Causes of Female Hair Loss with treatments and solutions for Alopecia Areata

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Localized Hair Loss

The following article discusses the causes of female hair loss where the alopecia is not diffuse but rather localized and patchy.

Localized hair loss in women can be sub-divided into scarring and non-scarring types:

Alopecia Areata
Alopecia Areata is a genetic, auto-immune disease that typifies the non-scarring type of hair loss. Alopecia areata (AA) is perhaps the second or third most common cause of female hair loss that is seen in a dermatology clinic after Androgenetic Alopecia and Telogen Effluvium. The life time risk for experiencing AA is nearly 2%. That is, 2 in every 100 people will have AA at some point in their lives. Alopecia areata is not only a cause for female hair loss, the disease alopecia areata also affects men and children.

Alopecia Areata manifests itself with the sudden onset of round patches of hair. It can develop in a matter of a few days anywhere on the scalp. Unlike some other hair loss diseases, the hair follicle is not destroyed and is able to grow after the inflammation at the root of the hair follicles subsides. However, in about 30% of individuals AA becomes more extensive and goes through many cycles of hair loss and re-growth.

When the hair loss spreads to cover the entire scalp it is called “alopecia totalis” and when the AA spreads over the entire body, affecting, scalp, eyebrows, lashes, beard, pubic hair, and everything else, then the condition is called “alopecia universalis”.

Hair Loss Restoration Treatment
In alopecia areata only growing hair follicles come under attack. Resting follicles allegedly escape destruction by immune cells. So by truncating the growth phase, total destruction of hair follicles can be avoided. This survival of the hair follicles despite the onslaught of the inflammatory cells, means treatment can be successful even after many years of persistent alopecia areata.

Thought not approved by FDA, the topical corticosteroids or a combination therapy using minoxidil and anthralin are the best available options for the treatment. The management of alopecia areta also takes into consideration many factors such as the age and the extent of the disease.

For more patients with more than 50% hair loss or rapidly advancing disease, cosmetic aids, scalp prostheses and other camouflage techniques can also be tried.

Scarring Alopecia
Scarring alopecia can be caused by a variety of medical or dermatologic conditions such as lupus and lichen planus, or local radiation therapy. Baldness from injuries, or from local medical problems that have been cured, are the probable reasons for scarring alopecia. Most forms of scarring alopecia first occur as small patches of hair loss that may grow with time. In some cases the hair loss is gradual, without symptoms, and may go unnoticed for a long time. In other instances it is rapidly progressive and is associated with severe itching, burning and pain. The alopecia patches usually look a little different from alopecia areata in that the edges of the bald patches look more “ragged”. Since the destruction of the hair follicle occurs below the skin surface, the affected areas of the scalp are mostly smooth and clean, but in few cases there can be redness, scaling, increased or decreased pigmentation or pustules at the affected area.

These visual indicators may help with diagnosis, but it is difficult to diagnose a scarring alopecia. Often when scarring alopecia is suspected, one or more skin biopsies are done to confirm the diagnosis and to find out the particular form of scarring alopecia that is involved. A pathologist or dermatologist will look for destruction of the hair follicles, scar tissue deep in the skin, and the presence and location of inflammation around hair follicles. However, sometimes a biopsy from a scarring alopecia affected individual can show very little inflammation when the disease is in the “burnt out” stage. The bald patches stop expanding and any itching, burning or pain goes away. Sometimes hair follicles, at least those at the periphery of a bald patch, are not completely destroyed and they can re-grow.

Hair Loss Restoration Treatment
Scarring alopecia can involve a lot of damage and permanent hair loss. For this reason treatment of scarring alopecia is usually quite aggressive. The nature of treatment varies depending on the particular diagnosis. Scarring alopecias caused by lymphocyte inflammation are generally treated with corticosteroids applied as topical creams or by their injection into the affected skin. In addition, antimalarial and isotretinoin drugs may be used. The scarring alopecias caused by inflammation comprised of neutrophils or a mixture of cells is typically treated with antibiotics and isotretinoin.

Drugs like methotrexate, tacrolimus, cyclosporin and even thalidomide have been used experimentally to treat some forms of scarring alopecia. Once a scarring alopecia has reached the burnt out stage and there has been no more hair loss for a few years, small bald areas can be surgically removed. Hair Transplant Surgery is another hair loss treatment option available for bigger patches of bald scalp.


Infection as Cause of Hair Loss

Ringworm
The disease is caused by the fungus getting into the hair fiber and making them brittle to break off easily leaving a bald patch of skin. The affected areas are in form of scaly patches that are often itchy, red and inflamed, that may blister and ooze. The patches are usually redder around the outside with a more normal skin tone in the center.


Hair Loss Restoration Treatment
Treatment with Griseofulvin is the most common treatment approach for ringworm. The Griseofulvin blocks the fungus from infecting the keratin. More recently some fungi that cause tinea capitis have been showing some resistance to the drug Griseofulvin. As an alternative to Griseofulvin, newer anti-fungal drugs like Terbinafine, Itraconazole, and Fluconazole can also be prescribed as a hair loss restoration treatment

Folliculitis
Folliculitis is a term for focal inflammation of hair follicles. It looks like acne with little rings of inflammation surrounding the opening of a hair follicle. In the early stages of a folliculitis the hair fiber may still be present in the middle of the folliculitis, but as the folliculitis progresses the hair often falls out. It is also possible to have viral, fungal, or yeast induced folliculitis.

Hair Loss Restoration Treatment
Non-prescription topical antibiotics like bacitracin, mycitracin, or neomycin are used as hair loss restoration treatment options for minor folliculitis. For more serious infections, oral antibiotics such as erythromycin can be used. Hair loss restoration treatment with griseofulvin is also possible if the infection is fungal in nature.

Piedra
Piedra (Trichomycosis Nodularis) is a condition where the hair fibers are infected by a fungus. The visible indicator of a piedra infection is development of hard nodules on hair fibers.

Hair loss restoration treatment generally involves shaving off affected areas or a topical application of salycylic acid or formaldehyde. White piedra is resistant to azole based antifungals, but this category of hair loss restoration treatment is used for black piedra. Oral hair loss restoration treatment with either ketoconazole or terbinafine is also available.

Seborrheic Dermatitis
Seborrheic dermatitis is not an infectious disease, but it can involve infection. Seborrheic dermatitis is a skin disease, but it can also involve temporary hair loss if the dermatitis is located on the scalp or other terminal-haired skin areas. The condition worsens when the excess, rich sebum production in seborrheic dermatitis triggers the proliferation of skin flora. This excessive yeast proliferation causes more irritation and inflammation and can affect hair follicles in the vicinity and cause diffuse hair loss.


Hair Loss Restoration Treatment

The disease can be treated with medicated shampoos. A corticosteroid cream or lotion is also used as hair loss restoration treatment for controlling the immune response. As it is a persistent disease, preventative treatment is useful even when the symptoms are gone.