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Hair Loss – Special Forms And Causes

Hair Loss – Special Forms And Causes, certain diseases of the skin or scalp or internal diseases can cause hairless areas on the head. Sometimes hair roots perish, and the hair follicle is scarred so that no hair grows back there. Do not forget to indicate your opinions on our article about Hair Loss.

Hair Loss – Special Forms And Causes, This chapter is mostly about rather rare forms of hair loss, with or without scarring, with a rather focal or diffuse pattern, although sometimes there are also transitions here.

Non-scarring hair loss

  • Focal hair loss after infections of the skin (circumscripts = focal postinfectious alopecia): If the hair root, especially the germ layer (matrix) from which a new hair sprout, is not destroyed by the inflammation or no scars have arisen, the hair loss is recoverable.
    Cause: boils (blood-blackening, deep purulent hair follicle inflammation), carbuncles (multiple, merging boils), impetigo contagiosa (bark lichen: oozing or vesicular, bacterial, highly contagious rash, which occurs mainly in children and newborns), erysipelas (bacterial skin infection with flu-like symptoms), herpes zoster (shingles), syphilis (here diffuse ” motherwort-like” distributed bald spots).
    Symptoms: Bald patches on the head or other hairy areas of the body, in addition, depending on the clinical picture, more or less typical skin changes, sometimes also with itching or pain.
    Diagnosis: dermatological-clinical, if there is a suspicion of a disease, possibly a smear for bacteriological examination, further clarification by other specialists, such as a specialist in internal medicine.
    Therapy: According to the cause, for example, antibiotics for erysipelas, bark lichen, sometimes also for carbuncles, or an antiviral drug (if necessary also a painkiller) for Herpes zoster, sometimes surgically for certain infections such as carbuncles.
  • Loose(-anagen) hair syndrome: This temporary, diffuse hair growth disorder is mainly affected by children with blond hair aged two to five years, girls apparently more often than boys. The hair grows more slowly overall and is easy to pluck. The disorder is limited to the scalp and can be associated with no other abnormalities, but sometimes also with other developmental problems.
    Cause: Unclear, hereditary factors are discussed.
    Diagnosis: symptoms, positive hair plucking test. The hair can be pulled out easily and painlessly, even in tufts with a visibly thinner head. If necessary, Trichogramma: it shows predominantly meager (dystrophic) anagen hairs without a root sheath.
    Therapy: None. Hair loss usually stops after a few years, the hair grows back.
  • Mental disorders: Occasionally, there may also be a mental illness behind the alleged hair loss. Some people feel the compulsion to pull out their hair when they are tense. This by no means the rare behavioral disorder is called trichotillomania. Experts assume a disturbance of impulse control. It often begins in adolescence, women are more often affected than men.
    Cause: Various psychological factors such as fears or mental injuries (traumas), learned behavioral patterns such as dealing with stress. However, it is still unclear how the disorder arises. A hereditary predisposition is also discussed because the disorder occurs frequently in some families.
    Symptoms: In severe cases, the scalp has numerous bald spots, although the hair is actually completely healthy. Many sufferers invent alleged causes for the supposed hair loss or try to hide the light spots under headgear or hairpieces.
    Diagnosis, therapy: The conversation with a psychotherapist is considered groundbreaking. He also decides whether psychotherapy, usually in the form of cognitive behavioral therapy, is necessary. Among other things, those affected learn to deal with stressful situations and gradually release them from their compulsion.
  • Purely mechanical causes: Some hairstyles or lashed headgear can strain the hair. If you always wear a tight ponytail, you sometimes notice that the hair on the temples and in the parking area becomes thinner. The constant train may then be to blame. Also, prolonged pressure is not conducive to hair growth. So, after prolonged bed rest, hair on the back of the head can be lost.
  • Temporal triangular alopecia (Alopecia triangular congenital, focal hair loss): non-scarring hair loss.
    Symptoms: Coin-sized, hair-free area, usually at the hairline in the temporal region, so to speak reinforced receding hairline, often only on one side
    Cause: Congenital; there is a lack of mature hair roots.
    Diagnosis: Clinical-dermatological, medical history
    Therapy: None, hair transplantation if necessary
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Hair Loss - Special Forms And Causes
Hair Loss – Special Forms And Causes

Scarring hair loss: no hair regrowth

Hair Loss – Special Forms And Causes, Inflammatory diseases of the skin or scalp, and physical or chemical damage can destroy the hair roots and leave scars. Then there will be no more hair growing there. The causes of scarring hair loss are many (see below). In some cases, other skin areas can also become ill.
General symptoms on the scalp: Often there are skin changes such as itching, redness, blistering, swelling, oozing, pus formation, scaling, loss of pigmentation, and thinning of the skin. Then you will no longer see any hair outlets on the scalp, and the scalp will look shiny. This sequential state is called the pseudopelade state.

May be responsible for a pseudopelade status:

  • Chronic discoid lupus erythematosus:
    Cause: autoimmune disease.
    Symptoms: Red hardened spots mostly on exposed parts of the body (exposure to light can trigger acute disease flare-ups) hairy head, cheeks, forehead, nose, auricles, chest section, rarely on the trunk and limbs. Diseased areas on the scalp are sensitive to pressure and touch. The affected areas scar in the middle, you can no longer see hair pores, the skin fades or changes color, and may have dilated vessels. The edges are reddened, depending on the inflammatory activity.
    Diagnosis: dermatological-clinical, blood examination, scalp biopsy. Important is the exclusion of systemic lupus erythematosus, which affects the body as a whole. This is usually done by specialists in internal medicine.
    Therapy of lupus erythematosus is limited to the skin: consistent photoprotection, smoking cessation, cortisone preparations for application, in severe cases, cortisone or other special medications internally. More about this in the guide “Lupus erythematosus (LE)”.
  • Lichen-diseases of the scalp, nodular lichen-like (rare): Lichen planopilaris and frontal fibrosing, lichenoid (= lichen-like) alopecia probably belong to “variants” of nodular lichen, which occur in the area of the hair roots. As a result of inflammation, there is a chronic cornification disorder and permanent hair loss due to scarring.
    Cause: In lichen planopilaris, various triggers could trigger a misdirected immune response. How frontal fibrosing, and lichenoid alopecia develops is unclear. It is predominantly found in older women.
    Symptoms: with itchy, reddish, slightly raised spots and hypersensitivity of the diseased areas on the scalp, lichen planopilaris is manifested. Older “burned-out” areas have scarred, smoothly reflected, bald patches, and the hair pores have disappeared. At the same time, skin and nail changes can occur, as is typical for lichen diseases.
    With frontal fibrosing lichenoid alopecia, there is a band-shaped hair loss with a receding of the hairline in the forehead and temple area, plus a hem with the smallest nodular redness of the skin. Occasionally, hair stops. The eyebrows and other hairy parts of the body can also be affected, sometimes even before the scalp.
    Diagnosis: Dermatological-clinical and a scalp biopsy with fine tissue examination (see also chapter “Hair loss: overview…what men and women should know”, section: “Diagnosis”).
    Therapy: Cortisone-containing creams or injections with cortisone solutions are used in each case to block the underlying inflammation. In severe cases, the internal use of cortisone or other immunosuppressive drugs may be considered.
  • Folliculitis decalvans: This rare, chronic disease repeatedly leads to purulent inflammation of the hair roots or hair follicles for years (lat. Folliculitis). The hair falls out and does not grow back. Men get sick more often than women, aged about 20-40 years.
    Cause: Unexplained, possible interaction of bacterial and immunological factors. Family accumulations are occasionally observed; in rare cases, a connection to acne is detectable.
    Symptoms: Initially, small, moderately painful, red nodules appear finely scattered on the scalp (signs of folliculitis), with a tendency to the formation of pus pustules. Over time, many bald spots with reflective scars form, which can also merge into each other over a larger area. Characteristic are tufts of hair in dilated pores and scaly deposits of the hair shafts near the base of the hair on the edge of the herd. Persistent irritation with reddish nodules in the peripheral zones is a sign of the progression of the disease.
    Diagnosis: dermatological-clinical; skin biopsy, pathogen culture from pustular contents.
    Therapy: antibiotics are selected as early as possible according to pathogen culture in order to limit hair loss. If the disease is kept stable for a long time without therapy and does not threaten to break out acutely, then with good quality of the hair on the neck and the hair on the back of the head, the gaps can be filled with transplants if necessary.
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Hair Loss - Special Forms And Causes
Hair Loss – Special Forms And Causes
  • Deeper fungal infections of the scalp: scalp fungus (tinea capitis), can develop only superficially on the skin, but also profoundly (so-called kerion).
    Symptoms: an acute inflammatory reaction of itchy skin areas that redden strongly, pustules form, swell doughy, harden and become bald (“plaques”). Most often, cervical lymph nodes also swell. Head fungus generally affects children, but Kerion sometimes also affects men with a beard.
    Diagnosis: dermatological-clinical, information on the medical history, dermatoscopy (striking black dots, scales, “comma” hairs), fungal culture. Once the diagnosis of tinea capitis has been established, the source of infection should also be sought, for example, contact with cats.
    Therapy: various medications are used for local treatment. Either they inhibit the growth of fungi, or they kill the fungi. Often, the dermatologist prescribes a broad-spectrum antifungal agent in advance, which is effective against various types of fungi, since the result of fungal culture lasts longer. In the case of head fungus or beard lichen with deep foci of inflammation, he will also treat the patient internally with an antifungal agent – tablets, juice, or oral suspensions. This therapy can last up to three months. If it is carried out too short, there is a risk that the fungus will spread again. Oral medications are necessary because most medications do not reach the hair root from the outside.
  • Severe acne (Acne conglobata): may be accompanied by scarring and hair loss. More about the skin disease in the guidebook “Acne”.
  • Pseudopelade Brocq: A rare special form of scarring hair loss is the Pseudopelade Brocq (Alopecia atrophicans; atrophicans stands for shrinkage).
    Cause: Unknown.
    Symptoms: irregularly shaped, spot-shaped, sharply limited hairless areas, especially in the temporal and parietal region. They develop slowly, usually within two years. Adults are primarily affected, women three times as often as men. Although if the hair no longer grows back in the affected areas: the disease process can also come to a standstill.
    Diagnosis: Comprehensive dermatological-clinical examinations including scalp biopsy.
    Therapy: Currently unknown. A specialized center for rare skin and hair diseases should be involved in the medical diagnosis and consultation.
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Hair Loss – Special Forms And Causes

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