Trichotillomania

admin    Trichotillomania    

Of all forms of hair loss, Trichotillomania can either be the easiest to treat or the most difficult.  It is not caused by any biological or genetic disorder, rather by the sufferer’s own hand.  The literal translation from Greek actually means “hair pulling madness.”  Trichotillomania is the result of the individual twisting, pulling or manipulating the hair to such an extent that it pulls free from the scalp.  In light of this, hair loss is not permanent, however, if the psychological or behavioral disorder isn’t treated, the hair loss can be continual because the behavior will be ongoing.  Although it is evidenced in loss of hair, the condition is not treated by a dermatologist or general practitioner.  However, having said that, it is first necessary to get a proper diagnosis by a qualified Dermatologist.  Usually the person is then referred for psychological or psychiatric treatment and/or therapy.

Who is most likely to be susceptible to Trichotillomania?

In general, it is safe to say that young children between the ages of seven and fourteen years of age are more apt to present with this form of hair loss.  Based on statistics, children are seven times more likely to manifest this illness than adults.  Adults also can be diagnosed with Trichotillomania but prognosis for a ‘cure’ is much more guarded.  Most often adults who suffer from Trichotillomania first presented when they were children.  There has been no evidence that any race or ethnic group is more susceptible to the illness, nor is gender usually a consideration in infants or very young children.  In teenagers it is predominantly manifested in girls and in adulthood it is most often in women.

Is there a treatment or cure for this illness?

The success rate for treatment and/or cure generally depends on the age of the individual.  Young children (pre-adolescent) have a high success rate for realizing a cure.  It is much more difficult to treat teenagers and by the time the individual reaches adulthood the prognosis for a cure is not good at all.  Again, once diagnosed this disorder is not treated by a dermatologist or general practitioner unless the pulling is so severe that it causes secondary issues such as infections or severe inflammation.

Certain factors make a definitive diagnosis difficult.

While it is common for the individual, especially younger children, to willingly discuss the fact that it is ‘self inflicted,’ there are times when further examination must be undergone.  For instance, there a variation known as sleep-isolated Trichotillomania.  It is difficult to diagnose because the individual is not aware of having pulled out their own hair and in these cases it is common to be misdiagnosed as Alopecia Areata.  At other times the dermatologist might need to take on the role of detective to solve the mystery.  Some individuals are either reluctant to discuss having manipulated their own hair out of their head or they may be totally unaware of it since it can be an involuntary action.  An untrained physician may at first make an inaccurate diagnosis, but will probably ‘catch’ it when treatments for Alopecia Areata are not ‘working.’  At this point the individual will be referred for appropriate therapy.

What to do if you suspect Trichotillomania

Of course if an adult suffers from Trichotillomania, he/she will probably have the presence of mind to realize that it is not a dermatological condition.  In that case they know that they can either try to remedy the situation on their own or seek professional help.  A dermatologist would only be called for if some kind of infection and/or inflammation occurred.  However, if a parent notices that a child is evidencing bald spots or sparse areas of hair, the first thing to do would be to make an appointment with the child’s pediatrician and then start observing.  Many times a parent can help with a proper diagnosis by the time the child gets in to see the doctor.  If it is noticed that the child is tugging at or twisting the hair subconsciously, the pediatrician can then make an accurate referral to a child psychologist or behavioral specialist.

A word of caution.

Since Trichotillomania is not physiological but rather psychological it is important to get qualified help.  The symptoms may or may not be indicative of some bigger issue that is a greater cause for concern.  That is a chance that isn’t worth taking.  If you suspect that your child, adolescent or loved one is suffering from Trichotillomania, it is in their best interest to seek proper medical/psychological help.

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admin    Traction Alopecia    

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Telogen Effluvium

admin    Telogen Effluvium    

Telogen Effluvium is the second most common type of hair loss, second only to Androgenetic Alopecia.  It is the result of some physiological stressor or hormonal change and can also be caused by medications or psychological triggers.  It is a form of nonscarring alopecia, which means the hair follicle stays intact so regrowth is probable.  Also, Telogen Effluvium can affect hair on the entire body, but usually only the hair of the scalp is evidenced.

In order to understand this type of hair loss, it is necessary to understand the anagen and telogen phases of the hair growth cycle.  Anagen is the active growth stage which lasts up to 3 years under normal circumstances while telogen is its resting phase.  The resting phase generally involves between 5% and 15% of hair at any given time.  At the end of the anagen phase the normal process is for hair to be shed, or pushed out by new growth after the telogen, or resting stage.  However, in Telogen Effluvium something triggers more of the hair to go into the telogen stage which results in hair loss throughout the scalp and not in localized patches.  There is ample evidence that suggests that Telogen Effluvium may occur independent of the usual growth cycle which means that it is not triggered by anagen growth as is normally the case.

A few other interesting facts about Telogen Effluvium are that it is not age or gender or race specific, and it can be chronic or acute.  It is not uncommon for infants, within the first few months of their lives to go through Telogen Effluvium.  Parents often comment on a baby’s full head of hair and how it is only going to shed anyway.  This is Telogen Effluvium in all its glory!  Also, it is common in postpartum mothers, perhaps due to the rapid change in the hormonal balance within her body or other key stressors involved in childbirth.  Both men and women experience this condition, but since it is a cosmetic disorder, it appears that more women than men seek medical treatment.  There are no statistics that indicate that any race is more prone to this type of hair loss.  And, it can be brought about suddenly (acute) due to some extreme stressor or can be chronic as would be the case with some ongoing imbalance in the body until such time as that imbalance can be identified and rectified.

Acute Telogen Effluvium

This form of hair loss is evidenced in a sudden onset of hair loss throughout the entire scalp.  Patients often report to their physicians that their hair seems to be falling out, or thinning for no apparent reason.  Sometimes the cause can be identified after a careful medical questioning.  Some physiological or metabolic stressor becomes apparent.  Hair loss is not complete which means that total baldness will not be resultant.  This condition generally lasts up to six months with the average being at right around three months.  Hair is lost throughout the entire scalp and the remaining hair appears limp and ‘lifeless.’

Chronic Telogen Effluvium

Chronic Telogen Effluvium is when the shedding of hair lasts longer than six months.  The problem is that the onset is menacing and can be extremely difficult to ascertain what incited it.  Again, patients present with symptoms of unexplained hair loss and as in the acute form, their hair appears thin, lifeless and limp.

Physical Examination to Diagnose Telogen Effluvium

Unfortunately, it is often difficult for the physician to notice an appreciable difference in hair density unless old photos are used to compare the difference.  There are a few ‘tests’ that can be performed, however, to make an accurate diagnosis.  First of all there is the ‘pull test.’  When a clump of hair is gently tugged, if more than four or five strands pull free from the head this is a pretty good indicator that the condition is present.  Also, if there is no obvious inflammation or dermatitis on the scalp, a diagnosis can be made that it is probably this nonscarring form of alopecia.  And the most concrete test is to forcefully extract at least 20 strands of hair.  If they are greater than twenty-five percent of them are in the telogen stage then an accurate diagnosis can be forthcoming.  It should also be noted that complete patches of baldness are not present, hair loss is diffuse.

The Ultimate Cause of Telogen Effluvium

As alluded to above, any illness or physical stressor can trigger the onset of Telogen Effluvium.  Stressors such as childbirth, severe illness, malignancies, lupus, renal disease, major surgery and even serious trauma can incite the onset of Telogen Effluvium.  Also, certain medications and the discontinuation of medications can be a trigger.  For instance, medications that are most commonly a known cause could be (but not limited to) anticoagulants, retinoids, beta-blockers, immunizations, and medications for hypothyroidism.  Heavy metals such as thallium, selenium and arsenic can also be inciters.  Many times people go overboard on dieting and a crash diet can trigger Telogen Effluvium.  Anorexia is a common trigger as is low intake of protein and iron deficiency over a prolonged period of time.

The Good News

Although it may not seem like it at the moment if you are currently experiencing thinning hair that seems to be falling out by the handfuls, there really is light at the end of the tunnel.  If you are diagnosed with Telogen Effluvium it is usually only for a short period of time up to approximately six months at the high end and maybe only for a period of one month if the inciter isn’t serious.  It is a hair loss condition that can be corrected often by itself and will not result in total chronic baldness.

Scarring Alopecia

admin    Scarring Alopecia    

Unlike other forms of hair loss, Scarring Alopecia does not refer to a singular and specific disorder but rather a diverse group of hair loss disorders that result in permanent hair loss in which the hair follicles have been completely destroyed.  It is often difficult to distinguish between them unless a small section of scalp is biopsied and microscopically examined by a dermatologist or pathologist.  A definitive diagnosis is possible by examining deep scar tissue to determine whether or not there is any inflammation present and where it is located relative to the hair follicles.  There are some ‘clues’ that might come in handy when making a diagnosis, however.

Visual and Physical Characteristics

Although Scarring Alopecia often presents itself in much the same way as Alopecia Areata, there are discernible differences at times.  Both start with small patches of hair loss but Alopecia Areata usually appears more symmetric and round.  Most forms of Scarring Alopecia have ‘ragged’ edges and there will probably be some indication of inflammation, lesions, puss and/or skin discoloration that would not be present with Alopecia Areata.  Also, Scarring Alopecia may be accompanied by itching, pain and/or a burning sensation.  At some point Scarring Alopecias burn themselves out and the bald spots will stop growing.  At this point the physical discomfort usually subsides.  Unfortunately, even when a definitive diagnosis of Scarring Alopecia can be made through a visual examination, treatments will most assuredly vary depending on what type it is.

Various Types of Scarring Alopecias

First of all, it is important to realize that most types of Scarring Alopecia are extremely rare.  Probably less than 3% of all  hair loss cases can be attributed to all of the Scarring Alopecia diagnoses combined.  There are so many classifications that it would be difficult to name them all and even more difficult to pronounce them!  To cite just a few of them, examples would include follicular degeneration syndrome, eosinophilic pustular folliculitis, lichen planopilaris, folliculitis decalvans  and dissecting cellulitis.  And that is just a few of many!  Each is treated uniquely once a diagnosis has been confirmed.

Scarring Alopecia Treatments

Treatments will vary significantly depending on the type of Scarring Alopecia, but the one factor that is common throughout is that because it can result in much damage to the scalp, all treatments should be extremely aggressive.  This is because hair loss will be permanent and it is imperative to try to halt the progression of the bald spot.  Treatments will include anything from topical or subcutaneous (under the skin) injections of corticosteroids to antibiotics and isotretinoin.  Isotretinoin is interesting in that it is often used to treat severe acne however it was developed to treat certain forms of cancer and is still in use today as an effective form of chemotherapy.  Having said that, don’t be frightened if your doctor prescribes that for your hair loss.  It doesn’t mean you have cancer!  It works by destroying cells that divide rapidly.  That is a characteristic of cancer, in fact that’s what cancer is, but it is also a characteristic of some forms of Scarring Alopecia, albeit benign.

Closing Thoughts: Scarring Alopecia is Rare

The problem with talking about Scarring Alopecia is that many people become frightened when they notice a small bald spot beginning on their scalp.  Chances of it being Alopecia Areata are much greater than of it being one of the forms of Scarring Alopecia.  Alopecia Areata is reversible and does not usually result in permanent hair loss while Scarring Alopecia results in a permanent bald spot that will need to be surgically corrected through some type of transplant, grafting and/or surgical manipulation.  Remember, less than 3% of all cases of hair loss can be attributed to one of the many forms of Scarring Alopecia.  As is the case whenever you notice you are losing hair, a definitive diagnosis is necessary prior to any treatments whatsoever.  Only a trained medical professional has the ability to accurately diagnose what is going on and whether or not there are any known effective treatments available.  It is never in your best interest to self-diagnose, however, once a diagnosis is established you are free to choose your treatment or not as the case may be.  Some forms of Alopecia are treatable with natural or homeopathic remedies while others are not.  But, treatment always begins with a diagnosis.

Androgenetic Alopecia

admin    Androgenetic Alopecia    

Androgenetic Alopecia is commonly referred to as Male Pattern Baldness (MPB) although women can suffer from it as well.  Sometimes it is simply referred to as Pattern Baldness when general characteristics are spoken of that can affect either men or women.  Androgenetic Alopecia is the inherited or genetic form of hair loss and it is the most common form.  While it is more common among men than women, either gender can inherit this genetic trait.

Statistical Background of Androgenetic Alopecia

In men it most usually begins by the age of 21 with a receding hairline and progresses from there.  Actually, MPB can commence even as young as 12 and it may not be evidenced until a man reaches the age of 40.  It accounts for at least 95% of all cases of hair loss and it is felt that by the age of 35 as many as two-thirds of the male population in the United States will have evidenced it to some degree.  Statistics further indicate that approximately 85% of American males will have some degree of visible hair loss by the time they reach the age of 50.  Androgenetic Alopecia accounts for greater than 95% of all cases of hair loss in men.  The statistics in women are significantly different.  While 50% of women over the age of 40 may have evidenced some amount of hair loss due to Androgenetic Alopecia, it is believed that only 13% of women in premenopausal years will show appreciable loss.  According to some sources, postmenopausal women are much more likely to develop some degree of Pattern Baldness and as many as 75% of them will have some degree by the age of 65.

The Progression of Pattern Baldness

The reason why Androgenetic Alopecia is referred to as “Pattern Baldness” is because it usually follows a specific pattern as it progresses.  In males it usually begins at the hairline while women tend to gradually lose hair throughout the entire scalp.  In men the hairline will begin receding, usually at the temples and over time the loss will form a pattern resembling the letter ‘M’.  As it progresses, the hairline further recedes upwards and back until, quit often, the entire top and crown of the head are bald.  It is not uncommon to end with hair that circles the head from above the ears and around the back of the head with the entire top being bare.  In some cases it progresses to total baldness.  Although the ‘pattern’ is not as obvious in women since they tend to lose hair throughout the entire scalp, it is still referred to as Pattern Baldness to differentiate between other forms of hair loss.  In many women with Androgenetic Alopecia, by the time they reach 65 their hair will be extremely sparse.

The X-Factor

Until quite recently the actual gene that was responsible for this disorder had not been identified.  In 2008 a study was conducted and it was determined that this particular genetic disorder is linked to a specific gene on the X chromosome.  This was an amazing breakthrough and can significantly alter treatment for genetic hair loss in the future as even more becomes understood about this particular gene that causes the disorder.  In order to fully understand just how phenomenal this breakthrough really is, consider the fact that the X chromosome is comprised of more than 153 million base pairs (opposite complimentary strands of RNA and DNA).  While it would take a molecular biologist to fully comprehend this information, it is sufficient to say that a single gene is extremely complex and the segment of that gene that is a tiny segment of a strand of the X chromosome is responsible for Pattern Baldness.  The reason why both men and women can ‘inherit’ this genetic disorder is because it is tied to the X chromosome.  Men have an X (from their mother) and a Y (from their father) while women have an X and an X (one from her mother and one from her father’s mother, paternal grandmother.)  The site on the gene that has been found to be responsible for MPB has been named 3q26 and it can reside on either of the X chromosomes in women while the man retained that specific X chromosome from his mother.

This inherited gene is far reaching.

The specific gene that is the cause of MPB is actually responsible for the male hormone testosterone which in turn is responsible for a metabolite, Dihydrotestosterone (DHT) that is secreted from one of four locations.  It is manufactured in the prostate gland, the testes, adrenal glands or in hair follicles.  It is an overabundance of DHT that causes the hair follicle to shrink and at some point the hairs produced become short and thin.  Eventually the follicle dies and hair is no longer produced.  This is the ultimate cause for genetic baldness.  What is interesting about this is the fact that DHT is also responsible for Benign Prostatic Hyperplasia (BHP) which is an enlarged prostate that is not thought, at this time, to be a precursor to prostate cancer.  There is a tendency for males with Androgenetic Alopecia to also suffer from an enlarged prostate.  The two are genetically linked so finding a ‘cure’ for Male Pattern Baldness also has broad and significant implications for curing and/or preventing BHP.

Current pharmaceutical treatments give hope for the future.

At the moment there are two pharmaceutical medications that are able to effectively treat Androgenetic Alopecia with a decent rate of success.  Both Rogaine (Minoxidil), Propecia (Finasteride) have proven to be effective in inhibiting the amount of DHT that is secreted, thereby reducing damage to hair follicles.  The interesting thing about Propecia is that it was originally developed to treat BHP and is now approved for hair loss as well.  Since the gene responsible for these genetic disorders has been identified, there is much excitement in the scientific and medical communities.   There is a great deal of hope that genetic engineering can one day soon eliminate both MPB and BHP by manipulating the gene that causes both disorders.  And from there the possibilities are endless.

Remember, every cure came about by first identifying the ‘cause’ of the disease or disorder.  Now that the cause has been found, the cure is just around the corner.

Alopecia Areata

admin    Alopecia Areata    

Alopecia Areata is a form of nonscarring hair loss that is first evidenced by small, round bald patches usually on the head or facial hair.  Although it most typically presents itself on the head, it is possible to discover it anywhere on the body including patches of short body vellus hair or even in pubic hair.  The cause for this particular type of hair loss is not known with any amount of scientific or medical certainty; however, it is believed that it is a hereditary autoimmune disorder in which the body’s immune system targets the hair follicle and starts attacking it.

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admin    Causes and Types of Hair Loss    

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