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15 Hair Loss and Scalp Disorders and Their Treatments

1. Male Pattern Baldness (Androgenetic Alopecia)

Inherited from either parent and typically beginning in the late teens or early twenties, this genetic hairloss is characterised by a gradual thinning of hair around the temples and/or top of the scalp.

In some instances it may lead to total baldness on the top of the scalp. There are now available appreciably more effective treatments for Male Pattern Baldness. These consist of the full strength 5% Minoxidil combined with the Anti-Androgen Medroxyprogesterone Acetate (MPG). In addition Propecia (Finasteride 1mg tablets) is now licensed in the United States of America and is available in this country under medical prescription. This daily tablet markedly slows further loss and in a good number of men encourages growth in those areas where hair is still present.

Hair transplantation has continued to improve over the past 5 years. The use of micro grafts (single hairs) allows the surgeon to produce a completely natural hairline. Larger areas of baldness can be covered with an acceptable density of the patients own growing hair.

2. Female Pattern Hair Loss

Younger women are suffering from an epidemic of thinning hair and hair loss. The primary causes range from stress, improper diet and the greater use of hormonal therapies such as the contraceptive pill and Hormone Replacement Therapy (HRT).

This type of hair loss can usually be stopped or reversed with full strength 5% Minoxidil combined with Medroxyprogesterone Acetate (MPG) lotion.

Ladies are now having Micro Hair Grafts, something not considered ten years ago. Areas of thinning can now be infilled and strengthened using this latest surgical technique.

3. Alopecia Areata

Often triggered through stress, Alopecia Areata is an autoimmune problem. Typically beginning with sharply defined bald areas which can occur to any area of the scalp. In more acute cases all the hair may fall from the scalp (Alopecia Totalis) and all the eyebrows and eyelashes usually disappear. In rare case a complete loss of hair can occur from head to toe (Alopecia Universalis).

While it is normal for the hair to grow back without the need for treatment, this does take some time. To speed up hair regrowth, the following treatments are of benefit i.e. Ray Therapy both UVA and IR to the affected areas, topical stimulant medications such as Dithranol and 5% Minoxidil combined with Tretinoin. The oral intake of L.Tyrosone is also of benefit. Treatments should be carried out by a qualified Registered Trichologist.

4. Folliculitus Decalvans

Another autoimmune problem, this is where hair follicles are destroyed. Patches occur slowly, and inflammation and scaling around the affected hair follicles are typical. Treatments include taking L-Tyrosine and antibiotics.

5. Pseudopelade

Characterised by many slowly developing patches of baldness in which follicles have been destroyed, this is again an autoimmune problem. Treatments are normally not effective but the problem often stops of its own accord.

6. Traction Alopecia

This occurs when the hair has been held under tension by such styles as braids or ponytails, or the individual has slept in rollers. The baldness often takes 2 or 3 years to become apparent and it often occurs around the hairline.

7. Braiding

Hair is held too tightly for too long a time causing structural damage.

8. Trichotillomania

The pulling out of one’s own hair. Characterised by poorly defined areas in which there are many short hairs. Usually occurs in children. Any obvious signs of stress should be dealt with. Sometimes the best strategy is to do nothing in the hope the child will, in time, stop pulling their hair out. Psychotherapy is advised in most cases.

9. Ringworm (Tinea capitis)

A circular patch or patches of hair breakage. Hair stubble within the patch, redness, dilation of the hair follicles and itching of the patch are typical of ringworm on the scalp. The problem is caused by various fungi, usually caught from birds, puppies or kittens, which feed on the keratin of the hair and skin.

Treatment with oral antifungal therapy for about 2 months is usually effective in treating the problem. Hair should recover normally.

Fungal infections of the scalp do not always cause hair breakage. Some may just cause redness, scaling and itching of the scalp.

10. Psoriasis

Psoriasis is characterised by areas of very red skin covered by white scale. The affected skin bleeds easily on scratching and the severity of the patches can fluctuate in some people. Psoriasis can affect any part of the skin but the scalp is a common site. The crease of the ear is often affected and, sometimes, scaly area can be seen in the ears, on the scalp, psoriasis usually stays within the hairline.

Trichologists have seen many cases of Psoriasis that have been triggered by tints or perms. However, such a reaction cannot be predicted.

Treatments aim to control rather than cure Psoriasis. They range from the application of various creams to the use of ultraviolet therapy and taking oral medications for more severe cases. Creams containing tar, salicylic acid, zinc sulphate, anthralin or corticosteroids applied regularly can be of great benefit.

11. Seborrhoeic Dermatitis

Seborrhoeic Dermatitis is characterised by yellow greasy scales, inflammation to the hairline, oiliness and irritation. It appears that the sebum (oil) is acted upon by the yeast pityrosporum ovale (which we all have on the skin) and that the resulting product irritates the skin and causes the itching, scaling and redness.

Seborrhoeic Dermatitis is most commonly located along the frontal hairline but can occur anywhere on the scalp. It often begins at puberty, when the increase in male sex hormones increases sebum production. The sebum of those affected contains proportionally less linoleic acid.

Treatments consist of topical creams containing sulphur, salicylic acid or resorcinol. Trichological treatment is often advisable particularly where there is adherent scale. This can be effectively lifted with sulphur creams/steamers and ray therapy. As with all scaling maladies affecting the scalp, application of medications is more thorough if carried out by someone else. Specialist Trichological shampoos are also required to control this condition.

12. Pityriasis Amiantacca

This is characterised by thick white scale that sticks to the base of the hair. The cause is often stress related and can be seen with Psoriasis suggesting an autoimmune disorder. Treatments involve rehydration of the scalp using either Sulphur/Aqueous cream or Tar/Allantion cream and lotion. Again treatment is more effective if carried out as an intensive programme by a qualified Trichologist.

13. Lichen Simplex

Lichen Simplex, also termed neurodermatitis, is a rare problem characterised by white scale on a red base, normally located in the nape area. Severe itching of the area in question is typical. The problem is a result of excessive scratching and rubbing of the skin, but what initially causes scratching is not known.

Treatments include topical steroid and substances such as camphor to reduce the itching.

14. Contact Dermatitis

Contact Dermatitis is an inflammatory condition of the skin caused by an external substance. Sometimes scaling is associated with the dermatitis.

There are two types of contact dermatitis – irritant dermatitis and allergic dermatitis. Both these types can, on rare occasions, trigger such autoimmune problems as Psoriasis and Alopecia Areata.

Irritant dermatitis affects only the area exposed to the causative agent, whereas allergic dermatitis can occur away from the site of contact. An allergic reaction to a substance occurs on the second exposure to that substance.

15. Dandruff

Dandruff is probably the most common scalp scaling disorder. It is characterised by loose bran like white scales which are visible through the hair. The cause appears to be attributed to scalp yeasts and stress. Treatments are varied and involve the use of Trichologically prescribed medications. The use of some of the commercial shampoos which are abrasive can aggravate this condition. General advice on treatment would again be given by a qualified Registered Trichologist.

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