Alopecia is the medical term for hair loss in both men and women. On most days we lose around 100 hairs per day. Greater than this number can be a sign that things are not right with our bodies, and we need to explore why.
Stages of Hair Growth and Loss
To understand hair loss, we need to understand the normal stages of hair growth and loss.
There are 4 stages in the cycle of hair growth and loss.
Anagen (Growing Phase) - this stage is highly mitotic (cells are undergoing a lot of cell division), that leads to the production of the hair shaft from the hair follicle. Usually 90% of our hair is in this phase. This stage lasts for years.
Catagen (Transition Phase) - where the hair follicles shrink and hair growth slows. The hair separates from the hair follicle but remains in place. This lasts roughly 10 days.
Telogen (Resting Phase) - new hair starts to form in the hair follicle to replace the hair about to be shed. This lasts about 3-months.
Exogen (Shedding Phase) - where old hair sheds, and new hair growing in the hair follicles (over a 2-5 month period) is ready to replace lost hair. Losing up to 100 hairs per day is normal.
When we have more hair moving from the growing phase to the resting and shedding phase, we can see excessive hair loss. This is often seen when our body is inflamed. The point is to understand why our body is inflamed.
Why Am I Losing My Hair?
There are many causes of excess hair loss. This may help you identify a reason behind your question, 'Why am I losing my hair?'
Nutritional needs are not met - like the rest of our body, we need a full complement of vitamins and minerals for optimal hair growth. Sudden weight loss can result in temporary hair shedding. This can be from Iron deficiency, Zinc deficiency, B vitamin deficiencies etc.
Stress causing Telogen effluvian - this is a reversible condition in which hair falls out after a stressful experience. The stress pushes large numbers of hair follicles into a resting phase. Within a few months, those hairs can fall out. In many cases, no treatment is required and the hair often grows back when the stress goes away.
Androgenic Alopecia (Reproductive Hormonal imbalance in females) - excess androgens like testosterone can lead to female pattern baldness in conditions like Polycystic Ovarian Syndrome (PCOS). This can resemble male pattern baldness. Androgens can lead to miniaturisation of the hair follicles. Hair grows in tufts generally, so if the tuft shrinks and miniaturises, it leaves bare scalp between tufts.
Thyroid Disease - Hypothyroidism and Hashimoto's Thyroiditis is associated with hair loss, and we often see the outer third of eyebrows lost for example..
Autoimmune Conditions - Alopecia Areata, Alopecia Totalis and Alopecia Universalis are all autoimmune conditions (and discussed below), where an immune response is targeted at hair follicles at certain spots on the scalp causing hair loss in patches (Alopecia Areata), or total hair loss from the scalp (Alopecia Totalis), or where complete loss of hair on scalp, eyebrows, eyelashes, pubic hair, legs, arms, beards, etc is lost (Alopecia Universalis). Finding out what is triggering this is key. People with Alopecia Universalis often present with other immune issues including Eczema (atopic dermatitis), and autoimmune thyroid disease. Autoimmune conditions can be triggered by many external factors including viral infections and this is discussed below. Lichen planopilaris is another autoimmune response where the hair follicle is destroyed and hair loss occurs on the sides, front and back of lower scalp.
Trichotillomania - is a psychological condition whereby you obsessively pull hairs out due to stress and anxiety and Obsessive Compulsive Disorder (OCD).
Post-Partum - changes in hormone levels post pregnancy can result in hair loss (Telogen effluvium) where hair comes to the end of its cycle quicker and results in widespread shedding of hair where your hair may feel thinner all over. This usually settles after 3 months.
Traction Alopecia - Broken hair and sore skin with hair loss from damage or strain to the hair follicles by physical mishandling - straightening hair, tying hair too tightly etc
Infections - Syphilis can cause patchy hair loss.
Scalp Infections - like folliculitis, fungal infections (ringworm) for example can cause hair loss.
Viruses - studies have shown that many viruses have been implicated in hair loss, and in autoimmune conditions. This is discussed in detail below.
Psoriasis - from an overproduction of skin cells that can damage hair follicles and cause hair loss.
Inflammation - Seborrheic dermatitis as seen by itchy red patches, that can lead to loss of hair in patches.
Menopause - from resultant lower levels of oestrogen.
Ageing - both men and women will lose hair as the cycle of hair growth slows down and volume diminishes as they age.
Central Centrifugal Cicatricial Alopecia (CCCA) - a type of scalp scarring that begins in the centre of the scalp and spreads out slowly.
Genetics and Hereditary causes - male and female pattern baldness can be genetically linked. Hereditary hair loss in males for example, is seen by a 'U-shaped' loss of hair as a result of genes passed down from both sides of the family.
Medications - Chemotherapy, excessive Vitamin A, antidepressants, oral contraceptive pill, immunosuppressives, anti-clotting drugs (anticoagulants), and medications for lowering cholesterol can all interfere with cell division and growth. Hair loss from chemotherapy usually begins 2-4 weeks after commencement of therapy.
Excessive sun exposure - this causes an impairment to the hair shaft from triggering superoxide to form, that pushes hair from Anagen to Telogen phase.
Autoimmune Disease and Hair Loss
Alopecia Areata, Alopecia Totalis, Alopecia Universalis and Lichen planopilaris are caused by an autoimmune reaction, which occurs from a dysregulated immune response. Often (but not always) there is a genetic predisposition, but regardless of the genetics there needs to be a trigger to initiate the autoimmune response. Triggering factors can include pathogens, toxic chemicals, diet as well as viral infections.
Oxidative stress from either an inadequate antioxidant defence, or an overproduction of free radicals (reactive oxygen species - ROS), can lead to the collapse of the hair follicle and play a role in Alopecia areata. It is well documented as a cause of hair loss. Oxidative stress can be caused by chronic inflammation, hypoxia (lack of oxygen), infections, physical and psychological stress, trauma, chemical reactions etc. Glutathione is our body's major antioxidant able to assist with neutralising reactive oxygen species (ROS). Therefore it is important to ensure our biochemical pathways are running optimally, to obtain beneficial amounts of glutathione. Homocysteine is a test marker that can help us determine how well our pathways are running.
It has been reported in scientific literature that Alopecia areata may be a dermatological manifestation of COVID-19, with cases most often appearing 1 to 2 months following infection. Additionally, SARS-CoV-2 infection and its inflammatory sequelae have been reported to affect hair, with the most common association being telogen effluvium. The implicated mechanisms include stress of the disease, pro-inflammatory cytokine release, or direct viral damage to the hair follicles. COVID-19 has also been directly associated with the exacerbation of other autoimmune conditions. Additionally, when viral infections are chronic they can sustain long term inflammation that can lead to autoimmunity. It's important to have a thorough understanding of your history of viral infections to determine if this could be part of your hair loss explanation.
Prevention of Hair Loss
Healthy hair growth comes from a good blood flow, with nourishing nutrients with lots of beneficial antioxidants. Suggestions include:
Eat nourishing meals to ensure you are eating a full compliment of vitamins and minerals.
Managing nutrition helps manage our hormones and immune system that may be involved in hair growth and loss.
Good hair and scalp hygiene.
Scalp massages that stimulate blood flow.
Manage your stress levels.
Healthy sleep hygiene with consistent sleep hours (in bed by 10pm), and good length of time sleeping (7-9 hours per night).
Avoid inflammatory substances like smoking, excessive alcohol, poor eating habits, poor hygiene.
Where possible, minimise medication usage that can interfere with cell division.
Have pathology testing performed if you start to see excessive hair loss. There can be conditions that need correcting and early diagnosis is key.
If you would like to discuss your own personal hair loss concerns, and understand potential causations, then please don't hesitate to make a booking with me.
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