Alopecia in Women

Tumbling tresses, bountiful locks, crowning glory hair is inextricably tied up in a woman’s femininity and for some, alopecia can be seen not just as a loss of hair, but a loss of womanliness as well. Here you’ll find all the information you need about alopecia in women and what you can do to get back what’s rightfully yours.

Alopecia itself is a broad term that covers all hair loss conditions. There are two general categories of alopecia and a few different types:

1. Scarring alopecia where there is damage to the hair follicle:

• Cicatricial alopecia


• Traction alopecia


• Trichotillomania

2. Non-scarring where the hair follicle is normal but the hair growth cycle is abnormal:

• Androgenetic alopecia (also known as female pattern hair loss)


• Telogen effluvium


• Alopecia areata

It can sometimes be difficult to ascertain which type of hair loss you have, which is why it’s always advised that you seek professional advice. Diagnosis is usually a simple and non-invasive activity which takes into account:

• Diet


• Medications


• Past and present medical conditions


• Family history of hair loss


• Duration and pattern of hair loss


• Whether the hair is shed at the root or is breaking off along the shaft


• If the hair itself is thinning or rather there is an increase in the amount of hairs being shed.

The most common types of alopecia are the non-scarring variety.

Androgenetic Alopecia
Many assume that hair loss is something only men have to deal with, but this couldn’t be further from the truth. All women have some of the male hormone testosterone in their bodies, but those with androgenetic alopecia are more sensitive to its bi-product, dihydrotestosterone (DHT) than others. For those with the genetic tendency, the most common form of hair loss in both men and women that affects half of all people by the age of 50 is caused by DHT.

It looks like thinning on the top of the scalp and is in fact the result of shrinking hair follicles rather than excessive shedding. Androgenetic alopecia is most commonly seen after menopause, although it may begin as early as puberty, and it may take some time before you even notice that you’re experiencing some degree of hair loss. The thinning may be mild to moderate and treatment might not be necessary if you’re comfortable with your appearance. However, the follicle could eventually reduce so much in size that it stops producing hair altogether.

The best treatment for androgenetic alopecia is minoxidil, a topical treatment that was approved by the FDA in 1988. It appears to affect the hair follicle by increasing the length of growth time (normally two to seven years), enlarging the actual follicle and increasing circulation to the scalp, thereby delivering essential nutrients to the follicle. The mechanism by which minoxidil effects these changes is not known, but it has proven to increase thickness and reduce shedding.

Telogen Effluvium
Have you ever been through a stressful period and said something like, “Mark my words, I’ll be bald by the end of this!”? Well, you may have been exaggerating but the link between stress and hair loss is not exactly a myth. Usually, about 80% of your hair is growing at any one time and no more than 10% is in a resting stage. Telogen effluvium is brought on by any condition, physical or emotional, that shifts growing hair follicles into a period of rest. These could include:

• Medication (blood pressure medications, chemotherapy, Roaccutane and high doses of vitamin A)


• Diet (rapid weight change, anaemia)


• Hormonal changes (birth control pills, pregnancy, menopause)


• Physical stress (illness, surgery, thyroid condition)

It looks like overall thinning hair and is the result of excessive shedding as the resting follicles eventually let go of the hair. While most women shed up to 100 hairs a day, those with telogen effluvium can lose up to 300 a day. There are three classes of telogen effluvium. Sudden hair loss can occur rapidly after one of the above, or it may be delayed following prolonged stress, or it could be chronic if the underlying cause is ongoing.

Treatment usually centres on addressing the cause and once this is dealt with, normal hair growth usually resumes. However, telogen effluvium can induce androgenetic alopecia if you have the genetic predisposition and in these cases, a combination hair loss treatment program is recommended. The same is advised for chronic telogen effluvium, as well as continuing to address the underlying cause.

Alopecia Areata
Thinning hair is one thing but baldness is not something you’d expect women should have to endure. It’s not known for certain why, but for 2% of the population their immune systems gets confused and attack the hair follicles, causing them to shut down.

In looks like small, smooth bald patches on the scalp but can affect other hair-bearing areas of the body as well. It can occur slowly, rapidly or irregularly and may be the result of an allergic reaction, extreme stress, long term chemical exposure or a viral or bacterial infection. In one out five cases, there is also a genetic link.

In as much as 70% of alopecia areata cases, the hair will grow back on its own within a year. However, because hair loss can be devastating to a woman and stress can aggravate the problem, it’s often advised to seek treatment for the only noticeable symptom. The Belgravia Centre finds a high strength minoxidil the most effective treatment for alopecia areata but other treatments may include steroid injections into the scalp and UV light treatment (although these can have unfavourable side effects).

Cicatricial Alopecia
Cicatricial alopecia is an umbrella term for rare disorders that destroy the hair follicle, replace it with scar tissue, and cause permanent hair loss. These types of scarring alopecia can include frontal fibrosing alopecia, pseudopelade, follicular degeneration syndrome and lupus.

Genetics may play a part in the presence of various types of cicatricial alopecia and they are generally associated with illnesses, but the exact cause of most of them is unknown. And, considering they’re all classified as types if cicatricial alopecia, they can all look quite different and have different symptoms.

It can be confusing because the presence of a scar is not always apparent. Some people may have gradual hair loss without symptoms, and some may experience severe itching, burning and pain with rapid hair loss. The inflammation that destroys the follicle is below the skin surface and there is usually no "scar" seen on the scalp. The scalp may show little sign of inflammation, or have redness, scaling, or a change in skin colour.

With scarring or cicatricial alopecia, the inflammation destroys the stem cells and sebaceous (oil) gland within the hair follicle, meaning there is no possibility for regeneration. Depending on the particular conditions, some hair loss treatments may prevent further hair loss by controlling the inflammation, but generally, the only option for those scarring alopecia is hair replacement systems.

Traction Alopecia
We’re never really serious about it, but there’s probably not one woman who hasn’t had a bad hair day and thought it’d be easier to have no hair at all. While braids, cornrows, buns and ponytails may be a hassle-free maintenance style for the short term, they could lead to that wish eventually coming true.

Traction alopecia is commonly seen in women who wear their hair in a fashion that imparts constant tension on the hair follicles by pulling the hair shaft into a tight style and it can end up looking like bald patches or a receding hairline. Depending on the degree of damage, the condition is usually reversible with a combination hair loss treatment course, which generally includes minoxidil, that aims to provide the follicles with the regenerative nutrients they need and you with the hair care tips and advice you need to maintain hair health and growth.

Trichotillomania
One of the most traumatic experiences a woman could endure in life would be baldness, but some have an uncontrollable urge to pull out their own hair and they hate it. Trichotillomania was originally thought to be psychiatric disorder but it is now understood to be a medical condition. The genetics and biological components are not yet known and while there are hair loss treatments that can help the hair that’s been pulled out to re-grow, there is no cure for the relentless pulling behaviour. Some doctors think a combination of anti-depressants and behaviour modification techniques could help but many turn to groups for support. There are a few trichotillomania support groups around but the effectiveness of them is dependent on the individual.

More Information:
If you would like to consult a hair loss and scalp care specialists, please call to arrange a free appointment on 020 7730 6666, or you could send an email for more information. If you are concerned about thinning or hair loss and you are unable to visit The Belgravia Centre, feel free to fill in the online diagnostic form and one of our advisors will contact you shortly to discuss your condition and treatment options.

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