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Hair Disorders

Anagen hairs grow for a period of five years before entering telogen. Telogen is the resting stage which lasts 2_5 months, after which the hairs are shed.

Normally, about 85% of the hairs are in anagen and 15% are in telogen. Under certain circumstances, however, many anagen hairs are prematurely pushed into telogen and at the end of five months (sometimes less), these hairs are all shed. Such a condition is known as telogen effluvium (effluvium in Latin means to flow out). In this condition, between 30 and 50% of the hairs are in telogen and these can be lost over a matter of a few days. Hair loss occurs in handfuls and can be very alarming. There are several causes of telogen effluvium:

. Prolonged high fever (ie., typhoid, malaria)
. Post-delivery
. Surgery
. Haemorrhage
. Crash diet
. Emotional crises (Le., bereavement)
. Drugs, including birth control pills

Patients with telogen effluvium usually complain of sudden and excessive hair loss to begin with. Thinning becomes obvious when 40_50% of hair in one area are lost. This is different from patients with male pattern baldness who complain of gradual thinning, and those with alopecia areata who complain of the sudden onset of a few bald patches.

Telogen effluvium is a temporary form of hair loss. After the stimulus has passed off or is removed, hair will re-grow. Full recovery may take six months.

Karen, 32, started losing large quantities of hair about two months after delivering her second child. Examination confirmed that she suffered from telogen effluvium related to childbirth. I reassured Karen that the hair loss was temporary and recommended that she wear a wig until her hair regrew.

I saw Karen again three months and then six months later. On the latter occasion, all her hair had regrown and she was able to do without her wig.

Hair breakage is different from true hair loss, in which the hair is lost together with its root.
Hair breakage may be caused by:

Improper hair care. Excessive bleaching, permanent waving, hot combing, hair ironing and straightening can weaken hair and cause it to break easily.

Hairstyles. Ponytails, tight braids, corn rows, buns and curling the hair excessively tight may pull them out by the roots and cause traction alopecia. If the hairstyle is continued, permanent hair loss may occur.

Ringworm of the scalp (tinea capitis) produces bald patches with broken, off hair stumps. The underlying skin is usually red and scaly and the hairs can be easily pulled out (Fig. 7).

Structural defects of the hair. Many of these are inherited and appear during early childhood. Monolethrix (beaded hair) and pili torti (twisted hair) are just two examples. In these conditions, hairs break off a few centimeters from the scalp surface.

Trichotillomania . This causes patches of broken hairs with stubbled ends. It usually affects children and women and is due to underlying emotional stress. In adults, trichotillomania is often caused by severe psychological problems; help from a psychiatrist may be necessary. In children, helping them gain some insight into the cause of hair loss and reassurance is all that is necessary. Permanent hair loss may develop if the hair, pulling habit is continued.

This is a common problem in people who keep very long hair. Split ends are harmless. Conditioners help, but the best way to deal with them is to cut the split ends off.

This is a common condition affecting areas of the skin rich in sebaceous (oil) glands, namely the face and scalp and, to a lesser extent, the upper chest and back.

Ordinarily, seborrhoeic dermatitis just causes flaking of the scalp, or dandruff. Sometimes, it is more extensive and spreads to the eyebrows, the folds on the sides of the nose, behind the ears, the upper chest and the back.

There may be associated itching. Its exact cause is unknown, but there is increasing evidence now that it is in some way related to an overgrowth of a normal skin fungus, pityrosporon yeast.

Dandruff can be controlled with medicated shampoos, like those with zinc pyrithione, salicylic acid, tar or selenium sulphide. These are over the counter (OTC) products which can be bought off the pharmacy shelf.
More stubborn cases require the application of steroid creams, gels or lotions which have to be prescribed by the doctor. Anti-fungal shampoos such as ketoconazole and econazole shampoos have recently been introduced into the market. They are more effective than conventional medicated shampoos but rather expensive. Their effectiveness support a fungal cause of dandruff.

Dandruff is not contagious. You cannot 'catch dandruff from others and neither will you spread it to them. Dandruff is quite common and can be found coincidentally in people with hair loss. It does not cause hair loss. However, it can cause scalp itchiness and vigorous scratching may aggravate the hair loss. Treatment is, therefore, important.

This is a chronic skin disorder which causes well-defined red patches covered by thick, adherent, silvery scales. It may affect any part of the skin, particularly the scalp, elbows and knees.

On the scalp, the scales may get very thick and stick to the hair. However, alopecia is unusual unless complicated by bacterial infection.

In psoriasis, the skin cells divide about seven times faster than normal. They do not have time to mature properly and are more sticky than normal. As a result, they stick to one another, forming heaps of scales characteristic of psoriasis. Its cause is unknown, but heredity plays an important role. It is not contagious.
There is no cure for psoriasis, but it can be controlled. Scalp psoriasis can be treated with tar or salicylic acid containing shampoos, steroid or tar lotions and gels, and dithranol preparations (these are derived from tar).
PUVA is useful for treating psoriasis involving a large part of the body. The patient takes a light-sensitizing medicine psoralen and is exposed for a few minutes to ultraviolet-A light about two hours later. This treatment is repeated two to five times a week at the clinic.

Twenty to 25 treatments are necessary before there is clearance or marked improvement. PUV A has also been used to treat alopecia areata.

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