To achieve my goal of helping black women avoid the devastating disorder, alopecia, this is the third of three posts discussing the subject. I will begin by discussing traction alopecia, which is one of the three most common types of alopecia that I see in my black female patients. I will then go on to briefly discuss other common causes of alopecia.
Traction alopecia is hair loss that occurs as a result of continuous pulling of the hair. Pulling may occur from hairstyles such as tight cornrows, plaits or braids with or without extensions, weaves, ponytails or even hair rollers or curlers. Natural hairstyles can also lead to traction alopecia as well. Long heavy locks and tightly coiled twists can lead to traction alopecia. The hair loss associated with traction alopecia typically occurs at the frontal hairline, at the temples or the area of the scalp above the ears. It may also occur at the posterior hairline.
Many times, the traction causing hairstyles are uncomfortable or painful. You may notice a headache or soreness of the scalp from the tight hairstyle. For several days you may be unable to move your forehead or temples after a tight hairstyle is first done. During the early stage of traction alopecia, red bumps, pus bumps or flaking of the scalp may be seen. You may also notice short broken hairs. If you continue the tight hairstyle the hair loss may be permanent so it is very important to stop the hairstyle as soon as possible and begin treatment.
As we just stated, the mainstay of treatment is discontinuation of the traction producing hairstyle (and never returning to it!). Topical steroid creams or injections can be used to decrease or stop the inflammation as quickly as possible. The hair will most likely re-grow.
Alopecia areata, totalis and universalis.
The hair loss that occurs with alopecia areata usually begins with a smooth, round patch of hair loss. Normal hair surrounds the patch of hair loss. The patches can occur on any location on the scalp. The hair may re-grow without treatment although treatment is often required. For other people, the hair loss may progress to the point that all of the scalp hair is lost, and the condition is then called alopecia totalis. If hair is lost form the entire scalp as well as the entire body, the condition is called alopecia universalis. Another pattern of hair loss, called the ophiasis pattern of alopecia areata, occurs along the anterior and posterior hairline.
Alopecia areata can occur at any age, and there may be a family history of alopecia areata. This condition is considered an autoimmune disease because the cells of the body turn against the hair cells and causes the hair to fall out. People with alopecia areata may have other autoimmune disorders such as thyroid problems, vitiligo, diabetes, anemia or lupus.
Although your dermatologist can usually determine if you have alopecia areata based on an examination of your scalp, sometimes a scalp biopsy is needed. Since alopecia areata may be associated with other autoimmune diseases, your doctor might check blood tests such as a blood count, thyroid, anemia and lupus tests.
The course of alopecia areata is variable. Some patients with a few small patches will have regrowth of hair within one year. Those with extensive disease such as alopecia totalis or alopecia universalis may not have re-growth of hair. Treatment centers primarily on steroid injections or creams. Treatments directed toward the immune system are also utilized.
Telogen Effluvium is hair loss that occurs about three months after a major physical or emotional stress. It most commonly occurs after the birth of a baby or after stopping birth control pills. Remember that there is a 3-month delay, so if you give birth to your baby in October, the hair loss will most likely begin in January. There are other causes of telogen effluvium which include a major illness with or without fever, a major or minor surgery or a major emotional stress such as the loss of a job or a death in the family. When hair loss from telogen effluvium occurs the hair comes out in clumps or handfuls. A sure sign of telogen effluvium is that you will see white balls on the end of the hair that falls out. The good news is that telogen effluvium will stop on its own after three to six months and the hair will re-grow. There is no treatment.
Androgenic alopecia is a hereditary cause of hair loss in which the hair on the top of the scalp slowly thins. Unlike CCCA, the scalp does not have a shiny appearance and you often see the follicular pores. Unlike men, women usually do not go bald from this condition. There are no scalp symptoms. The diagnosis is usually made by a combination of history and examination, although a scalp biopsy is often confirmatory. Treatment centers on the topical medication, minoxidil.
Tinea capitis is a fungal infection of the scalp that may cause hair loss. It is commonly called ringworm. There may be flaking of the scalp, red bumps or pus bumps, sores and pain associated with tinea capitis. Performing a fungal culture in which several strand of hair are removed, place in a jar and sent to the laboratory makes the diagnosis of tinea capitis. Treatment involves taking an oral anti-fungal pill for four to six weeks. The hair usually re-grows once the fungus is treated.
Severe anemia, thyroid disease, and lupus may cause hair loss. These disorders can be identified through simple blood tests. There are medications that can treat each of these diseases, which usually result in re-grown of hair.
Medication induced alopecia occurs frequently in black women because many take medications for high blood pressure, diabetes, and high cholesterol.
In addition to these medications, antidepressants, blood thinners and weight loss medications may also cause hair loss. If you suspect that your medication may be causing hair loss, do not stop the medication but rather discuss your concerns with your doctor. Your doctor may substitute a different medication to treat your medical condition.
Now that you are armed with the knowledge that you need about alopecia, I want to remind you what you should do if you think that you may have hair loss. First, call your dermatologist. If you don't have one, visit the "Find a Doctor" section of the website of the American Academy of Dermatology. Secondly, when you visit your dermatologist, have a list of your medications, allergies, medical conditions and your hair care practices (for example: relaxers for 20 years, hot combs for 10 years, no weaves, braids with extensions for two years and natural styles for the last 5 years). Do not be afraid if your doctor suggests blood tests, a scalp biopsy or culture. These procedures are recommended so that the doctor can determine the type of hair loss that you have and treatment can be started. Do not loose sight of the fact that there is always hope.
This is the third installment of a three part series on hair loss.
Susan C. Taylor, MD