The Truth About Hair Loss

Every month our beauty department in-box fills up with e-mail from readers struggling with some aspect of their appearance. But none of the mail is as emotionally charged as the letters from women dealing with hair loss—an issue that will affect up to 60 percent of us at some point.  The good news: "In almost all cases, you can get improvement, even if it's just stopping further loss," says trichologist (hair and scalp specialist) David Kingsley, PhD. "And about 80 percent of the time, regrowth of hair is a possibility."

When it's temporary... If your thinning is triggered by a specific event—childbirth or a high fever or a period of extreme stress—it will probably manifest as excessive (more than 100 hairs a day), and sudden, all over shedding. Once the trauma passes, your hair will grow back within a few months. And if a blood test traces your widening part to a thyroid imbalance, endocrine disorder (like polycystic ovarian syndrome), dietary deficiency, or a specific medication, your hair will most likely return to its former glory once the underlying issue is addressed.

When it's chronic... The most common cause of female hair loss is androgenetic alopecia, a genetic condition in which new hair shafts grow in progressively thinner. Women usually notice a wider part and gradual reduction in overall volume, often with a concentrated thinning at the head. The condition can begin any time after puberty but often becomes noticeable during and after menopause, when it's compounded by hormonal shifts.

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WHAT CAN I DO ABOUT MY BABY'S HAIR LOSS ?

There's nothing you can do about newborn hair loss related to hormone levels except look forward seeing your baby's new 'do.

If the bald spot is the result of your baby spending too much time in the same position, try alternating the way your baby sleeps during naps and at night. If you usually put him to sleep on his back with his head at one end of the crib, try putting him down with his head at the other end every other night. Your baby will naturally turn his head to the side to look out of the crib, so he'll be resting on a different part of his head.

If you have a sleep wedge to keep your baby from flipping over onto his stomach, you can try putting him to sleep on his left side, the next night on his back, and then the next on his right side.

Also make sure your baby spends some time on his tummy every day. In addition to giving the back of his head a break, tummy time is essential for your baby's overall physical development. Mention your baby's hair loss to his doctor, especially after your baby's half birthday. Chances are the hair loss is normal, but his doctor can make sure that there isn't an underlying medical condition and help with treatment if there happens to be a problem. If your child has ringworm, for example, she'll prescribe an antifungal medication.  

If the doctor suspects alopecia areata, she may refer you to a dermatologist for further evaluation. (Some children simply outgrow alopecia areata without treatment. Others -  usually older children — receive medication to stimulate hair growth.)

If your baby's hair loss is due to breakage, you'll just have to treat his hair and scalp tenderly for a while until it grows back. (Keep in mind that a baby's hair is finer and more delicate than an adult's. Opt for natural styles and brush gently.)

There are no guarantees, but in most cases a baby's hair loss is temporary. There's a good chance your child will sport a full head of hair within a year.

SCARRING ALOPECIA

Scarring alopecia, also known as cicatricial alopecia, refers to a collection of hair loss disorders that may be diagnosed in up to 3% of hair loss patients. It occurs worldwide in otherwise healthy men and women of all ages.

Each specific diagnosis within this category is fairly rare, but some examples include dissecting cellulitis, eosinophilic pustular folliculitis, follicular degeneration syndrome (previously called "hot comb" alopecia), folliculitis decalvans, lichen planopilaris, and pseudopelade of Brocq, to name a few. Scarring alopecia may also be part of a much larger condition such as chronic lupus erythematosus, where many organs of the body can be affected.

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Understanding Hair Loss

Although you can't reverse natural balding, you can protect your hair from damage that may eventually lead to hair thinning.  Many people put tremendous stress on their hair. Hair dryers, hot curlers, hair dyes, permanent and hair straightening products, and chemical-laden cosmetics may cause dry, brittle, and thinning hair.  To prevent hair damage that may cause hair loss, follow these tips: Go natural: Leave your hair its natural color and texture. If that is not an option for you...

Read the Understanding Hair Loss

While there are many forms of scarring alopecia, the common theme is a potentially permanent and irreversible destruction of hair follicles and their replacement with scar tissue.

Most forms of scarring alopecia first occur as small patches of hair loss that may expand with time. In some cases the hair loss is gradual, without noticeable symptoms, and may go unnoticed for a long time. In other instances, the hair loss is associated with severe itching, burning, and pain, and is rapidly progressive.

The scarring alopecia patches usually look a little different from alopecia areata in that the edges of the bald patches look more "ragged." The destruction of the hair follicle occurs below the skin surface so there may not be much to actually see on the scalp skin surface other than patchy hair loss. Affected areas may be smooth and clean, or may have redness, scaling, increased or decreased pigmentation, or may have raised blisters with fluids or pus coming from the affected area.

These visual indicators may help with diagnosis, but it is difficult to diagnose a scarring alopecia just from the pattern of the hair loss and the nature of the scalp skin. Often when scarring alopecia is suspected, one or more skin biopsies are done to confirm the diagnosis and help identify the particular form of scarring alopecia. A small biopsy of 2 to 4 mm in diameter is taken and examined under a microscope. A pathologist or dermatologist will look for destruction of the hair follicles, scar tissue deep in the skin, and the presence and location of inflammation in relation to the hair follicles.

Often, the early stages of a scarring alopecia will have inflammatory cells around the hair follicles, which, many researchers believe, induces the destruction of the hair follicles and development of scar tissue. However, there is some argument about this among dermatologists, as sometimes a biopsy from a scarring alopecia-affected individual shows very little inflammation.

Scarring alopecia almost always burns out. The bald patches stop expanding and any inflammation, itching, burning, or pain goes away. In this end stage, another skin biopsy usually shows no inflammation around hair follicles. Bald areas usually have no more hair follicles. 

Sometimes, though, hair follicles, at least those at the periphery of a bald patch, are not completely destroyed and they can regrow, but often all that is left are just a few longitudinal scars deep in the skin to show where the hair follicles once were.