Hair Loss
Hair loss may affect any one of us at any time in our lives for a variety of reasons. Many assume that it is to do with stress. Others assume it is "alopecia" which I might add is simple a descriptive term to describe hair loss. Examples of the actual diseases in which the term alopecia appears are Alopecia Areata, Alopecia Totalis, Alopecia Universalis, Androgenetic Alopecia, Androgenic Alopecia and Diffuse Alopecia. How many times do I meet patients who have been diagnosed with "alopecia" from a so called specialist. As you can see, the question you should be asking is "which form of alopecia am i suffering?"
There are many different types of hair loss which may be divided into a number of different categories : acute or chronic, androgen related & traction. Each cover a variety of topics which i have tried to give an insight in the following paper. If you have any questions relating to this information or would like to arrange a consultation, please contact the helpline of your choice (top left of page) or e-mail us.
Types of Hair loss may be divided into separate categories:
1. Temporary hair loss - conditions such as Telogen Effluvium, alopecia areata, post natal alopecia, various hair loss relating to skin diseases, such as when affected by contact dermatitis (allergic/irritant reactions) or any hair loss condition that is related to stress or a temporary state of health. These type of hair loss conditions may regrow in time. However, some may well require some treatment to assist the body to produce hair.
It must be understood that there is no exact science to decide if treatment is required. For instance, not everyone with alopecia areata will need treatment. Some suggest that treatment is pointless as the disease will take its course as it pleases and nothing will alter that fact. Having 20 years experience within this profession I feel this is a bold statement. I have treated many patients with this disease, the vast majority of which have recovered fully. At consultation, I have advised some patients with alopecia areata that treatment is advisable, some I have simple said that this will regrow in time and to be patient.
When discussing such conditions as post natal alopecia it should be noted that in most cases the hair should in time regrow. However, we as professional trichologist understand that hair loss can be caused by many factors which need to be addressed. For instance, is the patient suffering from an iron deficiency? Or has the patient suffered a particularly stressful pregnancy with complications at birth and post trauma? Are there more sinister factors that have arisen? All these and more need to be addressed. It may well be necessary to administer some treatment. Again, all these factors need to be taken into consideration before making this decision.
2. Chronic hair loss - this describes various conditions that continue to affect the patient for more than 6 months and fail to regrow. Iron deficiency in women is a common example. Many women do not realise that iron may plays such a major part in the chronic hair loss condition. Using this example, should this be a case then, for the patient to simply take an iron supplement and everything will be ok? This may well be the case. However, are there other factors that need to be taken into consideration? Has the iron deficiency taken its toll on the body and created a state of dormant state of hair growth which could be helped by treatment? This question need be asked each time for each different patient when considering types of hairloss.
3 Androgen related hair loss - both androgenetic and androgenic alopecia's are androgen related. Androgenetic is genetically inspired and androgenic which is acquired. Androgenetic alopecia (AGA) is associated with the androgen dihydrotestosterone (5-alpha -DHT) which is the principle pathogen affecting androgen-sensitive hair follicles. Those who possess type 2 enzymes (5 alpha reductase) are those that are most likely to develop AGA which causes the gradual miniaturization of the androgen sensitive hair follicles. Therefore treatment is based around stopping or reversing the process of follicular miniaturization.
This may be possible by preventing DHT production using Finasteride (propecia) or by modulating DHT bindings to the androgen receptors with certain drugs such as Cyproterone Acetate.
Other enzymes such as 3 alpha - hydroxysteroid - dehydrogenase may also be involved with the metabolism of DHT. Aromatase which is found in epithelial follicular tissue should in theory reduce the quantity of testosterone available for conversion onto DHT. 3 alpha -hydoxysteroid-dehydrogenase found to be present in the dermal papilla actually accelerates DHT dependent hair follicle activity (scalp hair loss and secondary sexual body hair increase).
Hair loss that falls under the androgen related hairloss conditions are as you can see complex. The key is to diagnose this condition at the earliest opportunity to implement measures that may and I stress may slow the process.
One hair loss treatment that has recently come to light as a possible solution is the Laser comb. One of the few treatments that is FDA approved which in my view adds weight to this argument.
4 - Traction alopecia - hair loss relating to that which has been pulled either purposefully trichotillomania or by the use of particular hairstyling technique. Many patients particularly afro Caribbean types have no idea they are damaging there hair density. Naivety within the hairdressing field is undoubtedly to blame along with the ever increasing pressure to keep up with hairstyling fashion and trends. It is difficult to say that the hair will regrow after epilation with or without treatment. There are some cases that are simply beyond help. Some I have been able to treat.
Why visit a trichologist?
Remember, there is always a cause of hair loss. A professional trichologist will look into all factors and investigate why the hair loss is occurring which is not something that can be done is a five minute consultation. You should expect a consultation to last for at least 30 minutes. When you ring to arrange a consultation, ask how long the consultation is. Remember, each patient must be taken on an individual basis. No two patients are alike!
One other word of warning, if you ring and speak with a trichologist who offers you a treatment on the phone without seeing you, ask yourself how can this person know what problem i have without seeing me and discussing "the whole case"? In my opinion, it is not possible to diagnose and hairloss or scalp condition without seeing the patient. Please be careful when choosing a trichologist.
E Stevens
