Medical reasons for hair loss

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Ayo Otubanjo

There are different types of hair loss and only a proper clinical diagnosis can guide the specialist on the right course of therapy to recommend for effective hair restoration.  A particular type of hair loss (cicatricial alopecia) sometimes seen at our clinics in Nigeria and usually among women can be easily confused with the more common female pattern baldness because of the similarities in appearance.

The term cicatricial alopecia refers to a diverse group of uncommon disorders, which destroys the hair follicles and the associated sebaceous (oil) glands that eventually result in permanent hair loss.

The process may or may not be symptomatic. In some cases, hair loss is gradual with no symptoms and the patient may not even be aware of the hair loss until such time as it becomes more pronounced. In other cases,  the hair loss progresses rapidly with associated itchiness and pain or discomfort on the scalp.

The follicle is destroyed by an inflammation, just below the skin surface, with no visible scar to be seen on the scalp. The scalp becomes smooth and shiny and bereft of hair with little or no sign of any inflammation. Sometimes in less common cases, the inflammation is marked with the patient experiencing redness, scaling and an increased or reduced pigmentation on the scalp.

Despite the limited research carried out on this disorder, it is still not entirely clear what causes the different types of cicatricial alopecia, but we know it involves an inflammation of the upper part of the hair follicle where the stem cells and sebaceous glands are located. We also know that once the stem cells and sebaceous glands are destroyed, there is no possibility of the regeneration of the hair follicle, and this invariably results in hair loss.

Cicatricial alopecia occurs in both sexes and can be experienced at any age, but it is seen mainly in adults and rarely affects children. A specific type of cicatricial alopecia called central centrifugal alopecia is usually experienced by women of African origin.

Anecdotal evidence collected over several years in clinical consultations suggests that hair treatment is a triggering factor in patients. Some of the hair treatments mentioned by patients, who have attended consultations and had cicatricial alopecia diagnosed, include chemical relaxers and glue bonding products.

Most cicatricial alopecias are not contagious and they are generally not associated with any other illness, but can occur in otherwise healthy men and women. The majority of patients have no family history of this particular hair loss type, except those experiencing central centrifugal alopecia.

Visual evidence of cicatricial alopecia is manifested in the absence of any openings of hair follicles on the scalp where the hair fibres would be expected to grow through. However, a proper diagnosis can only be confirmed with a scalp biopsy.

A pull test might also be required to support the diagnosis and help focus the biopsy on the area affected by the disease. A pull test is performed by the doctor pulling a clump of hair around the area where the disease is active.

The results of the pull test are based on the number of hairs removed with each pull and by observing if the hairs contain intact follicles. A positive test would normally yield about five or more hairs. It indicates active inflammation that is damaging and loosening the follicles from the surrounding tissue.

The type of inflammation revealed by the scalp biopsy and the pattern of hair loss helps to determine the type of cicatricial alopecia and the most effective restoration therapy appropriate.

After the disease has been inactive for between one to two years, surgical hair restoration may be useful for restoring hair to the bald areas. However, it is worth noting that cicatricial alopecia may recur even after surgical intervention.

Further information can be found on www.vincihairclinic.com or send emails to [email protected]

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