Hair loss can be the sign of medical illness such as systemic lupus erythematosus (lupus), thyroid problems, sex-hormone imbalance or iron deficiency. Fungal scalp infections like tinea capitis (also known as “ringworm of the head”) can cause itchy circular scaly patches which could spread if not addressed immediately.
Trichotillomania
Trichotillomania is a mental health condition in which individuals compulsively pull out their own hair, most commonly on their scalp, eyebrows, eyelashes and sometimes other parts of their body. Trichotillomania may be caused by stress, boredom or restlessness and people often find relief by pulling out their locks instead (Cleveland Clinic, 2018).
People suffering from trichotillomania also often pick at their skin or bite their nails and chew their lips, and may engage in hair-pulling behavior to the point of embarrassment or shame for fear of ridicule by others; frustration often results from lack of understanding from family and friends, along with feelings of guilt and anxiety for which trichotillomaniaans struggle daily.
Talk therapy such as cognitive behavioral therapy or habit reversal training is the most effective treatment for trichotillomania. Therapists will help a person identify when they’re most likely to pull their hair, then work with them on developing what’s known as a competing response – for example clenching their fists when feeling the urge to pull.
People suffering from trichotillomania should visit their healthcare provider regularly in order to make sure all medical issues that could be contributing to their symptoms, such as thyroid disorders or stressors in their life, are diagnosed and treated. It is also wise to limit how much information about hair-pulling behaviors they disclose as it could misdiagnosed as anxiety disorder, obsessive compulsive disorder, personality disorder or body dysmorphic disorder.
Telogen effluvium
At any one time, 5-10% of your hair may be in its resting or telogen phase, leading to natural shedding of the remaining locks. Telogen effluvium occurs when 30 percent or more hair follicles switch into this resting phase which leads to excessive hair shedding over six months – but can occur anytime.
Stress or illness may push many of your hair follicles into telogen phase, leading to your hair falling out as you brush, shampoo or comb it; or when running your hands over your scalp. Your hair could fall out in handfuls when brushing, shampooing or combing; and can even come loose from its root when running hands over it (Contributors, n.d.).
Telogen effluvium (TE) is caused by hormonal fluctuations that can impact both men and women. TE can manifest after major health events like surgery, illness or pregnancy as well as during times of extreme emotional shock such as grieving the loss of loved one or divorce proceedings; or during menopause when hormone levels shift drastically in response to changing body chemistry.
Once your hair experiences telogen effluvium, it should begin growing back. This condition typically ends six months post-triggering event; however, in certain instances chronic cases may persist for years.
If you are experiencing telogen effluvium, try to lower your stress levels and eat plenty of proteins, fruit and vegetables in your diet. Furthermore, medications to support healthy hair follicles may help as well. Our dermatologists can offer additional solutions that may speed up hair growth such as topical steroids or oral medication; additionally they may provide advice to assist with dealing with psychological effects associated with telogen effluvium.
Diabetes
Hair loss may be a telltale symptom of diabetes, especially if it appears suddenly and without explanation. Causes could range from high blood sugar levels, stress or other autoimmune conditions (like Alopecia Areata or Hashimoto’s thyroiditis ) that impact hair growth; or it could even be brought on by medications like metformin.
Diabetes leads to hair loss by damaging blood vessels. When this happens, oxygen and nutrients have difficulty reaching all parts of the body including scalp area where hair follicles reside – depriving these essential follicles of necessary nutrition that they require in order to function and grow healthy (Is Diabetes Causing You to Lose Your Hair?, n.d.).
Hair loss may reverse once an individual manages their blood sugar and other health problems such as stress or nutritional deficiencies effectively. Unfortunately, left untreated or not managed appropriately, its symptoms only worsen over time and could eventually lead to other health complications including amputations, heart disease, kidney disease and vision loss.
To effectively prevent hair loss, the key is ensuring your blood sugar is under control and maintaining good health by managing stress, eating well, exercising regularly, and getting enough restful sleep. This will improve circulation while providing vital nutrition to follicles so they may function and grow healthy. If symptoms persist, consult with a healthcare provider who may recommend basic lab tests to identify any deficiencies that require attention.
Lupus
Lupus causes hair loss by prompting your immune system – usually responsible for protecting you against viruses and bacteria – to attack itself instead of protecting the rest of the body properly. Lupus may affect any part of the body from skin to kidneys to brain, with effects ranging from mild to life-threatening consequences (Lupus and Hair Loss | Lupus Foundation of America, n.d.).
Hair loss caused by Lupus can be temporary if medication that reduces inflammation or prevents blood clots is taken; however, permanent problems like deep vein thrombosis (DVT), pulmonary embolism (PE), or serious infections could prevent its return. Blood clots are more common among people living with Lupus than among the general public as their bodies produce proteins called antiphospholipid antibodies which create blood clots.
Lupus affects more women than men, though anyone can develop it. African-American and Hispanic women seem particularly prone to this condition with more severe symptoms and increased kidney problems compared to white female counterparts. Lupus can first appear between 15 and 44 years of age. Lupus may result from genetic abnormalities, physical trauma or infection – often running in families – which make diagnosis challenging.
Tinea capitis
Tinea capitis, commonly referred to as “ringworm of the scalp,” is a fungal infection which typically strikes children. This condition creates circular, inflamed patches on the scalp that lead to temporary or even permanent hair loss depending on whether or not treatment is sought immediately (Tinea Capitis Information | Mount Sinai – New York, n.d.).
Healthcare providers may find it challenging to diagnose this infection due to its similarity to dandruff or psoriasis, and healthcare providers will need to perform skin scraping to obtain samples of the infected area as well as plucked hairs placed into potassium hydroxide solution and examined under microscope in order to make an accurate diagnosis of whether there is indeed a fungal presence or not.
Tinea capitis causes itchy patches that range in severity depending on its cause. Some cases show mild erythema with sparse patches of hair loss resembling seborrheic dermatitis; other cases show clustered black dots (black dot tinea capitis) or gray patchy areas with short residual hair stubs (gray patch tinea capitis). When inflamed, tinea capitis can produce painful pustules called kerion lesions which ooze and crust over.
Diagnosing tinea capitis can be confirmed with either a skin scraping or potassium hydroxide wet mount of plucked hairs and scalp scale, which reveals spores inside (endothrix) and outside the shafts (ectothrix). Blue-green fluorescence under Wood light examination indicates infection with Microsporum species such as M. ferruginium or audouinii; fungal culture can also confirm infection but this takes time before results become available; polymerase chain reaction screening of hair samples may provide faster detection methods of detection of fungal species.
References
Cleveland Clinic. (2018). Trichotillomania (hair pulling) | Cleveland Clinic. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9880-trichotillomania
Contributors, W. E. (n.d.). Hair Loss: Effluviums. WebMD. https://www.webmd.com/skin-problems-and-treatments/hair-loss/effluviums
Is Diabetes Causing You to Lose Your Hair? (n.d.). Verywell Health. Retrieved November 7, 2023, from https://www.verywellhealth.com/diabetes-hair-loss-5111927
Lupus and hair loss | Lupus Foundation of America. (n.d.). Www.lupus.org. https://www.lupus.org/resources/hair-loss-and-lupus
Tinea capitis Information | Mount Sinai – New York. (n.d.). Mount Sinai Health System. https://www.mountsinai.org/health-library/diseases-conditions/tinea-capitis
