Tag Archive for: Trichotillomania

Is Your Hair Healthy?

Has your hair been a little drier and frizzier than usual?  Is it less manageable than it used to be?  Figuring out whether or not your hair is healthy can be challenging.  It can be difficult to distinguish between when it’s time for a deep conditioning treatment and a haircut or if something else is affecting your hair.  If you know what to look for, though, assessing your hair’s health is easy.  Here’s a simple guide designed to help.    

How Do You Know When Your Hair is Healthy?

Is your hair smooth and shiny or dull and coarse?  Hair that’s shiny and smooth is deemed more healthy, even when hair is wavy or curly. (01)  As we age, natural graying can make hair seem dull or frizzy, but that doesn’t have to be the case.  Daily conditioners, moisturizing treatments, and shine-boosting sprays can help.

Androgenetic alopecia, a fancy name for male and female pattern baldness, can also change your hair’s texture and appearance.  Sometimes hair becomes finer due to miniaturization of the hair follicles.  Because the hair becomes thinner, it could become curlier.  In other cases, previously curly or wavy hair can flatten and be less able to hold its curls or waves.  

Healthy Hair From the Inside Out

Healthy hair isn’t just what you see on the outside.  What’s on the inside also counts.  Hair is primarily made of keratin, which is a protein.  Keratin is made out of amino acids and other molecules that come from foods we eat.  That’s why eating a balanced diet and ensuring that you have all the right vitamins are so essential.

Your hair grows from a follicle beneath your scalp’s skin.  A hair shaft extends from the follicle.  The shape and angle of your hair shaft are what determines what type of hair you have.  It’s made out of three layers:

  1.  Medullar- Inside layer 
  2. Cortex – Middle layer that determines your hair color and elasticity
  3. Cuticle – Outside layer that makes your hair look shiny

When the cuticle is damaged by the sun, chemicals, blow drying, or other elements, the cells in the cortex can break or unravel, making your hair look dull or brittle. 

What Damages Healthy Hair?

Typically, the hair’s cortex is filled with keratin, and the cuticle is smooth, allowing light to reflect.  When the cuticle is damaged, your hair may seem dry and frizzy.  The ends may be thinner than they used to be, but there is still an opportunity for repair.  A haircut, deep conditioning, and time to regrow usually solve the problem.  When the cortex is damaged, salvaging the hair is more complicated.  At that point, hair is coarse and dull with split ends and some breakage.  

Does Healthy Hair Fall Out?

According to the American Academy of Dermatologists, losing about 50 to 100 hairs per day is normal as part of the hair’s growth cycle. (02)  So, even if your hair is healthy, you might still see a few strands in the sink.  When you lose more than that, there’s a problem.  Hair loss due to physical defects is unusual compared to other types of alopecia.  Here are four of the most common ones:

  1. Loose anagen syndrome – When hair is loose and easily pulls out of the follicle because the root sheaths are not fully formed.  More common in children than adults.  
  2. Traction alopecia – When hair is pulled out of the follicle by tight hair bands, braids, or any other styling habits.
  3. Trichotillomania – A type of obsessive-compulsive behavior when people pull out their own hair.
  4. Overprocessing – Straighteners, perms, bleach, and dyes use harsh chemicals that can break down your hair’s fiber.  Using these harsh chemicals too often or incorrectly can irreversibly damage the hair’s fiber.  

Other Reasons for Hair Loss

If you are losing your hair, and it’s not due to a physical defect, it may be due to alopecia.  Here are some examples:

  • Telogen effluvium is a temporary form of hair loss that can happen after sudden illness such as Covid, surgery, or a stressful occasion.  Hair spontaneously regrows after a few months.  
  • Androgenetic alopecia (male or female pattern baldness) is the most common form of alopecia.  Although it commonly occurs during middle age, people in their 20s may have this type of hair loss due to an overproduction of Dihydrotestosterone (DHT).  Minoxidil, Finasteride, Dutasteride, and Spironolactone are prescription DHT blockers often prescribed to reverse hair loss caused by male and female pattern baldness.
  • Alopecia Areata is an autoimmune condition that causes circular bald patches about the size of a quarter.  In addition to Minoxidil and Finasteride, immunosuppressants have recently been found effective in helping people with alopecia areata regrow their hair.  

How to Keep Your Hair Healthy

Want your hair to look shiny and healthy?  Here are some tips to help you keep your hair in top condition:

  • Diet – Eat a well-balanced diet with plenty of vegetables, fruit, and plenty of protein
  • Vitamins – Check your vitamin levels, especially biotin, iron, vitamin C, niacin, and zinc.  Work with your dermatologist to supplement if any levels are low 
  • Exercise – Regular exercise not only helps manage your weight and keep your heart healthy, but it also reduces stress which has been proven to affect your hair
  • Habits – Quit smoking and only drink in moderation
  • Sun protection – Wear a hat when you’re in the sun to prevent damage from ultraviolet rays
  • Chlorine – Wear a swim cap when swimming, or rinse your hair before or after swimming to get all of the harsh chlorine out
  • Wet Hair – Use a wide-tooth comb and treat wet hair gently
  • Condition – Use a quality conditioner each time you wash your hair
  • Styling – Watch heat styling, eliminate or minimize chemical treatment, and avoid tight hairstyles (ponytails, braids, buns, etc.)

No matter your age or gender, having healthy hair is a confidence booster.  If you have questions about your hair’s health or are concerned about hair loss, let us know.  One of our board-certified dermatologists will review the information you provide and let you know if you would benefit by using one of our customized prescription medications.

 

Resources:

(01) https://pubmed.ncbi.nlm.nih.gov/18004288/

(02) https://www.aad.org/public/diseases/hair-loss/insider/shedding#:~:text=It%27s%20normal%20to%20shed%20between,this%20condition%20is%20telogen%20effluvium.

 

Does Stress Cause Hair Loss?

“I was so stressed I was losing my hair.” 

“All these bills have me pulling out my hair.” 

“This new job has my hair falling out.”

People often joke around about how stress causes hair loss, but for many people, it’s no laughing matter. Stress can cause you to lose hair. And when you’re trying to keep as much hair on your head as possible, managing stress becomes a top priority. 

Stress: The Good and the Bad

When you feel your heart rate rise because you’re running late or you start to sweat during a work presentation, what you’re feeling is stress. This emotional and physical tension is part of the body’s natural response to potentially dangerous or new situations. 

Known as the body’s stress response or the “fight-or-flight” response, stress can be positive. This emotion keeps you alert and driven, pushing the body to work harder and think faster. Stress works well for short periods, giving you enough energy to power through a challenging event. Long-term (chronic) stress, however, compromises your well-being – and may cause you to lose your hair. (01)

The Physiological and Psychological Effects of Chronic Stress

The stress response comes from your body’s autonomic nervous system, the same system responsible for your heart rate, vision changes, blood pressure, and breathing. 

During a stressful situation, you may experience the following: 

  • Increased heart rate
  • High blood pressure
  • Faster breathing
  • Sweating
  • Tremors

With chronic stress, you can see these additional symptoms: 

  • Headache
  • Muscle tension or pain
  • Chest pain
  • Restlessness
  • Insomnia
  • Fatigue
  • Stomach upset

Chronic stress can lead to health problems like high blood pressure, skin conditions, obesity, and heart disease. (01)

Why Stress Causes Hair Loss

To understand why stress causes hair loss, you first need to know the basics of hair growth. Hair grows in a cyclical pattern, with new hair growth to replace older hair once it falls out. Every healthy strand of hair typically grows in three primary stages: 

  • Anagen Phase
  • Catagen Phase
  • Telogen Phase

Anagen Phase 

The anagen phase is also known as the “Growth Phase.” During this phase, a strand of hair grows from the hair follicle. As it grows, sebaceous glands condition and lubricates the hair. Hair grows at an average rate of six inches a year for most people. At any given time, about 80% of hair is in the anagen phase. This phase of rapid growth usually lasts about 2 to 8 years. 

Catagen Phase 

Unlike the anagen phase, the catagen phase lasts only briefly. The catagen phase lasts about ten days, though some people may have hair that remains in the catagen phase for up to 4 weeks. This phase accounts for about 1 to 2 percent of a person’s hair. It is at this point that growth stops, and the hair follicle shuts down to rest. (02

Telogen Phase

Hair falls out of the follicle during the telogen phase. The telogen phase is aptly named the “resting phase” because the hair follicle shuts down for a short rest. During this phase, the follicles no longer supply nutrients, which causes the air to fall out. 

The hair that’s lost is usually hairs that are at the very tail end of the telogen phase, called the exogen phase. Approximately 15% of hair is in the telogen phase at any given time. The scalp sheds an average of 100 hairs a day. With about 100,000 hair follicles on the scalp, the daily loss of 100 hairs is negligible. (03)

Hair Loss and Stress 

Hair growth is determined by the stem cells within the follicles. Chronic stress affects the adrenal glands. A recent study published in the journal Nature– with support from the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), showed how the hormone corticosterone is impacted by the adrenal glands, which respond to stress. (04

Stress increases corticosterone levels. Corticosterone prevents the stem cells within hair follicles from activating hair growth. Instead, hair follicles remain in an extended resting phase – in the telogen phase. 

Telogen Effluvium

Telogen effluvium is the primary condition responsible for hair loss during stress. Stress can cause a greater than usual amount of hair to suddenly shift to the telogen phase all at once. During telogen effluvium, many strands stop growing, and hair follicles become dormant. Fortunately, hair typically regrows within 6 to 9 months. (05)

Signs of Telogen Effluvium 

With telogen effluvium, hair loss is often abrupt. However, hair loss may begin only a few months after experiencing significant stress. Hair follicles prematurely enter the telogen phase, and the follicles may take up to 3 months to start regrowing hair. 

Unlike other hair conditions, like alopecia areata, the hair loss pattern typically experienced by individuals with telogen effluvium is diffuse hair loss. In other diagnoses like female pattern hair loss or alopecia areata, hair falls off in a patchy pattern, or they may experience a widening of the hair part. In telogen effluvium, hair loss occurs throughout the head resulting in an overall thinning rather than bald spots. (05)

Other Hair Loss Conditions Caused by Stress

Telogen effluvium is the second most common type of hair loss for men and women, but it’s not the only hair loss condition due to stress. Chronic stress may also indirectly cause the following conditions:

Alopecia Areata

Although alopecia areata (AA) is an autoimmune disease, It results in hair loss. In alopecia areata, the immune system mistakenly targets hair follicles, causing patchy hair loss throughout the scalp. Stress may be a trigger for the immune sustain, resulting in further hair loss. There’s no cure for AA, but some prescription hair medications can help manage hair loss. (06)

Trichotillomania

During a bout of trichotillomania, known as “hair pulling disorder,” an individual may feel compelled to pull or tug at their hair. People with trichotillomania have episodes of the disorder during times of significant stress. Trichotillomania causes patches of bald areas where the hair pulling occurred. (07)

Does stress cause male pattern baldness? 

Male pattern baldness, also known as androgenic alopecia, is not caused by stress. The condition is caused by genetics. Unlike telogen effluvium, androgenic alopecia is not temporary. With early treatment, however, individuals with androgenic alopecia can slow hair loss or regrow hair. 

In general, hair loss can be caused by a variety of factors. Finding the reason for your hair loss is an important step in addressing the issue. Our hair specialists at Happy Head are licensed dermatologists who can help you determine the best approach to your hair loss. Contact us to learn what Happy Head can do for you.

Resources: 

(01) https://medlineplus.gov/ency/article/003211.htm

(02) https://www.ncbi.nlm.nih.gov/books/NBK499948/

(03) https://www.nejm.org/doi/full/10.1056/nejm199908123410706

(04) https://www.nih.gov/news-events/nih-research-matters/how-stress-causes-hair-loss

(05) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606321/

(06) https://www.niams.nih.gov/health-topics/alopecia-areata

(07) https://www.sciencedirect.com/topics/medicine-and-dentistry/trichotillomania

Is There a Genetic Test that Can Predict Hair Loss?

Nowadays, there’s a genetic test for just about everything.  Even to determine our dog’s lineage.   Just one quick saliva sample or blood test and, within days, you can find out if you’re destined for cancer, diabetes, or heart disease.  There’s even a DNA test to determine whether you’re likely to experience anxiety.  

Suppose a genetic test can give you accurate information to guide your health care plan and prevent future disease.  Can it also accurately predict whether you’re predisposed to losing your hair?  If a genetic test shows that you are likely to inherit your Great Uncle Bernie or Aunt Bonnie’s hairline, is there a way to ensure that you don’t follow in their footsteps?  Are genetic hair tests reliable?  Do dermatologists use DNA tests to help make diagnoses? Before you click “Buy Now” to order a genetic test kit, keep reading.  We’re here to answer your questions about genetic testing for male and female pattern baldness.

Can Alopecia Really be Inherited?

When people hear the word “alopecia,” they often think of hair loss caused by a medical condition.  Types of alopecia such as alopecia areata and lichen planopilaris are caused by autoimmune conditions.  Androgenetic alopecia, however, is a type of alopecia that is inherited.  It’s the most common type of alopecia.  As many as 80 percent of all men will experience male pattern baldness in their lifetime. (01)  In addition, many women experience female pattern baldness, usually around menopause.  

What’s the Link Between Genetics and Pattern Baldness?

A study conducted on twins confirms what we’ve long suspected.  Male and female pattern baldness have a genetic component. (02)  About 79 percent of men who were balding in the study could attribute their hair loss to their genes.  But, there’s a catch.  Researchers are still working to fully understand which genes are affected.  We’re still learning.  Here’s what we do know.  There are 63 genes that could potentially cause baldness.  Six of those are associated with the X chromosome, where the Androgen Receptors (AR) are found.  It’s also possible that not one isolated gene is the culprit.  Several genes working together may be to blame.

Can You Take a DNA Test to Determine Whether You Will Go Bald?

Ads make genetic testing very tempting, especially if your Mom or Dad starts losing their hair in their 20s.  It would be nice to know whether you will lose your hair too.  But, unfortunately, we’re not quite there yet.  As mentioned previously, there are still too many unanswered questions about which genes are involved and how the genetic process affects your locks. Also, false positives are not unusual with genetic testing.  You don’t want a test to tell you that you’ll experience androgenetic alopecia if that isn’t really the case. (03)

How do you Know if the Type of Alopecia You Have is Genetic?

When men and women experience androgenetic alopecia, they see specific hair loss patterns.  The first sign for men is usually a receding hairline.  The hair loss then progresses to the top, creating a horseshoe pattern above your ears that circles around to the back of your head.  Female pattern hair loss typically presents differently.  Women usually notice thinning on the top and crown.  Often, women will notice a widening of the center part.  Many other conditions cause hair loss besides androgenetic alopecia.  If you think your hair loss is genetic, be sure to have your dermatologist confirm your findings.  Early diagnosis is key to preventing further hair loss and to stimulating new growth.  You also want to make sure you’re addressing the right condition with the right treatment.  

Do Dermatologists Use Genetic Testing to Diagnose Male and Female Pattern Baldness?

The truth is that dermatologists don’t need high-tech tests to determine whether or not patients have androgenetic alopecia.  Most of the time, they can tell from your hair’s appearance and your hair loss pattern.  If there is any doubt, he or she may use a densitometer to magnify your hair follicles to see if miniaturization is occurring.  Miniaturization is when the hair follicles shrink, causing existing hair to fall out and preventing new growth.  Your dermatologist may order a biopsy and blood test to rule out other causes. Patients often ask about the benefits of running a hair analysis based on what they hear about on social media.   Hair analysis is not used to diagnose male or female pattern baldness.  Instead, it’s used to determine whether there’s lead, arsenic, or another substance causing your hair loss.  

What Can You Do to Treat Hair Loss Caused by Genetics?

Treatment for male or female pattern baldness is designed to meet two goals.  The first is to stop the progression of your hair loss.  The second is to promote new hair growth.   The best way to accomplish those two goals is by using a combination of medications simultaneously.  Here are medications often included in treatment plans for androgenetic alopecia:

  • Minoxidil topical foam – A vasodilator that enlarges the hair follicles
  • Finasteride, Dutasteride, or Spironolactone  – Prevents testosterone from converting to DHT that attacks the hair follicles and causes hair loss
  • Topical or oral cortisone – Treats any redness or irritation (not needed for evey patient)

Some men are concerned about experiencing sexual side effects with oral Finasteride.  If this is the case, topcial Finasteride has been proven to be just as effective without the side effects. (04)  Even better, topical solutions which mix Finasteride with Minoxidil, Cortisone and Retinol offer an even more effective all-in-one solution.  The retinol improves absorption of the other three medications.  

Are There Other Causes of Hair Loss Besides Genetics?

Male and female pattern hair loss are the only types of genetically induced alopecia.  However, other types of alopecia exist and treatment plans are designed to treat the type of alopecia you are experiencing.  Examples of other types of alopecia include:

  • Temporary Alopecia (Telogen Effluvium) – Occurs due to sudden illness, stress, or shock and usually reverses itself without treatment
  • Autoimmune Alopecia (Alopecia Areata and Lichen Planopilaris) – People experience flares and periods of remission
  • Trauma-induced Alopecia (Traction Alopecia and Trichotillomania) – Alopecia results from hairstyles that pull on the hair follicles or when people pull out their hair as a stress response)

Can You Prevent Hereditary Hair Loss?

Let’s play pretend for a minute.  Let’s say that a genetic test does exist that will determine whether or not you will lose your hair.  The tests come back showing that you are genetically predisposed to androgenetic alopecia.   Is there a way to prevent hair loss before it begins?  Sure, eating right, exercising, and managing stress never hurt.  But, even with that, you can’t necessarily fight Mother Nature.  That would be nice, though.  If male or female pattern baldness does rear its head, then it’s time to take action.  

Can You Reverse Hereditary Hair Loss

If you’re experiencing male or female pattern baldness and want to learn more about products available, contact us.  Although there isn’t a way to prevent androgenetic alopecia from occuring in the first place, there are things you can do to reverse the condition.   Minoxidil, Finasteride and other medications have been found to be safe and effective. Our board-certified dermatologists and hair specialists are available to answer your questions and help you develop the ideal treatment plan for your needs and lifestyle. 

 

Resources:

(01) https://www.ncbi.nlm.nih.gov/books/NBK538178/

(02) https://academic.oup.com/biomedgerontology/article/60/8/1077/545174

(03) https://www.nature.com/articles/gim201838

(04) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609098/