Dermatologist Dr Hanish Babu, MD

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

How to Diagnose the Exact Cause of Alopecia or Hair Loss?

Diagnosis of Hair Loss includes extensive history taking and investigations
Diagnosis of Hair Loss includes extensive history taking and investigations.

Treatment of hair loss depends upon finding and treating the cause of alopecia. Hence diagnosing the cause of alopecia is the first step in the effective management of hair loss. This involves extensive history taking, thorough examination of the hear bearing areas and doing relevant lab tests. What makes the alopecia an enigma is that even after such thorough clinical approach, the cause of hair loss may still remain a mystery,

As we have already seen in the previous article on different types of hair loss, alopecia can either be scarring or non-scarring. Androgenic alopecia  or male pattern baldness, alopecia areata, and telogen effluvium are examples for  non-scarring alopecia.

Taking extensive history about the hair loss is of utmost importance in making a diagnosis as to the cause of the hair loss. Your dermatologist may ask the following questions:

  1. How long have you been experiencing hair loss?
  2. Is the hair loss gradual or sudden?
  3. Whether extensive or localized and patchy?
  4. Any associated symptoms like itching, scaling, burning sensations etc?
  5. Has the patient noticed hair thinning also, in addition to hair loss? Gradual hair thinning and hair loss may be due to male and female pattern baldness.
  6. Do you feel tired all the time(anemia)?
  7. Any history of hormonal imbalances (Thyroid disease or hyperandrogenism)
  8. Is hair pulling test positive? In hair shedding due to telogen effluvium and alopecia areata, hair pulling test will be positive.
  9. Any history of recent illnesses, trauma, stress, medications?
  10. While doing hair pulling test, is the hair coming out along with the root or is it breaking on traction?
    • Hair pull test (coming out as a whole with root) is positive in:
      • Telogen effluvium
      • Alopecia areata
      • Androgenic alopecia
      • Drug induced hair loss
    • When hair breaks on pulling, showing hair shaft weakness, the causes may be:
      • Tinea capitis (fungal infection)
      • Use of hair straighteners and other abrasive hair cosmetic treatments
      • Hair shaft abnormalities
      • Hair growth retardation
  11. In females, a detailed menstrual history is important to rule out hormonal causes
  12. Is there hair loss in other body parts as well??
  13. Is there a family history of hair loss? A genetic predisposition has to be ruled out.
  14. What are your food habits? Balanced nutrition is essential for normal hair growth.
  15. How often do you expose your skin to sun? Vitamin D deficiency is an important cause for chronic hair loss and hair thinning.

What is hair pulling test?

This is a simple and easy test to assess the status and degree of hair loss.

  • Hold around 50- 60 hairs firmly between the thumb, index, and middle fingers , near the base of hair shaft. Pull firmly along the direction of hair follicle.
  • If more than 10% (5-6) whole hairs (with roots) come out from the scalp, the hair pull test is considered as positive. Shampooing should be avoided at least 1 day before.

Trichoscopy for Hair Loss

      Trichoscopy (dermoscopy of hair) is very useful in outpatient diagnosis of hair loss causes. Being non-invasive it carries better patient acceptance as well.

Laboratory investigations in alopecia:

Essential tests in case of chronic hair loss:

  1. Serum ferritin
  2. Hemoglobin
  3. Vitamin D3, Serum Zinc and Calcium levels should be routinely tested
  4. Thyroid Function tests
  5. in women with androgenic alopecia, an endocrinologic profile including serum testosterone, androstenedione and dehydro-epiandrosterone (DHEA) are done to rule out hyperandrogenism.
  6. if discoid lupus erythematosus is suspected, antinuclear antibody tests are indicated.

Once the diagnosis is made, a comprehensive treatment plan can be charted out.

Read also:

Published by Dr Hanish Babu, MD on 9th June, 2018

Click here to book an appointment with Dermatologist Dr Hanish Babu, MD

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

Hair Loss: Causes & Types

Hair Loss Causes
Hair Loss Causes are Many
Proper diagnosis is essential for effective Hair Loss Treatment

Hair loss is a universal occurrence and has a high cosmetic impact on the affected individuals. It is depressing for the sufferer and a headache for the physician, because, except in a few instances, finding the exact cause of the hair loss remains a mirage.

Shedding of hair is known as effluvium or defluvium and the resulting condition is known as alopecia (Greek alopekia for baldness) or hair loss.

Hair Loss Causes

Causes for hair loss  or alopecia may be classified into two major types: scarring and non-scarring alopecia.

In scarring or cicatricial alopecia, there is sign of tissue damage like inflammation, atrophy and scarring in the hair loss area. The hair loss is permanent.

Noncicatricial or nonscarring alopecia is the commonest type, shows a normal skin structure with loss of hair and usually is amenable to treatment. Nonscarring hair loss can either be diffuse or localized depending upon the extend of involvement.

Diffuse Non-scarring Hair Loss Causes

In diffuse non-scarring alopecia, hair loss is  disseminated throughout the scalp, and, at times, on the body as well. These are caused by

  1. Failure of hair follicle production due to hormonal and genetic reasons, as in male pattern baldness (the common baldness),
  2. Hair shaft abnormalities, as in chemical damage due to hair straighteners.
  3. Abnormalities in hair cycling, as seen in telogen effluvium, anagen effluvium, loose anagen syndrome or generalized alopecia areata. Abnormalities of hair cycling occur usually following a prolonged illness, pregnancy, stress and nutritional deficiencies including anemia and vitamin deficiencies.

Focal or Localized Non-scarring Hair Loss Causes

Focal, patchy or localized non-scarring alopecia may be caused by

  1. Hair follicle production decline as in focal male pattern hair loss.
  2. Hair breakage: Trichotillomania, traction alopecia, tinea capitis, hair straighteners etc.
  3. Abnormal hair cycling: Alopecia areata, secondary syphilis.

Scarring Alopecia Causes

Cicatricial or scarring alopecia may cause hair loss in many hereditary and acquired disorders of the hair and hair follicle.

  1. Hereditary diseases: Defective development of hair follicles and skin, as in aplasia cutis, darier’s disease.
  2. Traumatic: Chemical and mechanical, as in burns
  3. Neoplastic: Basal cell carcinoma
  4. Follicular inflammation: Discoid lupus erythematosus, tinea capitis
  5. Dermal Inflammation leading to secondary damage to hair follicle, as in morphea, skin tuberculosis, lichen planopilaris etc

From the above short review of causes of hair loss, it is evident that a correct diagnosis is essential for effective treatment of alopecia.

Read also:


Published by Dr Hanish Babu, MD on 5th June, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD