Alopecia / Hair loss
Humans are mammals and mammals have hair. However, we don’t really know why we have head on our hair or even pubic hair. Hair does certainly play an important role in society and how we show ourselves to the world. Any changes to hair or loss of hair can have a big impact on how we feel about ourselves.
What is alopecia / hair loss?
There is a huge variety to hair and hairiness between people. Abnormal hair loss is called alopecia. It is very common and there are lots of different causes. The most common cause in children and young people is a condition called alopecia areata.
What are the causes of alopecia / hair loss?
- Inherited – there are some genetic conditions that can affect the skin, hair, and sometimes the teeth and nails.
- Underlying health conditions – thyroid disease and anaemia – often caused by low iron in the blood – can both lead to generalised loss of hair, so treating the underlying health condition will help if this is the case.
- Medicines – certain drugs – particularly those used for chemotherapy – are designed to target fast-growing cancer cells. Hair cells grow quite quickly and are therefore also affected, but the hair will usually grow back once treatment is finished.
- Telogen effluvium – as we mentioned before, the hairs on our scalp are normally all at different stages of their growth cycle at any one time. A significant illness or pregnancy can push all the hair to cycle at once however, meaning they all fall out at the same time a few months later. This leads to a period of hair thinning, but should then settle over time.
- Traction and rubbing – hair styling techniques that pull hard on the hair, or put strain on the hair through use of heat treatments, can sometimes lead to hair loss. Rubbing over time will also do this; it’s the reason we have less hair around the top of our socks, and explains why cats have less hair under their collars.
- Trichotillomania – persistent rubbing or pulling on hair is a condition called trichotillomania. It can be a serious problem, and is considered to be an obsessive-compulsive disorder that requires psychological support.
- Infection – fungal infection of the scalp can cause inflammation and hair loss, which can be treated with antifungal medications.
- Inflammatory conditions – uncommon inflammatory conditions, such as lupus and lichen planus, can also cause inflammation in the skin on the scalp. There are treatments available, but sometimes the hair loss caused by the inflammation is unfortunately scarring and therefore permanent.
- Hormonal conditions – a hormonal condition called androgenetic alopecia can cause hairs to become smaller, and is the reason males become bald as they get older. It may happen occasionally in people’s teens and twenties however, and can also occur in females. Treatments aren’t brilliant, but hormone tablets and a foam called minoxodil can sometimes help.
- Autoimmune conditions – the most common type of hair loss in young people is caused by an autoimmune condition called alopecia areata.
Alopecia areata is a condition that causes non-scarring hair loss. It is an autoimmune condition. This kind of condition develops when your immune system, which is supposed to attack infections that might be harmful to your body, has ended up targeting bits of yourself instead. In alopecia areata, the hair follicles are the targets; how or why this happens isn’t really understood though. What we do know is that it’s more common in people who have – or have family members with – other conditions: asthma, eczema, or other autoimmune conditions such as type 1 diabetes, rheumatoid arthritis, vitiligo or coeliac disease.
Most children and young people with alopecia areata are otherwise very healthy, with no significant medical conditions. It’s unclear what triggers their immune systems to start attacking their hair follicles, although many patients have their own theories. Some identify a stressful event that happened just before the hair loss started for example, although stress is not clearly linked to alopecia. What’s important to remember is that you haven’t done anything wrong to cause your alopecia, and it’s not contagious; you haven’t caught it from somebody, and you can’t give it to other people.
Alopecia areata covers a whole spectrum from patchy loss of head hair or facial hair to more widespread loss which can include, eyebrows, eye lashes and all hair on body. As there is no scarring and the hair-follicles remain healthy, the hair is able to regrow. This is more likely to happen if only a small patch is affected, but the longer it goes without re-growing, the less chance there is of it coming back. Frustratingly this is really difficult to predict, and some people have patches that come and go for many years.
Losing your hair can have a massive impact on how you feel about yourself. The uncertainty of whether your hair will grow back or not is understandably difficult to deal with, but unfortunately there’s no easy way to predict what’s going to happen in a condition such as alopecia areata.
It is important to have realistic expectations about what can and can’t be done. There are some treatments that can help some people but you always have to weigh up the possible benefits with risks of any treatments. There is support out there and you are definitely not alone.
There is evidence that the stigma attached to hair loss has reduced over time, which can only be a good thing. That’s not to say it makes things easy; just that increased awareness means young people might find it possible to make alopecia a positive part of their identity. Young people with alopecia are starting to appreciate that the skin doesn’t hurt or itch, that it doesn’t make you unhealthy, and that bald can be beautiful.
Sumaya lost her hair out of the blue several years ago when she was 8 years old. As a Muslim girl, Sumaya saw straight away that she could start to wear a headscarf. ‘It felt protective,’ she says. ‘It protected me from other people’s awkwardness.’
Even so, Sumaya experienced some bullying at school, which she felt wasn’t dealt with effectively. She says that both teachers and the Asian community need to
understand more about alopecia.
‘It did affect my confidence for a while,’ she admits. ‘There were some difficult moments, with classmates I’d known all my life. It affected my parents too. My mum says she wishes it had happened to her, instead of me. But I came to terms with it more quickly than other people expected. I thought if I could be happy, then they would come to terms with it too.’
Sumaya sometimes wears a wig for special occasions, like family weddings. But generally, she’s more comfortable wearing her headscarf.
Starting at secondary school offered a fresh start for Sumaya. Early on, in a discussion about bullying, she decided to tell her class that she had lost her hair. Five years later, apart from her closest friends, she thinks most people have forgotten now.
Now 17, Sumaya is always busy. ‘I concentrate on my education and my hobbies – I love reading. I am going on a Duke of Edinburgh expedition, and I won a trip to NASA last summer. There are so many things I’m concerned with, my hair loss doesn’t concern me.
Sumaya’s alopecia is probably caused by an auto-immune response. ‘It is hard not knowing what causes it,’ she says. ‘I’ve tried different treatments. We always ask the consultant if there is anything new to try. I think there should be more research to find causes and cures. It’s good to remain hopeful, but I try not to let it take over. That could stop you from doing other things.’
Sumaya finds her faith helps her to cope.‘I see my alopecia as a test from God,’ she says, ‘and God also gives me the strength to cope with it. When my hair first fell out, the doctors said it might never come back, even if I live to be 80. It is in God’s hands whether my hair will ever grow back.
‘It’s a big thing to cope with, but once you’ve got over it, you’re over it. It’s a part of me, now, my scarf and my alopecia.
Story provided via the Birmingham Women’s and Children’s NHS Foundation trust.