Alopecia: Understanding hair loss

The medical term for general hair loss is alopecia. There are different types of alopecias with their own causes and symptoms. All forms of alopecia can be divided into one of two categories, it is either a temporary, or non-scarring (non-cicatricial) form of alopecia, which can be reversed with topical and oral medications, or permanent scarring alopecia (cicatricial). The most common forms of temporary hair loss include telogen effluvium, alopecia areata and androgenic hair loss, which is commonly known as female and male patterned hair loss (typically experienced later in life). Considering there are so many forms of alopecia, it is necessary to specify which condition you are referring to when delving into what the condition is.

Alopecia areata

Alopecia areata is a non-scarring type of hair loss that is experienced in coin-sized sections of the scalp, beard, eyebrows, limbs or other areas. Alopecia areata can come at various times, recovering and reappearing without warning. The prognosis is uncertain and depends on the severity of the condition and the extent of the hair loss. Regrowth in instances where more than half the hair was lost have less promising outcomes, generally. The first appearance of new hair is white for some people. This often returns to normal over time. Related to this form of hair loss is also alopecia universalis – full body hair loss – and alopecia totalis, which means it affects the entire scalp.

What causes alopecia areata?

This form of hair loss is associated with inflammation, the exact cause of the inflammation and its link to hair loss has not been discovered by the medical industry as yet. It is suspected that the high levels of inflammation are linked to an overactive immune system, meaning the body’s defence mechanism is attacking itself, in this case, it is attacking the hair. Why it presents in certain areas and not others, and the reason for its (at times) spontaneous recovery is not understood. The theoretical connection between alopecia areata and an overactive immune system does potentially place you at a marginally higher risk of developing other autoimmune conditions, like diabetes, eczema, vitiligo, etc. While it is not a great risk, any new symptoms experienced alongside the loss of hair should be discussed with your doctor to rule out other health issues.

Alopecia areata is not contagious, has not been linked to any vitamin or mineral deficiencies or dietary trends. There is a connection between stress and alopecia, although this connection is not confirmed. Alopecia areata is thought to be hereditary, around 20% of those with the condition report having it in the family.

What are the symptoms of alopecia areata?

The symptoms of alopecia areata include patches of thinning hair and a tingling sensation on the scalp. If the hair loss is occurring in other areas, like the eyelashes, the eyes may become irritated or sore in windy conditions as they lack the shelter eyelashes provide.

How is alopecia areata treated?

This condition can not be cured. As mentioned before, the extent to which recovery is possible depends on the severity of the hair loss. Alopecia areata can be treated to encourage the growth of new hairs, but curing the disease itself is not possible.

Steroid creams and application – Dr. Khoza may decide to prescribe a topical application which is usually used twice daily. It is applied directly to the areas of the scalp that are affected.

Steroid injections – These have been found to be very effective in cases where small patches are affected. An injection to the scalp or brow is done monthly, sometimes at 6-week intervals, until new hair growth is observed.

Steroid tablets – We don’t make use of this treatment often. As with all medical treatments, it is important to weigh up the possibility of side effects versus the effects of the condition that is being treated. Alopecia is not a danger to the body in any way, other than the psychological impact it may have. Steroid tablets do help with encouraging the regrowth of hair, but the condition often recurs when treatment is stopped. Long-term use of the tablets can result in other undesirable side effects.

Ultraviolet light treatment (PUVA) – As mentioned, it is important to assess the risk of the treatment before starting it. This treatment involves giving the patient a tablet to enhance the skin’s sensitivity to light. Ultraviolet light is then used to stimulate hair growth. This treatment may become ineffective when it is stopped. It also carries the risk of causing skin cancers.

Immunosuppressant tablets – this treatment is only recommended for patients who have exhausted their other treatment options. It is sometimes effective, but this is experienced on a case-by-case basis.

Who gets hair loss?

Some forms of alopecia, like alopecia areata and telogen effluvium can occur to anyone at almost any age. Other forms of areata, like androgenetic hair loss tends to happen to people older than 40 or 50 years of age, although male pattern hair loss can occur at any point after puberty. A genetic predisposition certainly plays an important role. Proper hair care can prevent hair loss as some forms of alopecia are linked to tight hairstyles, like braids and weaves.

Hair loss and scalp disorders with Dr. Nokubonga Khoza.

Our hair loss and scalp disorders consultation take about 20-30 minutes. Only conditions relating to the scalp will be discussed during this session. All patients are expected to fill out a pre-assessment form on arrival to the practice. There are many causes of hair loss and scalp disorders and surprisingly they can look similar. Dr. Khoza’s primary goal is to provide the highest level of care when it comes to skin and scalp disorders. Our hair consults focus is on proper diagnosis, non-surgical management, counselling and preventing further disease progression.

During the consultation, Dr. Khoza will review the patients past medical history, medication, hair grooming practices, and styling. She will examine the scalp with the use of dermoscopy and take relevant pictures. Should there be a need; Dr. Khoza may order blood tests, take hair samples and perform a scalp biopsy. Dr Khoza performs the following in-office procedures for hair loss; Platelet rich plasma, micro-needling and intralesional injections.

Please note all procedures are scheduled for a separate appointment and are not performed on the same day as the initial consultation.

Estimated time for procedures:

1. Scalp biopsy – 20 minutes
2. Intralesional scalp injections – 10 minutes
3. Micro-needling – 30 minutes
4. Platelet Rich Plasma – 1hour

How to prepare for your consultation with Dr. Khoza for alopecia

1. Take careful note of your symptoms. It is important to give Dr. Khoza an accurate description of what you have been experiencing. Has the hair been falling out gradually? Has it been only in certain patches, or has it been a constant and ongoing “loss” from all over the scalp?
2. Think of any changes in your life that may coincide with the hair loss. Have you been taking a new medication, or have you stopped using a medication? Have you changed your level of physical activity? Have you gone through any major stresses, changed your diet, started or stopped taking any vitamins, or used a new hair or skin product, like shampoo?
3. Be prepared for questions. Dr. Khoza will also want to know if hair loss runs in your family, and if so, at what age did your relatives experience hair loss for the first time?
4. Dr. Khoza will examine your scalp during the consultation. Sebum, or oil, can sometimes play an important role in hair loss, so it may be advised to avoid washing your hair for a day or two prior to the appointment.
5. Bring a list of medications used in the last two years.
6. Bring latest bloods if you have done any in the last six months.
7. It always helps to bring all current hair and scalp products.
8. Bring old photos up to 5 years prior if possible.
9. Keep a positive outlook.