Losing hair

Losing hair is a worrying prospect to many people, especially since it is a common problem. Although it is often associated with older men, hair loss (alopecia) can begin at any time of life and affect both sexes. There are a number of types of hair loss and various causes, but all can result in a significant impact on self-esteem. Luckily, there are treatment options available…

Types of hair loss
Humans have over 5 million hair follicles, with 100,000 of these on the scalp. While loss of scalp hair is the most common cause of concern, people can also experience hair loss in other places such as their eyebrows, eyelashes, beards, sideburns and moustaches.

Hair loss on the scalp can be either patterned or un-patterned:
1. Patterned alopecia is the most common form, manifesting as male pattern hair loss (MPHL or androgenetic alopecia), which usually takes the form of a receding hairline or thinning mid scalp and crown, and female pattern hair loss (FPHL), which usually involves thinning of the central part of the scalp behind the hairline.

2. Un-patterned alopecia is be further categorised into scarring and non-scarring:

1. Scarring alopecia, as the name suggests, is the loss of hair that is accompanied by scarring. It may be due to:
• Trauma, burns or surgery
• Inflammatory dermatological conditions, e.g. lichen planopilaris (LPP), central centrifugal cicatricial alopecia (CCCA), fontal fibrosing alopecia (FFA)
• Infection

2. Non-scarring alopecias are not associated with scarring and may be due to:
• Side-effects of medication
• Trichotillomania (compulsive hair pulling)
• Telogen effluvium (after an illness)
• Traction alopecia (from chronic use of tight hairstyles, braids or weaves)
• Anagen effluvium (after radiotherapy or chemotherapy)
• Hair shaft abnormalities (such as trichorrhexis nodosa)
• Nutritional deficiencies (such as iron, zinc and Vitamin D)
• Metabolic disorders (such as diabetes, thyroid disease)


Treating hair loss
There are a number of options for managing hair loss. Some people prefer to use prosthetics to simulate a normal appearance, such as false eyelashes or wigs, while others use makeup and camouflage techniques. However these must all be removed from time to time. There are more permanent solutions, both surgical and non-surgical:


Non-surgical treatments:
Medication – very few medications are approved for hair loss treatment, and only two of these are approved for treating MPHL (minoxidil and finasteride). Bimatoprost has been used to strengthen eyelashes and eyebrows.
Micro-pigmentation – typically used for eyebrow restoration, this is also an option for simulating the appearance of stubble on a shaved head, with the possibility of giving a more youthful hairline.


Surgical treatments (hair transplantation):
Hairs naturally grow in follicular units, which can consist of 1-4 hairs per unit. Hair transplantation takes advantage of this to create a natural appearance. The technique involves placing single hairs around the hairline, double hair grafts behind these, and triple or quadruple hair grafts further back to maximise hair density. The hairs are usually taken from elsewhere on the scalp, but can also be taken from the beard or chest.