Glossary of Terms
An autoimmune cause of hair loss which occurs when the body attacks its own hair follicles. It usually results in round patches of hair loss but can sometimes be more patchy or very rarely result in loss of all hair. Milder cases can usually be managed by steroid injections into the affected area. The reason why Alopecia Areata occurs is not known.
This refers to hair loss arising as a result of alterations in the hair cycle, meaning that more hairs than usual are in the “telogen” or shedding phase. It is normal to shed up to 100 hairs per day, but this figure can increase as a result of a number of conditions, most commonly low iron, poor scalp health, stress and weight changes.
The hair cycle refers to the cycle of growth, rest and finally shedding which affects all hairs. The length of the cycle varies according to age, time of year and genetic disposition., but usually last 2-3 years for each scalp hair. In a healthy scalp about 90% of hairs are in active growth phase, so called “anagen”phase and up to 8% or so are in the shedding or “telogen “ phase.
Pattern Hair Loss
This is the term given to hair loss which occurs in a typical distribution, in men usually causing frontal thinning and thinning on top (the crown), in women typically causes a widen part width and thinning on the crown. It may be genetic, or may in women be associated with Polycystic Ovary Syndrome.
A procedure performed under local anaesthetic (usually using the same anaesthetic as dentists use) which typically takes 10-20 minutes to perform and is well tolerated with only very mild short-lived stinging at the time of injection of local anaesthetic. Sometimes stitches are used which can either be dissolvable or be taken out 5-10 days after the procedure. It is fine to go to work straight after the procedure, but swimming should not be undertaken and if possible it is best to avoid a biopsy just before going on holiday, for example.
Narrow Band UVB treatment
This is a treatment which can be used successfully for a number of usually inflammatory skin diseases. It involves standing in a specially designed and calibrated UV cabinet for a few minutes,usually 2-3 times weekly. The length of exposure is generally increased very slowly at each visit. Whilst there is a limit to the amount of UV an individual can have( depending on skintype) this treatment can be very helpful, if somewhat time- consuming.
This treatment can be very helpful for certain inflammatory skin condition and certain types of hair loss, when it can be used both to slow down rate of hair loss, stimulate new hair or halt progression of exisiting hair loss. It rarely causes any more than a very mild discomfort at the time of injection and is safe and well tolerated. Very rarely there may be slight temporary dip in the skin at the injection site, which soon settles and becomes normal again.
These have been in use for over 40 years and are usually well tolerated, effective and safe when applied in accordance with the prescriber’s instructions.
Ointments tend to work better than creams, although creams are usually more tolerable in terms in feel and are less greasy on the skin.
Topical Non-Steroidal Creams
These can be used in atopic eczema, alopecia and many other skin problems. They are useful especially at facial sites and for longer term or maintenance treatment. They may sting or burn initially but this side effect usually settles fairly rapidly. Flushing with alcohol may occur.
These are vitamin A based creams which can be very helpful for treating acne and for their antiageing properties. They may cause initial irritation which usually settles. Avoid pregnancy whilst using these.
A 4 mm cylinder of skin is taken from the scalp under local anaesthetic and sent to the histopathologist to confirm the cause of hair loss. The procedure takes about 15 minutes and is well tolerated with only very slight stinging at the injection site which passes almost immediately. A stitch is usually used. After the procedure you will advised to apply Vaseline to the biopsy site, on top of the stitch, and to apply Vaseline to the area before washing your hair. Results may take up to 1 week.
This is a vitamin A derived tablet used primarily for treating acne. It can cure acne. If your doctor is considering this treatment for you, you will be given a patient information leaflet outlining the use and possible side effects of this treatment. Women of child bearing age will be asked to sign a consent form regarding avoidance of pregnancy whilst on this treatment and for 1 month afterwards.
This is undertaken to see whether there is an allergic cause for your eczema or dermatitis. 3 visits are needed- at the first visit approximately 40 small discs containing diluted allergens are applied to the back and held in place with medical tape. These are removed after 48 hours and the back s examined for reactions to these allergens at 48 hours and again at 72 hours. Patch test are usually undertaken by dermatologists or clinics which specialise in this techniques, and you may therefore be referred to a dermatologist colleague at a different clinic for these to be undertaken.
Frontal Fibrosing Alopecia
This is a specific type of hair loss seen increasingly in recent years which usually (but not always) affects women at about the time of the menopause. Eyebrows may become sparser and may disappear altogether, along with retraction of the margin of the hair, making the hair margin recede back. There may sometimes be redness and scaling around the root of the hair.
Frequently asked questions (FAQs)
Hair growth stimulants
Q.I have read that your hair falls out more after you use a hair growth stimulant such as Regaine?
A. Whilst some individuals experience an initial increase in shedding of hair 4-6 weeks into the start of treatment, this settles down fairly soon afterwards and in fact may be a sign that that individual is more likely to respond well to the treatment in the longer term.
Q. I have heard that your hair falls out when you stop using a hair growth stimulant such as Regaine?
A. Any hair growth stimulant is only going to help whilst you are actually using it. This is because the hair is an actively growing fiber and therefore if you stop stimulating it then it will grow at its natural rate/thickness. Rather like applying nail varnish- the nail as it grows will need further applications of varnish to keep it looking polished. Stopping a hair growth stimulant will not cause you hair to fall out any more than it would be doing naturally.
Q. My doctor has advised me to use an anti-inflammatory product(topical steroid /nonsteroid anti-inflammatory product) as well as a hair growth stimulant.Is it OK to use the two together?
A. Yes it is fine to use the two products at the same time- I usually suggest using the anti-inflammatory( Steroid or non steroid preparation) first and then apply the hair growth stimulant afterwards.
Q. If I start using a hair growth stimulant will I need to use it forever?
A. As I discussed above, any stimulant is only going to be helpful whilst you are actually using it- it will not act as a permanent “cure” for your problem.I tend to advise using hair growth stimulants nightly for 1 year and when maximum effect from them has been achieved( after 1 year of regular use) it is sensible and practical to use them 3 times per week as maintenance treatment.
Basic Blood Tests for Hair Loss
Q. I am losing hair and have heard that this can sometimes be a sign that I may be low in iron or have a medical problem. Which blood test should I have done?
A. It really depends on a number of factors-such as sex, general health, age. As a basic screen I like to request Full Blood Count, Urea Creatinine and Electrolytes, Liver Function Tests,Thyroid Function Tests, Iron status( ferritin), Antinuclear Autobody (ANA), Vitamin B12 and folate, Vitamin D, ESR, Zinc.
In a young man with early onset male pattern hair loss I might request cholesterol, free and total testosterone. If I am prescribing Finasteride in a man over 45 I will request a PSA.
In premenopausal women I may need to check Testosterone , SHBG, Prolactin, DHEAS as well as the above, depending on the clinical picture.
Q. What blood tests should I do if I think my hair loss may be related to underlying hormone problem?
A. FB, U and E, LFT, Ferritin and Iron studies B12 folate Vitamin D, Zinc, ANA, Thyroid Function, Prolactin, Testosterone and SHBG, FSH, LH