Hair Loss Index

What is traction alopecia?

   This is a small or localized hair loss area caused by repetitive or persistent pulling or traction on hair roots. Tight braids and ponytails can pull hard enough on hairs to make them fall out. If this happens, it's best to choose hairstyles that put less tension on hair. The sooner this is done the better to avoid permanent damage.

What is trichotillomania?

  This refers to the habit of someone voluntarily pulling at their own hairs or twisting them, sometimes without realizing it. The scalp and eyelashes are often affected. Unlike alopecia areata patches, which are perfectly smooth, hair patches in trichotillomania show broken-off hairs. Treatment is often entirely behavioral. One has to notice the behavior and then consciously stop. Severe or resistant cases may require stress counseling with a therapist or psychologist or medical treatment with a psychiatrist. Several antidepressant or anxiety medications have been shown to help with this condition.

What is tinea capitis?

    Tinea is the medical word for fungal infection, and capitis means head. Tinea capitis is fungal infection of the scalp that for the most part affects school-age children. Tinea capitis is more common in black African or African-American scalps. This condition is rare in healthy adults. Bald spots usually show broken-off hairs and is accompanied by a dermatitis. Oral antifungals can penetrate the hair roots and cure the infection, after which hair grows back. Sharing hats or combs and brushes may transmit tinea capitis.

What is generalized (diffuse) hair loss?

    This is an overall hair thinning without specific bald spots or patterns. While this type of hair loss may not be noticeable to others, often the individual will feel their hair is not as thick or full as it previously was. Common conditions in this category are

• telogen effluvium (rapid shedding after childbirth, fever, or sudden weight loss);
• androgenetic or androgenic hair loss ("male-pattern baldness," "female-pattern baldness"). 

What is telogen effluvium?

    Under normal conditions, scalp hairs live for about three years (the anagen, or growing, phase); they then enter the telogen, or resting, phase. During the three-month telogen period, the hair root shrivels up into a small "club," then the hair falls out. It is therefore normal to lose about 100 hairs every day, more of them on days when shampooing loosens the hairs that are ready to fall out. The hairs are then replaced by the body.

    Sometimes people who worry about losing their hair start noticing hairs on their pillow or in the sink, not realizing that they've always been there. A close look at these will usually reveal the club at the end, showing that these hairs were shed normally. Normally, about 10% of scalp hairs are in the telogen phase.

    There are several circumstances that produce a "shock to the system" that alters the hair growth rhythm. As a result, as much as 30%-40% of the hairs can cycle into telogen. Three months later, hairs come out in a massive shedding (effluvium), especially near the front of the scalp. These include

• childbirth,
• high fever,
• sudden weight loss (crash dieting),
• surgery,
• severe illness,
• severe emotional stress or loss.

    None of these need be life-threatening, nor does hair loss usually follow them. (Moreover, it can happen after one pregnancy, but not the next.) But when the hair falls out, it's all over the place -- covering the pillow, clogging the drain, and so forth. Paradoxically, the more dramatic the hair loss, the better the prognosis, because when the body gets back into normal rhythm, most if not all of that hair comes back; these people need no special treatment. Normal shampooing can continue, because this only loosens hairs that were going to come out anyway.