Chronic Alopecia

GENERAL INFORMATION:

What is chronic alopecia?

• Chronic alopecia (al-o-PEE-shah) is a condition of baldness or other hair loss. It may slowly get worse, come and go, or last for a long time. It usually occurs on the scalp, but can also happen on any part of the body that has hair. Chronic alopecia may not be noticed at first and can start as a patchy hair loss on the scalp or body. Over time, the condition may get worse until all the hair on the scalp or body area is gone. Unwanted hair loss can be upsetting and can make you feel embarrassed or bad about your appearance.
  
  
• Hair growth happens in a cycle process. Most of your hair is in a growing stage that lasts a long time. After it is done growing, there is a short resting stage. Then the hair falls out and the growing stage starts again. Hair grows from hair follicles in the skin. Many conditions can affect the hair follicles and reduce hair growth. Chronic alopecia is a symptom of an illness, infection, or another condition.

What are the types of chronic alopecia? There are many types of chronic alopecia. With some types, the hair loss is temporary and hair grows back, but this can happen multiple times. With other types, the hair loss keeps on or gets bigger. Depending on the condition, it may also continue on to affect more and more parts of the body over time. Some conditions result in permanent hair loss.

• Alopecia areata: This is a condition that affects the scalp or any part of the body. This condition may be caused by your immune system attacking your hair follicles. It may start with patchy hair loss on the scalp or in any part of the body. It is seen in both men and women, and usually in young adults and children. Many will recover from this condition within a year. It may come back or progress into a more severe (very bad) hair loss. In some cases, it can result in the complete loss of all hair on the body.
  
  
• Androgenetic alopecia: This is male pattern baldness and is limited to the scalp. It is a genetic condition where the hair follicles get smaller and produce less hair over time. Genes are little pieces of information that tell your body how to develop and what to do. Male pattern baldness is common in both men and women. It usually starts between 12 to 40 years of age. In men, it happens when there is too much hair loss on the temples and crown of the scalp. In women, hair thinning is more on the center and front area of the scalp.
  
  
• Telogen effluvium: This is when hair sheds more than usual and leads to hair thinning and hair loss. It can be caused by many things including certain medicines, injury, and physical or mental stress.
  
  
• Traumatic alopecia: These forms of alopecia result from injury to the scalp or hair follicles.
  
  
  • Chemical injury: Frequent use of heat or harsh chemicals on the hair may injure the scalp. This can damage hair follicles and prevent new growth of hair.
    
    
  • Scarring alopecia: A totally damaged scalp or hair follicles will lead to scarring alopecia (permanent hair loss).
    
    
  • Tension injury: Wearing your hair in tight hair braids puts tension on the hair follicles and can damage them. This can also happen if you use brush rollers or a curling iron.
    
    
  • Trichotillomania: This is a condition of behavior (an impulse-control disorder) that is a response to mental stress. It results in having a very strong urge to pull out your hair. This condition is common in women and children, and may worsen and last for a long time.

What causes chronic alopecia?

• Diseases: Autoimmune diseases, where your immune system attacks some part of your body, can lead to hair loss. The immune system is your body's defense system against infections and diseases. A problem with the immune system may result in the hair follicles being attacked. When this happens, your hair follicles may not grow normally and may lead to thinning or loss of hair. Other diseases, such as cancer or problems affecting the thyroid and pituitary glands, may also damage your hair follicle and cause hair loss.
  
  
• Hereditary: Having a close family member with alopecia may increase your risk of having the same condition.
  
  
• Infections: Many different types of infections can cause hair loss. These include infections from bacteria, such as tuberculosis, sarcoidosis, or syphilis. Viral infections, such as herpes zoster or AIDS, may also cause the condition. Fungal infection of your scalp also leads to hair loss. All of these infections may destroy hair follicles and lead to permanent baldness.
  
  
• Medicine or chemicals: Certain medicines used to treat cancer, seizures (convulsions), and thyroid or blood diseases may cause damage to your hair follicles. Too much exposure to heavy metals or taking certain hormones will also damage your scalp and hair.
  
  
• Stress: Stress on your body or mental stress can cause hair loss. Having a high or prolonged fever, too much dieting, or malnutrition can affect the hair follicles. Having a severe chronic illness within the last 3 to 4 months may stress and affect hair growth. Having high levels of mental stress may also lead to acts of repeated plucking of hair.
  
  
• Surgery or procedure: Chronic alopecia may happen after having a major surgery or radiation therapy.
  
  
• Trauma: Certain hairstyles, such as tight braids, may pull your hair too much and damage your hair follicles. Using brush rollers, curling irons, or brushes with square or angular tips may also cause damage. Frequent use of harsh chemicals on your hair may injure and burn your scalp.

How can I tell caregivers about my chronic alopecia? Tell your caregiver when you first noticed the condition, how long it lasted, and how much hair you have lost. Tell him if you have other signs or symptoms present in your scalp, such as scaling and itchiness. Tell your caregiver about any history of dietary changes, physical stress, or any recent procedure or surgery you have had. Tell him about your medical history, including medicines you have taken or are taking. He may also need to know about how you take care of your hair and what products you put on it. Tell your caregiver if a family member or a close relative has ever had the same condition.

What signs or symptoms may be related to my chronic alopecia? You may have any of the following:

• A burning or tingling sensation, or itchiness on your scalp.
  
  
• Hair that easily breaks.
  
  
• Problems with your fingernails or toenails, such as notching or pitting.
  
  
• Scales or flakes from the areas of hair loss.
  
  
• Shedding or falling hairs more than usual.
  
  
• Swelling and redness on your scalp.

How may my chronic alopecia be treated? The treatment for hair loss depends on the cause of your condition. Treating the underlying cause may resolve or improve your hair problem. Sometimes your hair loss may resolve on its own and no treatment is needed. If your hair loss is severe, you may need one or more of the following treatments:

• Medicine: If your hair loss is related to a medicine you are taking, talk to your caregivers. There may be other medicines you could take instead that would not cause hair loss. You may also be treated with any of the following medicines, depending on your condition:
  
  
  • Estrogen: This is a female hormone that is used for women with hyperandrogenism (high levels of male hormones). Estrogen can reduce the effects of male hormones on the stage of hair growth. This is the treatment used in women for male pattern baldness.
    
    
  • Hair growing agents: These are medicines that may help promote hair growth. They must be used continuously until new hair grows on the affected area. Ask your caregiver for more information on the types of hair growing medicines that you may need.
    
    
  • Steroids: Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling. Corticosteroids may be used to treat alopecia areata. Ask your caregiver for more information about this type of steroid treatment.
    
    
  • Immunologic agents: These are strong medicines used to affect the immune systems cells that may be attacking hair follicles. This treatment is used to treat alopecia areata. Your caregiver may start treatment with a small dose at first, and slowly increase the dose with each treatment. The frequency of treatment may be reduced once your caregiver sees improvement in your condition. Treatment is stopped when no improvement seen after a period of six months.
  
  

• Hair transplant surgery: This is a surgery procedure done generally on the scalp. It removes hair follicles from one part of your head and plants them in the bald area. This is done by cutting the donor scalp tissue into tiny pieces and placing each in a very small incision (cut) in the bald area. This is generally done only if your condition is severe and when medicines fail to improve your hair loss. Ask your caregiver for more information about hair transplant.
  
  
• Others:
  
  
  • Behavior modification: Behavior modification therapy teaches you how to change your behavior by looking at the results of your actions. With "behavior mod" therapy, you learn that certain behaviors (actions) have good or bad results. These results may make you feel either good or bad about yourself. Most people feel good about themselves when they use good behaviors. Good behaviors are often rewarded.
    
    
  • Hairpieces or wigs: These are used when your balding condition is severe (very bad) and widespread. They fit and cover areas of your scalp with hair loss. They may be made from natural hair or from acrylic (non-natural) material. You may need to look for the type of hairpiece that will fit you and give a natural look.
    
    
  • Hypnosis: This therapy helps you learn how to relax by deep concentration (focused attention). Hypnosis teaches you how to be calm and aware of your mind and body.
    
    
  • Psychotherapy: With this treatment, a specially-trained caregiver talks and listens to you. He will help you find the cause of your mental stress. You may meet with this caregiver alone or with a family member. This treatment may help if mental stress is causing your hair loss.

What can I do to prevent or treat my chronic alopecia?

• Avoid hair and scalp trauma: This includes choosing a soft-bristled hair brush to protect your scalp from damage. Avoid the overuse of chemicals such as permanent wave solutions on your hair. Avoid hairstyles, such as tight hair braids, that may pull your hair too much.
  
  
• Eat a healthy diet: You may need to see a caregiver about the diet that you may need. Eat foods such as fruits and vegetables, and avoid eating junk foods such as chips. Ask your caregiver if you need to be on a special diet.
  
  
• Reduce stress: Try to get enough sleep and daily exercise. Learn new ways to relax, such as deep breathing, meditation, and listening to music. These may help you cope with stressful events.

Will I need appointments with other caregivers? You will need to see a dermatologist, who is a specialist in skin and hair problems. This caregiver will help and also check on you when immunologic agents are given. For women with hormone problems, you may need to see an endocrinologist. An endocrinologist is a caregiver who takes care of hormone problems. You may also need to visit a mental health caregiver for your psychotherapy. He may help you if the cause of your hair loss is too much depression or stress. Those who need to have a hair transplant may need to visit a cosmetic or plastic surgeon.

What should I expect with time or treatment? Relief from chronic alopecia depends on the cause of your symptoms, your treatment, and other factors. It is a long term condition and one that may go away and come back. Children having the condition before puberty will have poor or slow improvement. Those who have a strong family history of baldness may also have the condition early and for a long period. You may need more appointments until your symptoms are gone. Chronic alopecia may continue even with treatment.

When should I call my caregiver? Call your caregiver if you have any of the following:

• Anxiety or a feeling of fear with sweating and a fast heartbeat.
  
  
• Increased or decreased appetite for food, or sleeping a lot more or less than usual.
  
  
• New signs or symptoms even while having treatment with medicines.
  
  
• Problems thinking and concentrating.
  
  
• Scalp that is very itchy.
  
  
• So much sadness that you are very tired or you cannot cope with your condition.
  
  
• Questions or concerns about your condition, medicines, or care.

When should I seek immediate help? Call 911 or get to the nearest emergency room if:

• You feel like hurting yourself or others.
  
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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