Causes of Alopecia or hair loss

Alopecia or hair loss is nothing but partial or complete loss of hair. Hair loss generally develops gradually and may be patchy or diffuse (all over). 

There are many reasons for hair loss.  Important ones are as follows 

1. Disorders of hair:

Hereditary thinning or baldness: 

• Most common cause.
• Also known as androgenetic alopecia. 
• In men, it is seen as a receding hairline as well as hair loss on top of the scalp.
• In women, tends to have their hairline and have visible thinning of hair over the front and top of the scalp.

Alopecia areata:

• An autoimmune disease
• Causes hair loss on the scalp and elsewhere on the body. 
• Develops in people of all ages and hair is lost in patches. 

Cicatricial (scarring) alopecia: 

• Can develop in healthy men and women, 
• A rare condition that destroys hair follicles. 
• Scar tissue forms where the follicles once were and re-growth are not possible. 
• Treatment attempts to stop the inflammation that destroys the hair follicles.

2. Diseases

Underlying medical condition: 

• Hair loss may be a warning sign for about 30 diseases. 
• Hence, hair loss often can be stopped or reversed with treatment for the underlying disease. 
• Examples are Thyroid diseases and iron deficiency anemia.  

Some cancer treatments: 

• Radiation therapy and 
• Chemotherapeutic medications can also cause hair loss. 
• While hair loss is usually a temporary but distressing part of therapy. 

Ringworm of the scalp:

• Fungal infection (most common in children) 
• Can cause balding and scaling on the scalp

Trichotillomania:

• It is a disorder that causes people to repeatedly pull out their own hair. 
• Aside from a constant urge to pull out the hair on the scalp, sufferers often feel compelled to pull out their eyelashes, nose hair, eyebrows, and other hair on their bodies.

3. Stress and Hormones

Stress: 

• Mental or physical stress, 
• After a major surgery, high fever, severe infection, or even flu. 

Hormone fluctuations: 

• Changes in hormonal levels (especially in women) 
• Common during menopause and after childbirth due to falling estrogen levels which is usually temporary. 
• Hair can be re-grown.

4. Diet

• Weight loss: Common, and hair growth can return to normal with proper diet and weight. 
• Vitamin A excess: Intake of too much vitamin A.
• Protein intake too low: Can be reversed and prevented by eating enough protein.  
• Iron intake too low: Vegetarian sources of iron are iron-fortified cereals, soybeans, pumpkin seeds, white beans, lentils, and spinach. Clams, oysters, and organ meats are good animal sources of iron. 
• Eating disorder: Anorexia or bulimia is the other cause of hair loss.
• Zinc deficiency 
• Malnutrition

5. Medication

Medications that can cause hair loss are

• Blood thinners
• High-dose vitamin A
• Medicines for arthritis, depression, gout, heart problems, and high blood pressure
• Birth control pills: Women taking or discontinuing birth control pills experience hair loss. It occurs in women with an inherited tendency toward hair thinning.

6. Hair Care Practices

Hair cosmetics:  

• Frequent coloring of hair 
• Regular or improper use of dyes, gels, relaxers, and sprays  
• Doctors recommend limiting the use of these hair cosmetics to decrease hair breakage. 

Blow dryers, flat irons, and similar devices:

• Regular use of a blow dryer 
• The high heat from a blow dryer can boil the water in the hair shaft leaving the hair brittle and prone to breakage. 
• Doctors also recommend limiting the use of flat irons, which straighten hair by using high heat, and other devices such as curling irons.

Hairpins, clips, and rubber bands: 

• If the hair is held tightly with hairpins, clips, and rubber bands, it can break hair. 
• To minimize the breakage, one should use loosely fitting clips and wear them in different areas of the scalp so that hair breakage is not localized.

Too much or vigorous grooming: 

• Regular shampooing, combing or brushing (100 strokes or more a day) 
• Doing any of these too vigorously can cause hair breakage. 
• When hair breakage occurs, the hair appears shaggy or too thin

References:

1. https://www.nhp.gov.in/disease/skin/alopecia-hair-loss
2. John M. Murtaghs Patient Education. of 6th revised ed edition. North Ryde NSW: McGraw-Hill Australia. 2012
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7. https://www.medicalnewstoday.com/articles/326665 photo credit
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