Most people recognize dermatologists as physicians with specialized training in health and diseases of the skin. However, many people are unaware of the fact that dermatologists are also the specialists who manage health and diseases of the nails and hair. Over the last few months we have discussed nail health and disease, and hair health; today we will discuss some of the most common diseases affecting hair.
Although hair is not essential to survival, it plays a very important socio-psychological role. As a society, we devote enormous resources to groom hair so that it reflects our cultural norms. Thus, there is a great deal of frustration, grief, and social dysfunction associated with damage or loss of hair. Dysfunction of hair can be due to a variety of insults including infections, inflammatory or autoimmune conditions, medications, stress, hormonal changes, and trauma. If the pathologic process leading to hair dysfunction is allowed to continue for a prolonged period of time, it can cause temporary alopecia (hair loss) and subsequently permanent alopecia.
One of the most common hair disorders in young children is pediculosis capitis, commonly known as head-lice infestation. Head-lice infestation is highly contagious and spreads by direct contact with infected individuals. The lice typically live on the hair and pierce the skin to obtain blood, leading to itching. Fortunately there are a number of safe and effective treatments that your dermatologist can offer to quickly eradicate lice infestation. Another commonly seen infection in children is tinea capitis, a superficial fungal infection of the hair that leads to flaking of the scalp (as occurs with dandruff), itching, redness, and hair loss. Rapid treatment of tinea capitis is important because persistent infection will lead to permanent hair loss. The condition can be effectively treated using an oral antifungal agent.
There are many inflammatory and autoimmune conditions that can be limited to or have involvement of the scalp and hair as one of its manifestations. One of the most common inflammatory conditions of the scalp is seborrheic dermatitis, commonly referred to as dandruff, which causes redness, itching, and flaking of the scalp. Milder cases can be treated with over-the-counter shampoos and good hair care, but severe cases require prescription medications. Another common condition, allergic contact dermatitis of the scalp, is typically seen in patients who chemically treat or dye their hair, leading to itching, pain, flaking, redness, and alopecia. Patch testing maybe helpful in determining the offending allergen. Alopecia areata, on the other hand, is a common autoimmune condition in which the immune system causes destruction of hair follicles, usually in a circular pattern. In some cases, alopecia areata can lead to complete loss of hair on the scalp, eyebrows, and sometimes the entire body. There are many systemic autoimmune and inflammatory conditions that can cause hair loss and inflammation of the scalp and hair follicles (as seen by redness, itching, pain, etc.) including psoriasis, lupus, sarcoidosis, thyroid disorders, lichen planus, acne, and folliculitis. Sometimes the diagnosis of the systemic condition is discovered solely on the basis of the hair disorder. Early diagnosis and treatment of these conditions will not only help in avoiding hair loss but also in avoiding systemic complications.
Hair loss can also result as a side-effect of medications. For example, most of us are aware of the rapid and dramatic hair loss that occurs as a temporary side effect of chemotherapy. However, most medication-induced hair loss is a slow hair loss that doesn’t become evident for number of years, associated with/caused by/resulting from more common medications including anti-hypertensives, blood thinners, anti-depressants, and anti-diabetes medications.
Perhaps the most common cause of slow and steady hair loss is androgenetic alopecia (male or female pattern baldness) that is a result of our genetic make-up and the physiologic changes that take place as we age. Over time, the hair loss becomes irreversible, thus androgenetic alopecia is best treated at early stages to either reverse, or at the very least, to stop the progression of hair loss. There are some very good treatments for androgenetic alopecia; however it takes many months to see the results, causing many patients to prematurely abandon the treatment protocol. A final resort for many involves hair transplantation. Other conditions that cause gradual hair- loss include: trauma caused by certain hairstyles that cause excessive pulling of the hair; repeated chemical and/or heat treatments; and rarely, a psychiatric condition causing individuals to pull out their own hair (trichotillomania). Finally, stressful events can cause dramatic hair loss, for example after the loss of a loved one, surgery, or hospitalization. Fortunately, in many of these conditions resolution of the stress leads to complete recovery.
Hair plays an important functional, protective, and cosmetic role. By maintaining healthy hair habits and seeking early diagnosis and intervention to treat hair disorders, one can maintain a healthy head of hair and avoid the significant medical and psychosocial complications of hair loss.
If there is a specific topic or question that you would like to see addressed in upcoming issues, readers are encouraged to contact Dr. Patel at 17222 Hospital Blvd, Suite 346, Brooksville, FL 34601.
Utpal Patel, M.D., Ph.D. is an NYU-trained board certified dermatologist and American College of Mohs
Surgery (ACMS) fellowship-trained skin cancer and reconstructive surgeon who specializes in Mohs