What is hair and scalp disease?

Hair loss may refer to baldness, excessive shedding or both. Balding affects men and women and can be extensive or localised. Chemotherapy taken during cancer treatment can result in hair loss. The hair usually grows back after the chemotherapy treatment has been completed. Increased hair growth can be due to hormonal factors (hirsutism) or non-hormonal (hypertrichosis). Scalp disorders may or may not be associated with experiencing hair loss.

What skin diseases affect the scalp?

Skin diseases affecting the scalp may not cause any hair loss, but when they do it can be very severe.

The most common conditions affecting the scalp are:

  • Dandruff (pityriasis capitis)
  • Seborrhoeadermatitis
  • Psoriasis
  • Pityriasis amiantacea
  • Head lice
  • Lichen simplex
  • Folliculitis

What are the different types of hair disorders?

The 4 broad categories of hair loss include:

  • Hair loss (alopecia)
  • Excess hair (hirsutism)
  • Hair infections
  • Hair shaft disorders

1 Hair loss (alopecia)

Hair is in a constant cycle of growth, rest and renewal. It is natural for the average person to lose as many as 100 hairs per day. Excessive hair loss (also known as alopecia) affects men and women. It can patchy or widespread and may be caused by genetic conditions, disorders or diseases.

Alopecia can affect both men and women and is more commonly known as male pattern baldness or female pattern baldness. Different types of alopecia include:

  • Androgenic alopecia
  • Alopecia Areata
  • Alopecia Totalis
  • Alopecia Universalis
  • Traction alopecia

Androgenic alopecia develops because of:

  • A genetic predisposition,
  • The ageing process, and
  • The presence of hormones and corresponding receptors.

Hair loss and baldness in men occurs because the male sex hormone DHT triggers hair follicles to shrink over time (follicular miniaturization). This process stops new hair from growing. Men will typically experience hair loss at the crown and hairline, which extends around the back and side of the head, creating a horseshoe hair shape.

The same sex hormone (DHT) that triggers male pattern baldness will also activate female pattern baldness. Women experiencing hair loss usually have a scattered thinning over the top of the scalp instead of a bald spot. They usually maintain their hairline.

Androgenic alopecia develops because of an autoimmune condition. With an unknown cause it results in patchy hair loss on the scalp. The hair will generally grow back without treatment because it is associated with autoimmune dysfunction.

Alopecia Totalis develops because of an autoimmune condition with an unknown cause. It leads to a loss of hair on the scalp.

Alopecia Universalis is an autoimmune condition with an unknown cause that leads to a loss of hair on the scalp and body.

Scarring alopecia occurs when inflammation of the hair root stops hair from being produced. Because hair follicles are killed off, the hair loss will be permanent.

2 Excess hair (hirsutism)

Hirsutism in women is characterised by the growth of thick, dark hair in typically ‘male’ areas of the body including the back, chest and face. A common cause of this is polycystic ovarian syndrome (PCOS). In some cases, there may be a genetic reason behind developing PCOS. For other women, excess hair only occurs when they are overweight.

3 Hair infections

Hair infections are usually contagious and usually result in hair loss. Types of hair infections include:

  • Demodex folliculorum infection: this parasite lives in the follicles of your scalp and face. A severe infection can cause irritation and inflammation.
  • Folliculitis: depending on the severity and duration of this bacterial infection of the hair follicles, temporary or permanent hair loss can occur.
  • Piedra: this fungal disease causes hard nodules to form along the hair shaft resulting in hair snapping off at the nodules.
  • Ringworm: this fungal infection of the scalp typically starts as a small circle of red, itchy and scaly skin. As the ring grows, the hairs close to the scalp within its circumference snap off.

4 Hair shaft disorders

Hair shaft disorders are a result of inheriting faulty genes. This results in either unmanageable hair or hair loss. Types of hair shaft disorders include:

  • Marie Unna hypotrichosis: this occurs when a child is born without scalp hair. They will grow coarse hair until pre-puberty until the hair falls out.
  • Menkes syndrome: an inability to properly metabolise copper causes a range of problems including brittle and unpigmented hair.
  • Monilethrix: usually only affecting the scalp, the nodules cause hair breakages.
  • Pili torti: this condition causes patches of hair loss and hair stubble.
  • Trichorrhexis invaginata: this hair disorder is also known as ‘bamboo hair’ where the hair shaft has abnormal nodules. Breakages of the hair occur at these weak points.
  • Trichorrhexis nodosa: a condition where the cortex frays, splits and weakens the hair, which causes it to split and break off.
  • Trichothiodystrophy: this hair disorder occurs when the hair shaft is brittle because of insufficient elements and proteins including sulphur and cystine.
  • Uncombable hair syndrome: people with this hair disorder typically have silvery-blonde hair that is slow to grow, dry and unusually stiff.
  • Woolly hair: this hair disorder appears in people with a non-African descent who have frizzy and tightly curled hair.

Hair loss treatments

Even though there is no cure for hair loss, a number of treatments can reduce or slow the rate of hair loss. They can also stimulate partial regrowth or replace damaged hair. Men with advance balding find that surgical hair transplantation is beneficial.

It’s important to note that age-related hair loss and hereditary forms of hair loss are hard to reverse. Hair loss treatments for alopecia areata or hair thinning can help stabilises hair loss so baldness can be avoided.

Cosmetic hair loss and alternative treatment options include:

  • Wigs and hair pieces,
  • Massage,
  • Vitamin supplements,
  • Herbal remedies like saw palmetto,
  • Zinc,
  • Amino acids,
  • Hair lotions and
  • Tonics.

It’s important to note that none of the above treatments have been scientifically shown to prevent hair loss or promote hair growth. The use of laser therapy to prevent hair loss has no scientific evidence either. Consulting with your doctor or dermatologist before starting any hair loss treatment is the best course of action.

Hair loss tablets include:

Finasteride:

Since the late 1990’s, Finasteride (Propecia) has helped stop hair loss in over 90% of men. This prescription tablet is taken once a day and has stimulated hair regrowth in over two-thirds of men who have taken it. While regrowth is visible at 6 months, it can take 2 years for visible results. It’s important to note this is only suitable for men.

Spironolactone:

Developed in the 1960’s this prescription medication is effective for women with hair loss as it blocks the effect of androgen hormones. These hormones lead to acne, oily skin, unwanted facial and body hair and hair loss on the scalp. This hair loss medication isn’t suitable for men, pregnant or breastfeeding women.

Cyproterone acetate:

Developed in the 1960’s this prescription medication will block the effect of androgen hormones. As a weak progesterone it’s also used in some oral contraceptives. Cyproterone acetate is effective at treating acne, unwanted body and facial hair and hereditary hair loss in women. This oral hair loss treatment is not suitable for men.

Hair loss lotions include:

Minoxidil

This over the counter lotion is available at pharmacies and has been used for hair loss treatment since the 1970’s. Minoxidil (Rogaine) comes in drops or a foam preparation that needs to be applied in the morning and at night. It’s important to note that hair regrowth can take six months to appear. This lotion is not suitable to use if you’re on high blood pressure medication, are pregnant or breastfeeding.

Hair transplantation surgery

Hair transplantation surgery uses techniques that include micro-grafts, follicular unit transfer, and single unit transfers on patients who want a fuller, thicker head of hair. These hair transplantation techniques produce a much more natural appearance than older techniques of plug grafting. For optimal hair loss, multiple techniques can be used.

Find out more about hair transplantation surgery options here.

The best way to treat your hair loss and scalp disease in Melbourne

Hair loss and scalp disease can be treated. To book a consultation with our specialist dermatologists contact us here