Abnormal hair loss

Abnormal hair loss is hair loss related to causes such as cancer chemotherapy, autoimmune disease, or triggers such as childbirth, fever, weight loss, skin disease or hair styling treatment. This isn't the same as normal hereditary hair loss which runs in families.

Abnormal hair loss is usually temporary and stops when the cause of hair loss is removed or treated.

Alopecia is the medical term for hair loss. Alopecia areata is an autoimmune condition that causes abnormal hair loss. It may be due to hereditary factors, however, many people with this condition don’t have a family history of it. People with alopecia areata may, or may not, experience regrowth of their hair.

Hair growth follows a cycle with 3 main phases.

• Anagen phase – this is when active hair growth takes place. At any one time most hairs are in this phase. It lasts up to 6 years or longer in scalp hair.
• Catagen phase – this is when hair growth stops and the hair follicle shrinks. 1 to 3% of hairs are in this phase which lasts 2 to 3 weeks.
• Telogen phase – this is a resting phase lasting 1 to 4 months. At any one time about 10% of scalp hair is in this phase. 

Image credit: Depositphotos

At the end of the resting stage your hair goes through a shedding phase – this is when a hair falls out. When a hair is shed, it’s replaced by a new hair from the same hair follicle. Hair follicles make new hairs and are found just beneath the skin surface. You have about 100,000 hairs on your head. Every day you may lose 50 to100, and what is lost is replaced with a new hair.

Disturbances to any phase of the hair cycle can cause abnormal hair loss.

Causes

Abnormal hair loss can be due to:

• decreased hair growth – anagen hair loss (eg, due to chemotherapy or alopecia areata)
• increased shedding of hair – telogen hair loss (eg, due to stressors such as pregnancy/childbirth, fever, weight loss, surgery)
• congenital (present from birth) or acquired hair shaft abnormalities (eg, due to use of hair re-shaping products or persistent physical stress from tight hairstyles)
• inflammatory skin disease that damages or destroys the hair shaft.

Alopecia areata

Alopecia areata is an autoimmune disease where your immune system mistakenly attacks your hair follicles, causing them to shrink and stop producing hair. 

Alopecia areata causes sudden hair loss which can affect any part of your body. You may have an itching, burning or tingling sensation in the affected area before or after the hair loss. Nails can also be affected, with pitting or breaking.

This condition causes your hair to fall out abruptly, resulting in totally smooth, round patches about the size of a coin, or larger, on your scalp. The condition may run in families, although not all people with the condition have a family history of alopecia areata. It can affect children and adults of any age, commonly those under 20 years of age.

Hair re-growth may happen even without treatment and even after many years. However, if you develop total scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis), there’s less chance of full re-growth. People with alopecia areata commonly experience hair loss on and off throughout their lives.

Image credit: Canva

Telogen hair loss

Telogen hair loss, also known as telogen effluvium, is a condition in which you shed too many hairs. Many of your hairs have been pushed into the resting (telogen) phase and 2 to 4 months later shedding happens all at once. This may lead you to lose up to 500 hairs a day, instead of the usual 50 to 100.

You may realise you’re shedding more hair than usual or find handfuls of hair on your pillow, comb, hairbrush or in the plughole. Causes include:

• stress, eg, a major life event or accident
• childbirth (for both mother and baby)
• fever or severe infection including COVID-19
• thyroid disease
• weight loss or nutritional deficiency, eg, iron
• eating disorders
• excessive bleeding
• major surgery or illness
• medicines such as contraceptives (especially when you stop taking the combined oral contraceptive pill), anticoagulants and anticonvulsants.

Anagen hair loss

Anagen hair loss, also known as anagen effluvium, is when your hair is held in the growing (anagen) phase. Your hair can’t grow longer and is broken or tapers off. Your hair loss is sudden and can be caused by:

• cancer treatment such as chemotherapy, radiotherapy or medicines that can suppress your immune system
• infections
• short anagen syndrome – an inherited condition where children can’t grow their hair long.

If your anagen hair loss is caused by medicines, hair growth will return when the medicine is stopped.

Skin conditions

Skin conditions that affect your scalp can also cause hair loss. Examples include:

• seborrheic dermatitis (dandruff)
• psoriasis
• lichen planus
• discoid lupus erythematosus
• tinea capitis – a fungal infection of your scalp.

If you have a skin condition causing hair loss, you may have other skin symptoms such as skin redness, rashes, scarring or itchiness.

Traumatic hair loss

Traumatic hair loss or traumatic alopecia (also known as traction alopecia) is caused by hair reshaping products (relaxers, straighteners, hot combs) or persistent pulling with tight rollers and tight braiding. Using these styling methods over a long time can lead to irreversible hair loss (your hair won’t grow back). If you notice traumatic hair loss, the only thing you can do to stop it getting worse is to change the way you style your hair.

While some hair dyes (such as those containing paraphenylenediamine/PPD) may cause scalp irritation, hair loss is uncommon with these products.

Trichotillomania

Trichotillomania, also known as hair-pulling disorder, is a behavioural disorder that mainly affects young people. It can be associated with other mental health conditions such as obsessive compulsive disorder, depression or anxiety. This condition causes recurrent urges to pull your hair, which leads to hair loss.

Hair loss may affect just your scalp, hair on another part of your body or all of the hair on your body. You may notice increased hair shedding that happens suddenly, patchy hair loss, or short or broken hair depending on the cause. 

Round ring-like patches, especially if they’re itchy, either on your scalp or elsewhere may be ringworm. Check your cat or dog for the source – your vet can easily diagnose and treat your pet for the fungus causing ringworm.

If your hair loss is caused by a medical condition affecting other parts of your body, you may also notice other symptoms. Some of these are listed below.

Contact your healthcare provider if you have hair loss as well as any of the following symptoms:

• skin problems
• breathing problems
• poor appetite or unexplained weight loss
• vomiting (being sick)
• fever
• pain, particularly back pain or eye pain
• constipation or diarrhoea (runny poos)
• swelling of your hands and feet
• a rapid heartbeat.

Your healthcare provider will ask you questions about your hair loss, including the pattern of your hair loss and whether you have any other medical conditions. They’ll also examine your hair and your skin. Often they’ll be able to work out the cause of your hair loss straight away. If not, they may do a blood test, or skin swabs or scrapings.

If your GP or nurse practitioner isn't sure about the cause of your hair loss, or if you need specialist treatment, they will refer you to a dermatologist (doctor who specialises in skin conditions). 

Most abnormal hair loss gets better when the cause gets better. This means often your hair will grow back on its own without treatment. Hair loss caused by a medical condition will stop when you recover from that medical condition.

If treatment is needed, it will depend on the cause.

• Infection can be treated.
• If any of your medicines appear to be causing you hair loss your healthcare provider may stop them.
• Nutritional deficiencies can be treated by your healthcare provider.
• Skin conditions can be treated though some may not be curable.

If you have mild alopecia areata you may not need treatment as your hair may regrow on its own. More severe alopecia areata may be treated with corticosteroids which are powerful anti-inflammation medicines. These are given as injections into the area, creams or tablets.

Minoxidil is a medicine used to treat normal hereditary hair loss(external link) (male or female pattern hair loss). It's available from your pharmacy. Minoxidil is sometimes useful for other types of hair loss (eg, alopecia areata) and after hair replacement surgery or hair loss related to medicines such as chemotherapy. Read more about minoxidil for hair loss(external link).

Complementary and alternative therapies, such as acupuncture and ultra-violet therapy, have been promoted by some healthcare providers. However, there’s no evidence that these are effective.

In the meantime, makeup including false eyelashes, permanent makeup through a cosmetic technician, tattooing, and hats, bandanas or scarves are all options. You may consider wearing a wig. Your healthcare provider can help you find a source. Health New Zealand | Te Whatu Ora also provides a wig and hairpieces subsidy(external link) when hair loss is caused by a medical condition or from some cancer therapies.

Most types of hair loss can’t be prevented. However, there are a few things you can do that may help keep your hair healthy and strong for longer. 

Things to avoid include:

• tight hairstyles, such as braids, buns or ponytails
• twisting, rubbing or pulling your hair
• excessive heat treatments. 
• smoking which causes inflammation throughout your body which can make hair loss worse. 

Hair loss can be upsetting. You look different and other people may treat you differently. It can be difficult to get used to. Talking to others who've experienced it may help. You can also ask your healthcare provider about counselling available in your area.

The NZ Alopecia website(external link) provides information from fellow New Zealanders living with hair loss. 

Look Good, Feel Better(external link) provides free services for any person with any cancer at any stage. The programme is focused on skin, hair, mind and body – and the feel better moments provide practical tools and tips to help people face cancer with confidence.