Indifferential Diagnosis #2: Hair Loss

Welcome to the long-overdue 2nd installment of Indifferential Diagnosis, the feature that poses – and even suggests possible answers for – the age-old question, “What’s wrong with you?” Last time we learned about visual hallucinations; today we delve into the equally disorienting world of hair loss. But before we begin, I would like to again draw your attention to the important disclaimer that I am not a doctor and indifferential is not a word.

As anyone who has ever swept the floors of an apartment inhabited by several females (or long-haired males) can tell you, human hair falls out all the time. The average adult head houses over 100,000 hairs and sheds between 50 and 100 of them each day. Hair loss – or alopecia, to use the clinical term – becomes noteworthy if it exceeds these parameters long enough to leave bald patches and/or completely eliminate hair. Hair can be lost from just the head or from the whole body. And, while it is typically associated with males of a certain age, the problem can occur at any age and in both genders.

Androgenetic and Involutional Alopecia

These are the staples of human balding and both increase with age. Prior to its ousting from the scalp, any given strand of hair has gone through a growth phase (2 to 3 years) and a rest phase (3 to 4 months). After a hair falls out, a new one takes its place and the cycle starts over – growth, rest, shedding of hair. Involutional alopecia is a gradual thinning of the hair caused by a shortened growth phase. Less growth means more hairs in rest phase, a higher rate of shedding and shorter hairs overall.

While living long enough almost guarantees some age-related thinning of hair, androgenetic alopecia – which you may know as “male pattern baldness” – only affects part of the population and is believed to be governed by hereditary factors. The “pattern” starts with a receding of the hairline at the temples, accompanied by the classic bald patch at the crown of the head (the spot where you would wear your yarmulke, if you’re into that sort of thing). Gradually these hairless patches may bleed into each other, resulting in the full Patrick Stewart effect.

Women too can be afflicted with androgenetic alopecia, but it tends to be less severe and starts later in life. Men with the genetic predisposition can experience noticeable hair loss as early as their teens. Hair loss from either androgenetic and involutional alopecia is largely permanent. As with aging overall, society has yet to produce a solid cure for this kind of gradual balding.

Tell-tale signs: The pattern of androgenetic alopecia is pretty easy to spot. Having relatives with similar hair loss histories is also a good indicator that you’re suffering from male pattern baldness.

Hormones

Amidst all the other risks associated with childbirth, hair loss gets little press. But major hormonal changes that occur during/after pregnancy can make your hair fall out. Menopause is another likely source for this. In both cases what happens is that a large number of hairs opt to exit the growth stage and make a beeline for the rest stage, yielding a bunch of shedding.* The good news is that such hair loss is only temporary. Once things calm down with the endocrine system, the normal growth cycle resumes, allowing hair to return at its previous rate.

Tell-tale signs: This condition has a more sudden onset than that of age-related thinning. The volume of extra hairs in your brush will inspire mild panic rather than just nagging doubt. There’s no reason to panic though. Don’t panic. Panicking never helped anyone grow hair.

Poison

Hair loss can be caused by exposure to an array of chemicals. These range from overdoses of medications – examples: Warfarin, a blood-thinner (though in higher doses it also functions as rat poison); Lithium, a mood-stabilizer (it’s not great for your kidneys either, FYI) – to work-related hazards (metals like mercury and arsenic have been causing problems for ages) to cold-blooded, premeditated attempts on your life made by your enemies. If you don’t take medications and your job exposes you to nothing stronger than white out and ball-point pens, you may want to ask yourself, “Who would benefit from my death and how much access do they have to my morning coffee?” Depending on what toxin is entering your system, the effects can be immediate (Warfarin) or build up slowly over time (arsenic), important factors to consider in deducing your would-be murderer.

Tell-tale signs: Poisons don’t just cause hair loss, they make people sick all around. Look for accompanying symptoms like nausea, weakness, dizziness, headaches, etc. Being poisoned will make you feel thoroughly awful.

Trichotillomania

Here’s an interesting source of bald patches – pulling out your own hair one strand at a time. Strange though it may sound, up to 4% of people are afflicted with an uncontrollable compulsion to pluck hairs from their head, eyebrows, etc. Think of it as an extreme form of hair twirling. The problem usually starts in adolescence or childhood, and many people outgrow it somewhere during adulthood.

Tell-tale signs: Hopefully you will realize if you’ve been doing this yourself, so this is more for spotting the condition in others (namely, your offspring). Watch out for bald-patches and vigorous denial of these being self-inflicted. Other anxiety-soothing fidgets (like nail biting) may also be an indicator. Trichotillomania isn’t especially common in calm and well-adjusted types.

Alopecia Areta

If you haven’t heard that term before, brace yourself for some disheartening news; there is a malady out there that can cause sudden and sometimes profound hair loss in perfectly healthy individuals and for no apparent reason. Alopecia areta (AA) is thought to be an autoimmune disease in which the body’s immune system targets its own hair follicles as perceived pathogens. Often the hair grows back, but it can fall out again and there is no way to predict when and if these recurrences will happen. At its most severe, the disease causes the loss of all hair from all parts of the body – a conditional called Alopecia universalis.

Tell-tale signs: The fun generally begins with a small bald patch somewhere on the scalp, unaccompanied by skin abnormality or discoloration. The complete absence of any likely cause is also a good indicator that AA may be to blame. Other than being freaked out by losing their hair, patients feel perfectly fine. The condition isn’t especially common though (less than 2% of the population suffers from it), so before you race to the doctor, you may want to review that paragraph on male pattern baldness (pretty ubiquitous once you get past your 20s). 

Ringworm

I used to think that ringworm was an actual parasite, but it’s just a fungal infection. Less gross, but still no fun. If it occurs on your scalp it will cause the hair in the infected area to fall out. The problem is easily treatable with antifungal creams, and your hair will grow back after the skin heals. Oh, and don’t forget that this is contagious. Housemates and pets (cats are notorious for spreading this stuff around) may also benefit from medication.

Tell-tale signs: The skin exposed by the lost hair will look infected (since it is). Unhappy words like “itchy”, “scaly” and “oozing” often crop up in descriptions of ringworm. †

Diabetes, Thyroid disorders, Lupus

Hair loss can be a symptom of an underlying disease. These are serious conditions that I can't help you with. Go see a doctor already.

* This change in the growth cycle is known as telogen effluvium (telogen is the rest phase) and can also be brought on by disruptions like stress, malnutrition or a high fever.

† The fungus that causes ringworm – Microsporum gypseum – also causes athlete’s foot. It’s an icky world we live in.