Hair Loss

By Hannah Missen

We have all probably noticed our hair falling out at some point. For most of us, this means seeing some on our hairbrush or in the plughole after washing our hair and is nothing to worry about. However, less commonly hair loss can be a sign of an underlying medical condition.

How do hairs grow?

In order to understand why we might have hair loss, let’s first understand how hair grows. Hair grows on most parts of our body, except the palms of our hands, soles of our feet, or eyelids.

There are 3 layers to each hair; the medulla, cortex and cuticle, which are mainly made up of the protein keratin.

Hair follicles develop when we are a foetus. This is a really long time when we think about how long we live for, so it is inevitable that we will notice some degree of hair loss in later life, and this can happen to men or women.

A hair shaft grows within a follicle at a rate of around 1cm per month. Hair growth happens in a cycle, but not all of our hairs are in the same part of the cycle at the same time; they are not synchronised.

The three main phases of the hair cycle are:

Before we start talking about hair loss, it’s important to appreciate that some hair loss is totally normal. Hairs in the telogen phase will naturally fall out and this is normal. Secondly, most hair loss doesn’t need treatment as it’s caused by something temporary and will grow back, or it’s just part of getting older. I will talk about treatments for some of the conditions we go on to talk about, but if you are in any doubt about the diagnosis you should first see your GP who can listen to your description of the problem and have a look at your hair and scalp.

Anagen Hair Loss

This is when hair in the anagen phase is broken off, or when it tapers. Tapered hairs are long, but get very thin before they go into the scalp.

Short androgen syndrome is normally first seen in childhood, and is when the anagen phase of scalp hair is shorter (1-2 years, rather than 4-7). The hair itself looks completely normal, it’s just short. Most children grow out of this condition.

Shedding of hair in the anagen phase is normally sudden, and is known as anagen effluvium. It has many potential causes including:

Autoimmune disease

This includes alopecia areata. Alopecia areata is the total loss of hair, normally in patches, where the hair follicles are preserved. This is a chronic inflammatory condition. The cause is not known but is thought to be genetic in some cases, or in others a response to stress or caused by autoimmune reactions (where the body can’t tell the difference between its own cells and foreign cells, and mistakenly attacks its own cells). Hair may be missing entirely, or some short hairs with tapering at the scalp might be seen. Normally no treatment is required, and hair growth starts again within a year. Sometimes steroid creams might be used, or you might be referred to a dermatologist.

Medication, including chemotherapy. Some types of chemotherapy cause you to lose all hair from your body, but others might lead to partial loss or thinning. Your oncologist should be able to advise you of what to expect. A cold cap is a type of hat that is worn 15 minutes before chemotherapy to reduce blood flow to the scalp. This reduces the amount of chemotherapy delivered to this area, to try to reduce hair loss.

Genetic conditions. Loose anagen syndrome is an inherited condition that can cause hair loss. It results in short, brittle hair as the hair shaft gets easily detached from the follicle. It is normally first noticed in young girls.

Telogen Hair Loss

Excessive shedding caused by more hairs than expected moving into the telogen phase is called telogen effluvium. This tends to occur 2-6 months after an event that stops natural hair growth. Triggers might include pregnancy, weight loss, stressful events, surgery, or certain medications. Some medications that might cause this include contraception, anticoagulants or anti-epileptic medications. If you are worried that a medication could be having hair loss as a side effect, visit your pharmacist. Sometimes, no trigger is identified. Scalp hair continues to grow, but might be shorter than expected. Normally, no treatment is needed and hair starts to grow again after the telogen phase.

Pattern Hair Loss

50% of people can have this by age 50. In men the distribution tends to be the top and sides of the scalp, and for women at the front of the scalp. It is influenced by genetics and male hormones.
Hair loss tends to progress over time, but how quickly and markedly this happens varies greatly from person to person. Normally no treatment is required, but there are some drug treatments that can be tried.

For male pattern hair loss, the following can be tried:

– Minoxidil 5% solution (for men aged 18-65 years) is not available to prescribe on the NHS, but can be purchased over the counter.
– Minoxidil 5% cutaneous foam (for men aged 18-49 years) can be prescribed or purchased over the counter.
– Finasteride 1mg tablets are not available to prescribe on the NHS but can be prescribed on a private prescription.
Results are variable, and it can take 4-6 months before benefits can be seen. Any benefit is normally lost 6-12 months after stopping.

For female pattern hair loss, the following can be tried:

– Minoxidil 2% topical solution (for women aged 18-65 years) is not available to prescribe on the NHS, but can be purchased over the counter.
– Minoxidil 5% foam can be prescribed or purchased over the counter.
Again, results can be variable and it can take 4-6 months to see the benefits. Any benefit is normally lost 3-6 months after stopping, and the rebound shedding can be severe.

Hair Shaft Abnormalities

These can be inherited, or caused by trauma. Things like excessive pulling, heat or certain chemicals can damage the shaft of hair itself.

Skin or Systemic Disease

Some dermatological conditions can cause thinning of hair, hair loss or poor quality hair. These might include psoriasis, infections, erythroderma, and many more. Normally by treating the underlying condition, the hair growth can recover.

Other things might trigger hair loss, such as iron deficiency, underactive thyroid, lupus, syphilis plus others.

You should see your GP if you have sudden hair loss, you develop bald patches, you lose hair in clumps, your scalp itches or burns, or if you’re worried about your hair loss. Hopefully, this article has given you some reassurance about your hair loss, and ideas as to why you might be suffering this symptom. It can be a very emotive topic, and it’s important to consider the emotional impact it is having on you, as well as the physical ones. Remember there are also aesthetic options to deal with hair loss, such as hairpieces and wigs and the use of hairstyling, colouring, and hairsprays. Hair transplants are also available privately.

Some good resources for further information include:
www.nhs.uk/conditions/hair-loss
www.alopecia.org.uk
www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/hair-loss
www.nhs.uk/nhs-services/help-with-health-costs/wigs-and-fabric-supports-on-the-nhs/