Hair and Scalp Conditions
A qualified Trichologist is trained to diagnose and treat a number of hair and scalp disorders, which can largely be categorised into; Hair Loss (or Shedding), Scaling conditions, Cicatricial conditions, and Psychological conditions.
Hair Loss/Shedding
“Alopecia” is a blanket term for hair loss of any origin and presentation, and there are many different types of alopecias. On average we lose up to 100 hairs a day, but it can be easy to notice if this changes through our hair density, or the amount of hair we leave behind in the shower or hairbrush.
Key words for types of hair loss, and their definitions;
- Localised = contained within a location on the scalp/body
- Diffuse = evenly spread across an area of the scalp/body
- Patchy = complete loss confined to multiple, smaller areas
Telogen Effluvium
Telogen Effluvium is a diffuse thinning of the hair; it can be described as either “Chronic” or “Acute” depending on the cause and duration of the hair loss. It is caused by a shift in the hair growth cycle, causing a higher percentage of growing hairs to prematurely enter the next stage of the hair growth cycle and begin to shed. As a result, hair may feel much thinner towards the ends and there may be a more noticeable amount of shorter or differing length hairs throughout the scalp.
Alopecia Areata
Alopecia Areata is an autoimmune, patchy hair loss condition caused by the body’s immune system attacking its own cells within the hair follicles, causing hairs to break off and shed. It presents as a number of 50-pence-sized patches of complete hair loss throughout the scalp, but can also affect other areas of body hair including the eyebrows, eyelashes, and bodily hair. Any regrowth within these patches will display as fine, colourless (unpigmented) hairs before eventually returning to their original pigmented colour.
Androgenetic Alopecia
More commonly known as Pattern Hair Loss, this condition can affect both men and women through either genetic predisposition, age, or hormone levels. Presentation of this alopecia differs between male and female; male pattern loss is typically exhibited by a recession of the hairline and thinning in the crown area, whilst female pattern loss is usually a diffuse thinning all over the scalp, sometimes shown as a widening of the parting.
Scaling Conditions
The majority of these conditions implicate the health of the scalp, although they can also cause a knock-on effect to the hair as a result. These are the “itchy” and irritable conditions that require regular intervention.
Let’s talk about the itch-scratch cycle. Itchy or “pruritic” conditions such as these are very tempting to scratch. When we scratch our skin, not only do we invite the bacteria under our fingernails into the area and risk infection, we also aggravate the existing itch until we cannot leave it alone.
We may try our best to avoid temptation, but we have very little control over how much we scratch at night, so it is very important to have these conditions treated by a professional.
Scalp Psoriasis
Scalp Psoriasis presents as thick, craggy plaques of skin on the scalp, similar to the Psoriasis found on other parts of the body. This is another example of a condition of autoimmune origin, and can cause the scalp to feel very tight and pruritic, or “itchy”. If forcefully removed, these silvery plaques can create bleeding points across the scalp as well as strip any hair that has adhered to them. Other areas of the body that may be affected include; outer-knees, outer-elbows, shins, joints and fingernails or toenails.
Seborrhoeic Dermatitis
Also known as “Seborrhoeic Eczema”; this condition displays on a spectrum anywhere from mild scaling to full coverage crusting and erythema (inflammation). This condition occurs as a result of excessive yeast on the scalp which feeds off of the sebum produced through our hair follicles. The scaling produced here is more of a yellow hue and most commonly affects the margin of the hairline and behind the ears, causing a heavy amount of irritation. Other “seborrhoeic” areas affected include; around the nose, eyebrows, ears, chest, back, inner-elbows, and behind the knees.
Dandruff
Also known as “Pityriasis Simplex”, Dandruff is a less severe version of Seborrhoeic Dermatitis, with minimal flaking of the scalp by comparison and does not present elsewhere on the body. It can be exacerbated by the same causes as Seborrhoeic Dermatitis but can be easily managed.
Cicatricial Conditions
Cicatricial, or “scarring”, hair loss conditions are less common but must be handled with care. Time-sensitive conditions such as these require swift diagnosis and appropriate referrals in order to secure the best case scenario, otherwise they can progress and worsen. The main causes of scarring in hair loss are; chemical trauma, autoimmune response, and bacterial infection.
Examples of cicatricial conditions include;
- Frontal Fibrosing Alopecia (FFA)
- Lichen Planopilaris (LPP)
- Folliculitis Decalvans
- Central Centrifugal Cicatricial Alopecia (CCCA)
- Discoid Lupus Erythematosus (DLE)
- Systemic Lupus Erythematosus (SLE)
Psychological Conditions
The mind is a powerful thing and can be capable of both great creation and destruction. A term that heavily applies psychology to hair loss is “Hair Awareness“, which is a form of dysmorphia. Once we become aware of a problem with our hair, it can become easy for us to obsess over and monitor every lost or greying hair, which in turn further exacerbates the problem through the distress experienced.
Similarly, adopted behaviours or coping mechanisms can also manifest in some potentially more damaging ways, and one that particularly impacts the hair is a condition known as Trichotillomania. The main component of this condition is experiencing a strong urge to pull your hair, which can result in varying degrees of hair loss; it can also sometimes be accompanied by nail-biting or skin-picking. This condition causes very high levels of distress, despite the initial action providing a very brief relief, and often starts in early adolescence or younger, and can carry into adulthood.
Charity BFRB UK & Ireland specialise in offering support and providing a community for individuals experiencing hair-pulling and other associated behaviours; for more information see their website: https://www.bfrbukireland.com/
Areas of Knowledge
In their careers, Trichologists will encounter many individuals and a variety of hair and scalp conditions with differing triggers and causative factors. In doing so, they are consistently adapting and honing an already in-depth working knowledge of:
- Autoimmune conditions
- Genetic conditions
- Infections – bacterial, viral, and fungal
- Malnutrition and deficiencies
- Hormones and hormonal imbalances
- Thyroid activity
- Hairdressing procedures – relaxers, dyes, perms
