Parasites and hair loss

Contents

Hair loss: Who gets and causes

What causes hair loss?

Hair loss has many causes. What’s causing your hair loss can determine whether your hair:

  • Falls out gradually or abruptly

  • Thins

  • Can regrow on its own

  • Requires treatment to regrow

  • Needs immediate care to prevent permanent hair loss

Causes of hair loss

Hereditary hair loss

Both men and women develop this type of hair loss, which is the most common cause of hair loss worldwide. In men, it’s called male pattern hair loss. Women get female pattern hair loss. Regardless of whether it develops in a man or women, the medical term is androgenic alopecia.

No matter which term you use, it means that you’ve inherited genes that cause your hair follicles (what each hair grows out of) to shrink and eventually stop growing hair. Shrinking can begin as early as your teens, but it usually starts later in life.

In women, the first noticeable sign of hereditary hair loss is usually overall thinning or a widening part.

When a man has hereditary hair loss, the first sign is often a receding hairline or bald spot at the top of his head.

Is regrowth possible?
Yes, treatment can help stop or slow hair loss. It may also help regrow hair. The earlier treatment is started, the better it works. Without treatment, you will continue to lose hair.

Both men and women develop this type of hair loss, which is the most common cause of hair loss worldwide. In men, it’s called male pattern hair loss. Women get female pattern hair loss.

Age

With age, most people notice some hair loss because hair growth slows. At some point, hair follicles stop growing hair, which causes the hair on our scalp to thin. Hair also starts to lose its color. A woman’s hairline naturally starts to recede.

Is regrowth possible?
Caught early, treatment helps some people regrow their hair.

With age, most people notice some hair loss because hair growth slows.

Alopecia areata is a disease that develops when the body’s immune system attacks hair follicles (what holds the hair in place), causing hair loss. You can lose hair anywhere on your body, including your scalp, inside your nose, and in your ears. Some people lose their eyelashes or eyebrows.

Is regrowth possible?
Yes. If your hair fails to grow back on its own, treatment may help stimulate regrowth.

Alopecia areata is a disease that develops when the body’s immune system attacks hair follicles (what holds the hair in place), causing hair loss.

Cancer treatment

If you receive chemotherapy or have radiation treatment to your head or neck, you may lose all (or most of) your hair within a few weeks of starting treatment.

Is regrowth possible?
Hair usually starts to regrow within months of finishing chemotherapy or radiation treatments to the head or neck. Dermatologists can offer medication to help hair grow back more quickly.

Is it preventable?
Wearing a cooling cap before, during, and after each chemotherapy session may help prevent hair loss.

If you receive chemotherapy or have radiation treatment to your head or neck, you may lose all (or most of) your hair within a few weeks of starting treatment.

Childbirth, illness, or other stressors

A few months after giving birth, recovering from an illness, or having an operation, you may notice a lot more hairs in your brush or on your pillow. This can also happen after a stressful time in your life, such as a divorce or death of a loved one.

Is regrowth possible?
If the stress stops, your body will readjust and the excessive shedding will stop. When the shedding stops, most people see their hair regain its normal fullness within 6 to 9 months.

A few months after giving birth, recovering from an illness, or having an operation, you may notice a lot more hairs in your brush or on your pillow. This can also happen after a stressful time in your life, such as a divorce or death of a loved one.

Hair care

If you color, perm, or relax your hair, you could be damaging your hair. Over time, this damage can lead to hair loss.

Is regrowth possible?
You can change how you care for your hair, which can prevent hair loss. Once you damage a hair follicle, hair cannot grow from that follicle. Having many damaged hair follicles creates permanent bald spots.

If you color, perm, or relax your hair, you could be damaging your hair. Over time, this damage can lead to hair loss.

Hairstyle pulls on your scalp

If you often wear your hair tightly pulled back, the continual pulling can lead to permanent hair loss. The medical name for this condition is traction alopecia.

Is regrowth possible?
No. You can prevent hair loss by making some changes.

If you often wear your hair tightly pulled back, the continual pulling can lead to permanent hair loss.

Hormonal imbalance

A common cause of this imbalance is polycystic ovary syndrome (PCOS). It leads to cysts on a woman’s ovaries, along with other signs and symptoms, which can include hair loss. Stopping some types of birth control pills can cause a temporary hormonal imbalance. Women who develop a hormonal imbalance can develop thinning hair (or hair loss) on their scalp.

Is regrowth possible?
Treatment may help.

A common cause of this imbalance is polycystic ovary syndrome (PCOS). It leads to cysts on a woman’s ovaries, along with other signs and symptoms, which can include hair loss.

Scalp infection

A scalp infection can lead to scaly and sometimes inflamed areas on your scalp. You may see what look like small black dots on your scalp. These are actually stubs of hair. Some people develop a bald spot.

Is regrowth possible?
Yes, treatment can get rid of the infection. Once the infection clears, hair tends to grow.

A scalp infeciton can lead to scaly and sometimes inflamed areas on your scalp.

Medication

A possible side effect of some medications is hair loss. If you think a medication is causing your hair loss, ask the doctor who prescribed it if hair loss is a possible side effect. It’s essential that you do not stop taking the medication before talking with your doctor. Abruptly stopping some medications can cause serious health problems.

Is regrowth possible?
Yes.

A possible side effect of some medications is hair loss. If you think a medication is causing your hair loss, ask the doctor who prescribed it if hair loss is a possible side effect.

Scalp psoriasis

Many people who have plaque psoriasis develop psoriasis on their scalp at some point. This can lead to hair loss.

Is regrowth possible?
Hair tends to regrow once the scalp psoriasis clears, but this takes time. By following these dermatologists’ tips, you may be able to prevent hair loss.

Many people who have plaque psoriasis develop psoriasis on their scalp at some point. This can lead to hair loss.

Pulling your hair

Some people pull on their hair, often to relieve stress. They may be unaware that they’re pulling their hair. The medical term for this is trichotillomania.

Is regrowth possible?
If you haven’t destroyed the hair follicles, yes. For your hair to regrow, you have to stop pulling it.

Some people pull on their hair, often to relieve stress. They may be unaware that they’re pulling their hair.

Scarring alopecia

This condition develops when inflammation destroys hair follicles. Once destroyed, a hair follicle cannot grow hair. Diverse conditions can cause this. The medical name for this group of conditions is cicatricial alopecia.

Is regrowth possible?
Once a hair follicle is destroyed, it cannot regrow a hair. Catching this condition early can prevent further hair loss.

This condition develops when inflammation destroys hair follicles. Once destroyed, a hair follicle cannot grow hair. Diverse conditions can cause this.

Sexually transmitted infection

Left untreated, a sexually transmitted infection (STI) can lead to hair loss. Syphilis is such an STI. Left untreted, syphilis can cause patchy hair loss on the scalp, eyebrows, beard, and elsewhere. Other STIs can also cause hair loss.

Is regrowth possible?
After treating the STI, hair often starts to regrow.

Left untreated, a sexually transmitted infection (STI) can lead to hair loss.

Thyroid disease

If you have a problem with your thyroid, you may see thinning hair. Some people notice that their hair comes out in clumps when they brush it.

Is regrowth possible?
Yes, treating the thyroid disease can reverse the hair loss.

If you have a problem with your thyroid, you may see thinning hair.

Too little biotin, iron, protein, or zinc

If you’re not getting enough of one or more of these, you can have noticeable hair loss.

Is regrowth possible?
Yes. When your body gets enough of the missing nutrients, hair can regrow.

If you’re not getting enough of one or more of these, you can have noticeable hair loss.

Friction

People can develop hair loss where boots, socks, or tight clothing frequently rubs against their skin. The medical term for this is frictional alopecia.

Is regrowth possible?
Hair tends to regrow on its own when the rubbing stops.

People can develop hair loss where boots, socks, or tight clothing frequently rubs against their skin.

Poison

Being slowly poisoned can lead to hair loss. Poisons that can cause hair loss include arsenic, thallium, mercury, and lithium. If you ingest a large amount of warfarin, which is found in rat poisons, it can also cause hair loss. Taking large amounts of vitamin A or selenium is also toxic and can cause hair loss.

Is regrowth possible?
Yes, hair tends to regrow when you are no longer exposed to the poison.

Being slowly poisoned can lead to hair loss. Poisons that can cause hair loss include arsenic, thallium, mercury, and lithium. If you ingest a large amount of warfarin, which is found in rat poisons, it can also cause hair loss.

While many causes of hair loss can be treated successfully, the key to effective treatment is to find out what’s causing the hair loss. Without an accurate diagnosis, treatment is often ineffective. You’ll learn how dermatologists diagnose and treat hair loss at: Hair loss: Diagnosis and treatment

Images
1a,1b, 2,4,5,7,8,10,14,15,16,17,18: Getty Images

3, 9: Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

6, 11: Images used with permission of DermNet NZ.

12, 13: Images used with permission of Journal of the American Academy of Dermatology:

  • J Am Acad Dermatol. 2002;46:807-21

  • J Am Acad Dermatol. 2009;60:660-8.

Freites-Martinez A, Shapiro J, et al. “Hair disorders in patients with cancer.” J Am Acad Dermatol. 2019;80:1199-1213.

Guo EL, Katta R. “Diet and hair loss: Effects of nutrient deficiency and supplement use.” Dermatol Pract Concept. 2017; 7:1-10.

Jakhar D, Kaur I. “Frictional (sock) alopecia of the legs: Trichoscopy as an aid.” Int J Trichology. 2018;10:129-130.

Senthilkumaran S, Balamurugan N, et al. “Acute Alopecia: Evidence to Thallium Poisoning.” Int J Trichology. 2017; 9: 30-2

Shannon F, Christa S, et. al. “Demographics of women with female pattern hair loss and the effectiveness of spironolactone therapy.” J Am Acad Dermatol. 2015;73: 705-6.

Sperling LC. “Alopeica.” In: Fitzpatrick JE, Morelli JG. Dermatology Secrets Plus (fifth edition). Elsevier, China, 2016:179-84.

Vafaie J, Weinberg JM, et al. “Alopecia in association with sexually transmitted disease: A review.”Cutis. 2005;76:361-6.

Yu V, Juhász M, et al. “Alopecia and associated toxic agents: A systematic review.” Skin Appendage Disord 2018;4:245-60.

Hair Loss

What Is It?

Published: December, 2018

Hair loss can range from mild hair thinning to total baldness. Hair can fall out for many different reasons. Medically, hair loss falls into several categories, including:

  • Telogen effluvium — This common form of hair loss happens two to three months after a major body stress, such as a prolonged illness, major surgery or serious infection. It also can happen after a sudden change in hormone levels, especially in women after childbirth. Moderate amounts of hair fall out from all parts of the scalp, and may be noticed on a pillow, in the tub or on a hairbrush. While hair on some parts of the scalp may appear thinner, it is rare to see large bald spots.
  • Drug side effects — Hair loss can be a side effect of certain medications, including lithium, beta-blockers, warfarin, heparin, amphetamines and levodopa (Atamet, Larodopa, Sinemet). In addition, many medications used in cancer chemotherapy — such as doxorubicin (Adriamycin) — commonly cause sudden hair loss affecting the entire head.
  • Symptom of a medical illness — Hair loss can be one of the symptoms of a medical illness, such as systemic lupus erythematosus (lupus), syphilis, a thyroid disorder (such as hypothyroidism or hyperthyroidism), a sex-hormone imbalance or a serious nutritional problem, especially a deficiency of protein, iron, zinc or biotin. These deficiencies are most common in people on restrictive diets and women who have very heavy menstrual flow.
  • Tinea capitis (fungal infection of the scalp) — This form of patchy hair loss happens when certain types of fungi infect the scalp. This causes the hair to break off at the scalp surface and the scalp to flake or become scaly. Tinea capitis is a common form of patchy hair loss in children.
  • Alopecia areata — This is an autoimmune disease that causes hair to fall out in one or more small patches. The cause of this condition is unknown, although it is more common in people who have other autoimmune diseases. When the same process causes total loss of hair from the scalp it is known as alopecia totalis.

  • Traumatic alopecia — This form of hair loss is caused by hairdressing techniques that pull the hair (tight braiding or cornrowing), expose hair to extreme heat and twisting (curling iron or hot rollers) or damage the hair with strong chemicals (bleaching, hair coloring, permanent waves). In addition, some people have an uncommon psychiatric disorder (trichotillomania) in which compulsive hair pulling and twisting can cause bald spots.
  • Hereditary pattern baldness, or androgenetic alopecia — In men, hair loss may follow the typical male pattern (receding front hairline and/or thinning hair at the top of the head). This is the most common type of hair loss, and it can begin at any time in a man’s life, even during his teen years. It usually is caused by the interaction of three factors: an inherited tendency toward baldness, male hormones and increasing age. Many women will develop some degree of female-pattern baldness. In women, thinning occurs over the entire top or crown of the scalp, sparing the front of the scalp.

Symptoms

We normally lose approximately 50 to 100 scalp hairs each day. If more than this is falling out, you may find unusually large amounts of hair in brushes, on clothing, and in the drains of sinks and tubs. You may also notice that your hair is generally thinner, that your part is wider, that your hairline has changed or that one or more bald patches have appeared.

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Scalp Infections That Cause Hair Loss – Treatments Included

There are many factors that contribute to hair loss, and scalp infection is one of them. It is normal to lose 50 to 100 strands of hair per day but excessive hair loss means there is something wrong. Scalp can become infected if bacteria or fungi enter through hair follicles or damaged skin. Such infection can become a major cause of hair loss.

In this blog, Lordhair will tell you about the different types of scalp infections that cause hair loss and also list out treatments which will help you prevent hair loss. Read on!

Folliculitis

One of the common scalp infections that cause hair loss is Folliculitis. Folliculitis is a skin condition in which hair follicles become inflamed. Follicles are small skin cavities which let hair grow on the human body. Folliculitis can appear on any area of the human body but it most commonly affects arm, face and head. These are mostly caused by ingrown hair or sweat. Using hair products which may not suit your scalp can also cause infection which will result in Folliculitis.

Folliculitis can result in itchiness, burning skin, pus-filled blisters, white headed pimples and small red bumps.

Treatment for Folliculitis

If Folliculitis is located on your hairline area, wash it twice a day with antibacterial soap prescribed by your Dermatologist. Visit your doctor to get your folliculitis diagnosed and get the recommended medication. Here are widely recommended home treatments for the hair loss condition:

    1. Wash your hair or scalp daily with lukewarm water as hot water may affect the infected area.
    2. Use cortisone cream since it will help you to soothe down the inflammation and scalp itchiness.
    3. Try to put a limit on shaving your head. Make sure that your trimmer blade is clean and sharp.

These scalp infection treatments will help you to eliminate the problem of Folliculitis which will lower the chances of hair loss.

Ringworm

Most of the people think that ringworm is a worm but actually it’s a skin infection caused by Fungi that germinates in the dead tissues of the scalp and hair. It forms a bump that causes a circle-shaped patch on the scalp. Ringworm begins as the flat scaly areas on the skin which may get red and itchy. The area inside the circle is clear or scaly whereas outer area might be slightly bumped or raised. Ringworm spreads when a human comes in contact with other humans by touching. It can also be caused by touching animals that are already infected by ringworm.

In some cases, ringworm causes a severe, painful inflammation on the scalp which causes swelling that drain pus. If it is not treated properly, it can cause hair loss.

Treatment for ringworm

Treatment of ringworm is determined on the basis of infection severity. Visit a doctor to get your skin inflection diagnosed. Most probably, you will be given a lotion and few medications. Below are some home remedies to prevent the condition from spreading further:

    1. Make sure to wash your scalp regularly.
    2. Don’t let others use your personal items like towels, clothes and handkerchiefs.
    3. Wash your hands often to avoid the infection.
    4. Tend not to touch animals that are already infected by ringworms. Getting in contact with them can spread ringworm to your body

With these scalp treatment methods and precautions, you can eliminate your Ringworm problem completely and chances of hair loss on your scalp will get low.

Scleroderma

Scleroderma that affects scalp is referred as ‘En Coup De Sabre’. It is a condition in which skin hardens and tightens. According to medical science, Scleroderma affects women more than men and occurs between the ages of 30 to 50. The tissue beneath the thick skin disappears which leaves a line on the scalp and face. Scleroderma can cause hair loss on the scalp. One of the earliest symptoms is that the small blood vessels in your fingers and toes will get contract in response to cold temperature or emotional distress. Your fingers and toes will get swollen or numb.

Infection treatment for scleroderma

Scleroderma is a complex medical condition that can affect your multiple organs. Hence, it is best to visit a doctor as soon as you come across symptoms that are similar to this disease.

    1. Steroid creams and pills may help you to decrease the swelling and pain.
    2. Medications will help you to prevent lung and kidney problems that are caused by Scleroderma
    3. Physical therapy will help you to eliminate Scleroderma problems on your scalp.

With these scalp treatments, you can try to eliminate the problem caused by Scleroderma resulting in hair loss.

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Pediculosis

Pediculosis is another common infection caused by lice on our head. Lice are small parasites that are found on the head of the people and body of livestock. These wingless parasites live in the hair of your head and sucks blood from the scalp. Lice infestation is very common since ancient times. This problem can be mostly found among children. A person who comes in contact with someone who already has lice in his head has a chance to get his head infested. Lice are smaller than Louse. Their bite can cause itchiness and red bumps on your head. Such bumps results in hair loss.

Skin infection treatment for Pediculosis

Unlike other scalp infections listed in this blog, this one is not very serious. Use the below mentioned home treatments to fight Pediculosis:

    1. Use a fine tooth comb or flea comb to kill lice on your head
    2. Get a shampoo and conditioner that are used to kill lice prescribed by dermatologist.
    3. Stop sharing your combs, brushes, hats and clothes with others as sharing these will transfer lice from already infected heads.

These treatments will definitely help you to prevent the infection caused by Pediculosis on the scalp.

Scalp Acne

We have heard that Acne occurs mostly on the face, back and chest. But sometimes we feel the same pain on our scalp while brushing our hair or rubbing our head. Acne on scalp can cause small and itchy pimples which can also become sore and crusted. Popping them or Hiding them with the cap or hat can make the situation worse. Blocking of hair follicle by the oil can form a pimple. A pimple on your head is caused by dirty hair or by using hair products like gel, wax and hair color.

Skin Infection Solution for scalp acne

While this condition is a major embarrassment, it is not a serious medical condition and recovery is possible by taking some precautions and medications. Below is what we recommend:

    1. Remove dirt and oil from your scalp by using mild shampoo which contains salicylic acid. Salicylic acid deep cleans the scalp and shed the dead skin.
    2. Take antibiotics which will make the pimple dry. It will help you to eliminate the pain caused by pimples.
    3. Avoid brushing the area near Acne. There is also no need to put pressure on your head while shampooing it.
    4. Visit your dermatologist for medicine advice

Following these treatments will help you in eliminating the acne problems on your scalp and will prevent the hair loss.

Above are the common scalp infections that cause hair loss. Using the above hair recovery solutions and treatments will not only help you to eliminate these problems but it will also make you feel your best self.

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Discover if the fungus in the hair is your problem and get rid of them!

The fungus in the hair can be very persistent and can last for several months or even years. The fungus in the hair can be contagious, which means that the infected person can pass it on to others via contaminated objects (say, combs) or direct contact.

There are several ways to treat fungi in your hair, and the first and basic step is good hygiene. You will notice in time if you have not successfully mastered the hair washing technique, as well as the hair wash.

On the other hand, you did not use real natural shampoos that kill bacteria and provide adequate skin care. And in the end, nature, like every time, is gifted, so is the same case and when the fungus is in the hair.

Hair loss causes

Throat fungus grows faster in moist and damp areas, so the main cause is poor hair hygiene or skin injury or skin moisture, such as frequent sweating. The infection can also be transmitted through contaminated hair brushes, combs and other head objects, such as caps.

Trichophyton or “T” and “Microsporum” or “M” fungus are the most common types that cause fungal fungi.

The most common causes are:

  • Shaving of the shaving head
  • Removing combs, rags, hair brushes with infected persons
  • Your hair is wet for a long time. The fungi progress best in humid conditions
  • Head injuries

Hair loss symptoms

The fungus in the hair that causes hair infection grows and spreads in warm and humid areas, so those with poor hygiene or living in places with warm climates may be more prone to developing this condition. Hair fungus is not a serious health problem, although there are rare cases in which complications arise due to a severe infection.

Hair fungus will show symptoms such as round and damaged scalp surfaces. Damage can be present only on one part or on the side of the head or even spread throughout the body.

Occasional spots usually appear inflamed and red, often showing some signs of baldness. In some cases, small black spots can be seen on the skin. Some of the sites can cause fine particles on the skin, which appear as dandruff or seborrhea on the hair.

Some people may feel mild skin itching or, in some cases, constant and persistent itching, while in some people itching will not occur at all. Brown hair, yellow bark and the appearance of hips may be associated symptoms, depending on the type of fungus in the hair. Dandruff on the skin can also occur.

Other weight symptoms include permanent scarring on the scalp and hair loss.

The diagnosis of the condition is primarily determined on the basis of the appearance of the head skin. Skin biopsy observed through a microscope will show the presence of dermatosis.

Other symptoms:

  • Round seals on the skin
  • Constant bleeding. The natural reaction is likely to be combing, which leads to hair loss
  • Smooth and weak hair, which is usually shorter than other hair
  • Stains that can be red in severe cases
  • Yellow bark in hair

Medically reviewed by Drugs.com. Last updated on May 3, 2019.

  • Health Guide
  • Disease Reference
  • Care Notes
  • Medication List

We normally lose approximately 50 to 100 scalp hairs each day. If more than this is falling out, you may find unusually large amounts of hair in brushes, on clothing, and in the drains of sinks and tubs. You may also notice that your hair is generally thinner, that your part is wider, that your hairline has changed or that one or more bald patches have appeared.

When hair loss is the result of telogen effluvium or medication side effects, the hair loss usually is all over the head, while in tinea infections and alopecia areata, the hair loss occurs in small patches. Also, tinea infections can cause additional symptoms, such as scaling of the scalp or areas of broken hairs that look like black dots. In traumatic alopecia, the area of hair loss depends on the method of hair injury and follows the pattern inflicted by hot rollers, braiding or chemical treatments. In male-pattern baldness, the hairline usually begins to recede at the temples first, followed by thinning at the top of the head. Gradually, the crown area becomes totally bald, leaving a fringe of hair around the back and sides of the head.

Diagnosis

Your doctor will diagnose the cause of your hair loss based on your medical history, the medications you take, your nutritional status, your hairdressing habits and a physical examination. If your doctor suspects a fungal infection of your scalp, he or she may take a hair sample for laboratory testing. Blood tests probably will be needed if your doctor suspects a medical illness (such as lupus) or a thyroid problem, iron deficiency or sex-hormone imbalance.

Expected Duration

How long hair loss lasts depends on the cause. In telogen effluvium, for example, hair usually is lost over several weeks to months, but then grows back over the next several months. When hair loss is a side effect of a medication, hair growth usually returns to normal once the drug is stopped. If you are losing hair because of abusive hairdressing, the hair loss usually stops after you change to more natural styling, except in traction alopecia, which results from years of pulling the hair back in tight braids. In tinea scalp infection, the fungus that causes the problem must be treated for at least 6 to 12 weeks and hair regrowth may be slow. Early treatment is important in preventing possible permanent hair loss. Both male- and female-pattern baldness tend to get worse over time but can be treated.

Prevention

Some forms of hair loss can be prevented by minimizing stress, eating a healthy diet and using sensible hairdressing techniques, and, if possible, switching to medications that do not cause hair loss. Hair loss from fungal infections can be prevented by keeping hair clean and by never sharing hats, combs or brushes with other people. Hair loss from hereditary-pattern baldness can sometimes be prevented by medication.

Treatment

Hair loss resulting from telogen effluvium or drug side effects usually requires no treatment other than discontinuing the medication that is causing the problem. Limiting trauma or chemical exposure (such as use of a blow dryer, hair straightener, coloring or perms) may limit or stop hair loss. Hair loss from poor nutrition or medical illness usually stops with the adoption of a healthy diet and treatment of the underlying medical condition. Treatment of fungal scalp infection requires 6 to 12 weeks of oral medication, such as terbinafine (Lamisil) or itraconazole (Sporanox), with or without shampoos containing selenium sulfide (Selsun Blue, Head & Shoulders, others) or ketoconazole (Nizoral). Alopecia areata can be treated with a corticosteroid that is injected or applied to the skin. Other treatments for this condition include anthralin cream (Drithocreme, DrithoScalp, Psoriatec), minoxidil (Loniten, Rogain) or a combination of these therapies.

Many men and women with hereditary-pattern baldness do not seek treatment for hair loss. Those who do seek medical help can be treated with topical minoxidil (Rogaine) or (in men only) oral finasteride (Propecia, Proscar), or they can choose hair transplants or scalp-reduction surgery.

When To Call A Professional

Call your doctor whenever you are concerned about hair loss, especially if you are having other unexplained symptoms.

Prognosis

Many forms of hair loss are either self-limited (telogen effluvium or drug side effects) or respond to treatment with medication (tinea capitis). Even hereditary-pattern baldness tends to improve with treatment. However, treatment must continue indefinitely. In some conditions, hair loss cannot be reversed, especially if scarring has developed (as can happen in lupus-related scalp disease).

Learn more about Hair Loss

Associated drugs

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IBM Watson Micromedex

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Mayo Clinic Reference

  • Hair loss

External resources

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Tinea Capitis

Candrice R. Heath, MD, Caroline N. Robinson, BS and Roopal V. Kundu, MD

Tinea Capitis is a fungal infection that affects the scalp and hair. It is sometimes referred to as ringworm of the scalp. The signs and symptoms are variable, but most commonly include itchy, dry/flaky, bald patches on the scalp. Also in some cases, ringworm can result in severe inflammation and lead to permanent hair loss. Ringworm is very contagious and is frequently transmitted between young children. According to recent statistics, African-American and Hispanic children are most commonly affected.1,2

What is the cause of tinea capitis?
In the United States, tinea capitis is most often caused by a fungus (not a worm) called Trichophyton tonsurans.1 Depending on the causative fungus, tinea capitis can be acquired from other humans, plants or animals, though it is typically spread from human to human.1

A child can acquire ringworm by touching animals with asymptomatic infection, especially cats and dogs. The disease can also be spread through contact with objects such as: combs/brushes, clothing, linens and towels.

How do I know if I have tinea capitis?
Some signs of tinea capitis include hair loss (i.e., bald spots), dryness, flakiness, redness, pus, broken hairs (resembles black dots), fragile hair that is easily pulled out, open sores, tenderness. You may also have a swollen scalp and neck lymph nodes. As significant dandruff is uncommon in children, any flakiness of the scalp should be examined to rule out tinea capitis.1Your physician can take a sample of scale/ hair from your head and send it to be examined in the laboratory. Be aware that it may take several weeks for your sample to show signs of fungal growth.

What treatments are available for tinea capitis?
Unlike ringworm of the body, ringworm of the scalp must be treated with medications taken by mouth which may be prescribed for up to 8 weeks. Unfortunately, antifungal creams do not penetrate deep enough to adequately treat tinea capitis. The medication commonly prescribed to children is better absorbed with a fatty food (a spoonful of ice-cream).

If you are an adult, your doctor may check blood work before starting you on an antifungal oral medication to ensure that your liver is functioning appropriately. Although the most important treatment for tinea capitis is oral antifungal medications, an antifungal shampoo is typically prescribed (for the patient and their family members) to decrease the spread of the fungus.3

What actions should I take if I or any member of my family have been diagnosed with tinea capitis?

-Do not share hair brushes/combs, hats, caps or hooded clothing when the infection is active
-Any hair accessories, combs and brushes should be disinfected or thrown away to prevent reinfection or spread of disease.3
-Check all pets for patches of hair loss or dry skin. If noted to have any of these have them checked by a vet.

Hair shedding is a part of every day life, yes it clogs up your shower drain, and yes, it means you have to vacuum every other day or your carpet turns into a hairy rug… But the fact is, hair loss is totally normal.

On average we lose around 80 strands a day, if you begin to shed significantly more than that or you notice they aren’t growing back, well, that’s when things start to get a bit hairy (soz, couldn’t help it).

The thing is, when it comes to hair loss there are so many potential triggers, which means it can be tricky to pinpoint the exact reason why your strands are falling out, and henceforth, how to remedy the situation.

We spoke to hair loss expert, Anabel Kingsley, a leading Trichologist at the Philip Kingsley Clinic in London, to help break down the possible reasons why you’re losing hair.

First things first, Anabel explained that hair loss is a very common problem for women – much more so that people realise. “Research shows that at least 1 in 3 women will suffer from hair loss or reduced hair volume at some point in their lifetime”. So if you are losing strands, it’s important not to freak out, your mane will recover. In the meantime, here’s everything you need to know…

Firstly, there are different types of hair loss, genetic and reactive…

Genetic:

There’s a chance you’re genetically predisposed to hair thinning, which means you may see a progressive, gradual reduction in hair volume. “In these instances, certain hair follicles are sensitive to male hormones – and this sensitivity causes follicles to gradually shrink and produce slightly finer and shorter hairs with each passing hair growth cycle.” Explains Anabel.

Reactive:

This means your hair loss is the result of a trigger. “Excessive daily hair shedding (which is know as telogen effluvium) is not reliant on having a genetic predisposition, it occurs as the result of an internal imbalance or upset, such as a nutritional deficiency, severe stress, crash dieting or an illness” says Anabel.

Imaxtree

7 most common triggers of hair loss…

1. Hormonal imbalance

A hormonal imbalance can lead to multitude of annoying AF health and beauty issues, from adult acne to weight gain. If your hormones are out of whack the effects will radiate throughout the whole body (and of course, that includes your hair).

“Hormones play a huge role in regulating the hair growth cycle” explains Anabel. “Oestrogens (female hormones) are ‘hair friendly’ and help to keep hairs in their growth phase for the optimal length of time. Androgens (male hormones) are not very hair friendly, and can shorten the hair growth cycle.”

“An excess of androgens (which could be caused by an endocrine disorder, such as Polycystic Ovarian Syndrome) can cause hair loss. The extent of this is often down to genes – If you have a genetic predisposition to follicle sensitivity, a hormonal imbalance can affect your hair more than it would someone who does not have a predisposition.”

2. Stress

It’s no myth that excess stress can literally make your hair fall out. How does this happen? Well, it can raise androgen (male hormone) levels, which in turn can causes hair loss. “Stress may also trigger scalp problems, such as dandruff, disrupt eating habits and mess with the digestive system – all of which can have a negative impact on hair” says Anabel.

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3. Iron deficiency/anemia

“One of the most common causes of hair loss in women is an iron deficiency. Iron is essential for producing hair cell protein”, without it, your strands will suffer.

4. Hypothyroidism and hyperthyroidism

“The thyroid gland helps to regulate the body’s metabolism by controlling the production of proteins and tissue use of oxygen. Any thyroid imbalance can therefore affect hair follicles”, Anabel explains. Also, if hypothyroidism is left untreated it may result in anaemia, which – as we’ve just discussed – is another condition that can impact the hair (or lack of it).

5. Vitamin B12 deficiency

A lack of vitamin B12 can leave you feeling tired and low on energy, sound familiar? Well, the fun doesn’t stop there, it can also take it’s toll on your hair…

“Vitamin B12 deficiency often causes hair loss as it can affect the health of red blood cells, which carry oxygen to your tissues” says Anabel. “It’s most common in vegans as you can primarily only obtain B12 through animal proteins.”

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6. Dramatic weight loss

A steep drop on the scales can impact your tresses, “6-12 weeks after dramatic weight loss, whether it be intentional or unintentional, hair commonly comes out in excess” says Anabel.

While our hair is incredibly important to us psychologically, physiologically it is non-essential”

“While our hair is incredibly important to us psychologically, physiologically it is non-essential; we could survive without it with no detriment to our physical health. This means that any nutritional deficiency often first shows up in our hair.” Yet another reason to avoid crash dieting and instead try to adopt a healthy, balanced lifestyle.

7. Age

If you’re going through or about to enter the menopause, changes in your body may also have an effect on your hair. “Hair loss becomes more prevalent leading up to and after the menopause” reveals Anabel. That being said, “it’s important to realise that our hair ages, and as we get older, hair naturally gets finer. It’s a totally normal part of the ageing process.”

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And here’s what you can do to fix it:

Ok, so now you know what triggering the hair loss, here’s how to deal with it…

Recognise the problem

Hair loss doesn’t happen fast, our strands grow in cycles, which means it can take up to 3 months for hair to fall out after a trigger has caused it. “If you notice excessive daily hair shedding for longer than 3 months, see a trichologist or your GP, there could be an underlying factor that needs to be addressed”, Anabel advises. “Very importantly, try not to panic. Telogen effluvium (excessive shedding) is almost always self-eliminating and hair will start to grow back as usual once any internal imbalance is put right”.

Change up your diet

1) Get More Protein

“Hair is made of protein, making adequate daily intake of protein rich foods essential. Include at least a palm sized portion of protein at breakfast and lunch (approx. 120g in weight).” Anabel recommends.

2) Complex carbohydrates are essential

“They provide our hair with the energy it needs to grow. Snack on a healthy carbohydrates (i.e. fresh fruit, crudité or whole wheat crackers) if longer than four hours is left between meals; as energy available to hair cells drops after this amount of time.”

That being said, Anabel explained that if you are losing your hair because of something other than diet, like stress or an illness, changing what you eat will not remedy it.

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Take a supplement

“Being non-essential tissue, the hair’s nutritional requirements are unique – and supplementation can be very helpful in boosting levels of vitamins and minerals available to your follicles. But, they must be taken alongside a healthy diet for full benefit.”

Anabel recommends looking out for the following ingredients: Iron, Vitamin C, Vitamin B12, Vitamin D3, Copper, Zinc, Selenium, and the essential amino acids, L-Lysine and L-Methionine.

Get smart about styling

Yes, that messy topknot may look cool, but it could being placing stress on your strands. “Avoid hairstyles that place traction on the hair and hair follicles” Anabel says. She also recommends avoiding heavy styling creams and serums, as they can add unnecessary weight to the hair.

DON’T freak out

Losing your hair can leave you feeling stressed, but Anabel explains that it’s incredibly important to realise how common female hair loss is – and that if you are experiencing it, you are not alone and it is nothing to be embarrassed about.

“One product alone will not remedy hair loss – you must also look at your general health, your diet, as well as optimise the health of your scalp and the condition of growing hairs. Above all, although it is very difficult, be patient and do not despair. Due to the nature of the hair growth cycle, it takes at least 6 weeks to see an improvement.”

For more information about hair loss contact your GP or you can book in for a consultation a the Philip Kingsley Trichological clinic.

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Causes and treatments for hair loss

Possible causes of hair loss include:

1. Androgenetic alopecia

Share on PinterestPossible causes of hair loss include androgenetic alopecia, pregnancy, and telogen effluvium.

Androgenetic alopecia is another term for male or female pattern baldness. It is a very common cause of hair loss.

Both male and female pattern baldness is genetic. Males tend to lose hair from the temples and crown of the head. In females, hair usually becomes thinner all over the head.

Androgenetic alopecia is more likely to happen as a person ages but can start at any point after puberty. Many females who experience androgenetic alopecia develop it after going through the menopause. This means that hormones may have something to do with it.

It is possible to treat this condition with minoxidil, a medication for hair growth.

2. Pregnancy

Some women may experience excessive hair loss shortly after giving birth. This is due to a decrease in estrogen levels. This type of hair loss is a temporary condition and usually resolves within a year or sooner.

To help hair return to its normal condition, try:

  • using a volumizing shampoo and conditioner
  • using products designed for fine hair
  • avoiding intensive conditioners or conditioning shampoos as these can be too heavy for fine hair
  • applying conditioner to the ends of the hair, rather than the scalp, to avoid weighing hair down

3. Telogen effluvium

Telogen effluvium is a condition where the hair remains in the telogen (natural shedding) phase of the growth cycle. This causes more hair to fall out, sometimes in handfuls.

Telogen effluvium is usually a temporary condition that resolves over time. It is advisable to see a doctor to find out the cause.

Some possible causes include:

  • severe stress
  • surgery
  • childbirth
  • rapid weight loss
  • thyroid problems
  • certain medications

A doctor will need to treat any underlying causes of telogen effluvium.

If a doctor suspects that specific medications are causing hair loss, they may change them.

4. Anagen effluvium

Anagen effluvium causes large amounts of hair to fall out rapidly during the anagen (growth) phase of the hair cycle.

The condition may cause hair to fall out from the head, as well as from other parts of the body, including eyebrows and eyelashes.

Causes of anagen effluvium include:

  • chemotherapy
  • radiation
  • fungal infections
  • autoimmune disease

Treatment for this condition depends on the cause but can include a topical solution of minoxidil.

If a person has anagen effluvium as a result of undergoing chemotherapy, cooling the scalp during the procedure may help. Hair will often grow back 3–6 months after stopping chemotherapy.

5. Alopecia areata

Alopecia areata is an autoimmune condition that causes hair to fall out suddenly. The immune system attacks hair follicles, along with other healthy parts of the body.

Hair from the scalp, as well as eyebrows and eyelashes, may fall out in small chunks.

If a person has this condition, they should see a doctor. A doctor may prescribe medication to help the hair grow back.

6. Traction alopecia

Traction alopecia is hair loss due to pulling hair into tight hairstyles, which causes it to break and come loose. Hairstyles associated with this condition include:

  • tight buns or ponytails
  • braids
  • cornrows
  • extensions

If traction alopecia continues, a person may develop bald spots and thinning of the hair.

In terms of self-care, avoiding tight hairstyles will usually prevent further damage.

7. Medications

Certain medications have side effects that can cause hair to fall out.

Examples of such medications include:

  • blood thinners, such as warfarin
  • Accutane, to treat acne
  • antidepressants, including Prozac and Zoloft
  • beta-blockers
  • cholesterol-lowering drugs, such as Lopid

If a person thinks hair loss may be due to a medication they are taking, they should consider seeing a doctor for an assessment. The doctor might be able to reduce the dosage or switch the person to a different medication.

8. Nutritional deficiencies

Nutritional deficiencies can cause hair to fall out. Extreme diets that are too low in protein and certain vitamins, such as iron, can sometimes cause excessive hair shedding.

A person should see a doctor for a blood test to check if they have a nutritional deficiency that could be causing their hair to fall out.

9. Birth control pills

People may experience hair loss while using birth control pills. Others might experience hair loss several weeks or months after they stop taking them.

If people are taking birth control pills, they can choose one that has a low androgen index. This may help to lower the risk of hair loss.

Examples of birth control pills with a lower androgen index include:

  • Desogen
  • Ortho-Cept
  • Ortho-Cyclen

Ovral and Loestrin have a higher androgen index.

Other forms of birth control that affect the hormones, such as implants and skin patches, may also cause hair loss.

The American Hair Loss Association recommend that people who have an increased risk of genetic hair loss opt for a non-hormonal type of birth control.

10. Ringworm

Ringworm is a fungal infection that can cause hair loss. Ringworm on the scalp, or tinea capitis, can cause temporary bald areas on the head.

Symptoms include:

  • a small spot that gets bigger, causing scaly, bald patches of skin
  • brittle hair that breaks easily
  • itchy, red patches of skin in the affected areas
  • oozing blisters on the scalp
  • ring-like patches, with a red outside and the inside of the circle matching the skin tone

If ringworm does not heal by itself, then a doctor may prescribe an antifungal medicine. Alternatively, they may prescribe an antibiotic, such as Griseofulvin.

Top Causes of Hair Loss for Women, Plus Treatment Options

Causes of Hair Loss in Women

Many factors can cause women to lose their hair, from hormones to stress to going on or off birth control. Here are some of the main causes of hair loss in women:

  • Androgenetic Alopecia Androgenetic alopecia (AGA), or pattern baldness, can cause women to get thinning hair on the top of the head, says Rebecca Baxt, MD, a dermatologist in Paramus, New Jersey. “It’s hormonal. Sometimes it’s hereditary, sometimes it isn’t, and it’s extremely common,” she explains. Dr. Baxt sees AGA in patients of all ages starting in the late teen years, but notes that it can certainly get worse around menopause due to hormonal changes.
  • Telogen Effluvium Another reason for hair loss is telogen effluvium, a condition in which women suddenly lose hair by the handful. Childbirth, surgery, disease, malnutrition, and other events and conditions that cause stress can cause telogen effluvium. Marital status may also play a role. A study published in the journal Plastic and Reconstructive Surgery found that women who had experienced the stress of losing a spouse, either to divorce or death, exhibited more hair loss than married women.
  • Alopecia Areata Alopecia areata is an autoimmune condition that causes round patches of sudden hair loss as the immune system attacks the hair follicles. Certain thyroid disorders can put you at risk for alopecia areata.
  • Birth Control Going on or off birth control, such as oral contraceptives, progestin implants, hormone injections, and the patch, can sometimes trigger hair loss in some women, Baxt says. The AHLA advises all women to use birth control pills with a “low androgen index,” and women with a family history of hair loss to use nonhormonal birth control.
  • Chemotherapy By attacking growing hair follicles, chemotherapy can cause almost complete hair loss. Scalp cooling caps can help minimize hair loss during chemotherapy.
  • Hairstyles Repeatedly wearing braids, cornrows, or other hairstyles that pull hair too tightly over a long period of time can cause hair thinning and hair loss. Overprocessing your hair with chemicals like bleach and heating tools like blow-dryers and flat irons can also damage your hair and cause breakage, but that’s different from hair falling out at the root, Baxt explains.
  • Nutritional Deficiency Anemia, or low iron stores, as well as a protein deficiency can also lead to hair loss, Baxt says.

Hair loss can be devastating for women, so early intervention is key, advises Dr. McMichael. “As with most medical conditions, the key to controlling the hair loss cycle is to seek treatment early.”

Hair-Loss Treatments

Fortunately, there are several treatment options available for hair loss and thinning hair. Your doctor may prescribe one or more of the following hair-loss treatments:

  • Testosterone-Blocking Drugs As women approach menopause, they have decreasing levels of estrogen compared with testosterone. Treatments geared toward blocking testosterone at the hair follicle, such as Aldactone (spironolactone) and Eulexin (flutamide), are helpful in treating hair loss, according to McMichael. Spironolactone is a blood pressure medication that’s sometimes used off-label to treat androgenetic alopecia, Baxt adds, which means the U.S. Food and Drug Administration (FDA) has not approved the drug for hair loss.
  • Rogaine (Topical Minoxidil) The sole treatment for female pattern baldness to receive FDA approval, Rogaine is available over the counter and works by stimulating new hair growth.
  • Treating Underlying Problems Treating an underlying condition that is causing the hair loss, such as a thyroid disorder or nutritional deficiency, can reverse hair loss problems.
  • Topical or Injected Cortisone This can help reverse some hair loss, and it works really well for patients with alopecia areata, Baxt says.
  • Hair Transplantation This involves surgically moving existing scalp hair to thin spots. “Surgical hair restoration is a very helpful treatment for women because women usually have less bald area to cover than men, so it is easier to make the density of hair look fuller,” says McMichael.
  • Laser Phototherapy Also known as low-level laser therapy, this light treatment may help to regrow hair. But McMichael says this therapy needs to be refined because its effectiveness in most patients is not yet proven.
  • Platelet-Rich Plasma Therapy Platelet-rich plasma (PRP) therapy is another “off-label” hair-loss treatment that has been growing in popularity over the last few years. During a PRP session, a technician draws a patient’s blood, then spins it to extract plasma. The plasma contains platelets, which promote hair growth, according to the Cleveland Clinic. The technician then injects the plasma into areas on the scalp affected by hair loss — usually about 15 to 20 injections per PRP session (patients typically require three monthly sessions plus a follow-up appointment, and then yearly maintenance sessions). “PRP does work for a majority of patients, but it’s expensive and you have to keep doing it,” Baxt says.

Hope for Women With Hair Loss

New research offers hope for women (and men) suffering from hair loss. In a study published in May 2018 in the journal PLoS Biology, researchers used an osteoporosis drug to prolong the growth phase of the hair cycle and potentially treat hair loss.

Other studies with mice have also been promising. In one series of experiments, researchers used an experimental compound to reverse hair loss in mice, according to a report published in July 2018 in the journal Scientific Reports. In a third study, published in July 2018 in the journal Cell Death and Disease, researchers discovered that turning off a mutant gene expression reversed hair loss in mice.

Additional reporting by Jennifer D’Angelo Friedman.

INTESTINAL PARASITES

Intestinal parasites are parasites that populate the gastro-intestinal tract in humans and other animals. They can live throughout the body, but most prefer the intestinal wall. Means of exposure include: ingestion of undercooked meat, drinking infected water, and skin absorption. A parasite is an organism that feeds off another organism, called a host. The major groups of parasites include protozoans (organisms having only one cell) and parasitic worms (helminths). Of these, protozoans, including cryptosporidium, microsporidia, and isospora, are most common in HIV-infected persons. Each of these parasites can infect the digestive tract, and sometimes two or more can cause infection at the same time.

INFECTION

Parasites can get into the intestine by going through the mouth from uncooked or unwashed food, contaminated water or hands, or by skin contact with larva infected soil, they can also be transferred by the sexual act of anilingus in some cases. When the organisms are swallowed, they move into the intestine, where they can reproduce and cause symptoms. Children are particularly susceptible if they are not thoroughly cleaned after coming into contact with infected soil that is present in environments that they may frequently visit such as sandboxes and school playgrounds. People in developing countries are also at particular risk due to drinking water from sources that may be contaminated with parasites that colonize the gastrointestinal tract.

SYMPTOMS

A list of common symptoms: Abdominal pain Hemoptysis Dysuria Central nervous system impairment Chest pain Chills Chronic fatigue Colitis Coughing Diarrhea Digestive disturbance Dizziness Fever Enlargement of various organs Headaches Vaginitis Jaundice Joint Pain Weight loss due to malnutrition Weakness Immunodeficiency Nausea/vomiting Swelling of facial features Sweating Insomnia Skin ulcers Rectal prolaspe Mental problems Lung congestion Memory loss Night sweats Muscle spasms Hair loss or thinning In some people, intestinal worms do not cause any symptoms, or the symptoms may come and go. If you have some of these symptoms, it does not necessarily mean that you are infected. These symptoms may also indicate to other diseases. Common signs and complaints include coughing, cramping, abdominal pain, bloating, flatulence and diarrhea. Some parasites also cause low red blood cell count (anemia), and some travel from the lungs to the intestine, or from the intestine to the lungs and other parts of the body. Many other conditions can result in these symptoms, so laboratory tests are necessary to determine their cause. In children, irritability and restlessness are commonly reported by parents.

DIAGNOSIS

Due to the wide variety of intestinal parasites, a description of the symptoms rarely are sufficient for diagnosis. Instead, two common tests are used: Stool samples may be collected to search for the parasites, and an adhesive may be applied to the anus in order to search for eggs.

TREATMENT

Prescription drugs are generally used to eradicate the parasites. Special poisons are tailored to kill one or more common varieties of intestinal parasites. Good hygiene is recommended to avoid reinfection.

For more information view the source: Wikipedia

Recommended Test: Full GI Panel

Recommended Product: Freedom Cleanse Restore Parasite Cleanse

Hair loss: Is it related to one’s health status?

She says that around and after menopause, it is natural for a woman to lose hair, explaining a reduced estrogen level as the root cause of this and that it mostly comes with menopause.

Pande also points out that any sickness can cause temporary hair loss.

Adverse effect of corticoid therapy, anti-cancer drugs, infections of the scalp like fungal infections, dandruff, lice infestation, can also cause excess hair fall and baldness, she says.

“Hair loss can be due to poor hair and scalp hygiene, use of shampoos and hair conditioners with harsh chemicals, lack of regular combing or using a comb with sharp bristles,” Pande says.

She adds that stress, dandruff and infections of the scalp are some of the other factors that cause hair loss.

Increase in testosterone or androgen levels can cause baldness and this can occur due to stress, or hormonal disorders, Pande notes.

“Drugs like corticoids, cancer treatment drugs, are some of the common causes. Apart from this, genetic factors also play a part. Chemicals like sodium lauryl sulphate and polyethylene glycol present in shampoos lead to hair loss, hence one should look out for these, while buying a shampoo,” she says.

Pande is of the view that hair loss may also happen without an apparent cause, for instance in cases of alopecia areata. Alopecia areata is a type of hair loss that occurs when the immune system erroneously attacks hair follicles, this damage is usually not permanent.

According to Julius Habimana, a general doctor at La Medicale’ Clinic in Nyarutarama, Kigali, loss of hair can be due to excess dryness, which is brought about by use of shampoos and hair conditioners.

He, on the other hand, says hereditary factors can play as a crucial factor when it comes to hair loss.

Habimana says some persons inherit thick hair, whereas others inherit sparse hair.

Prevention lies in taking in a well-balanced diet and avoiding factors that are capable of causing hair loss or its breakage, according to him.

“It is important to keep the hair clean and well-groomed to prevent hair loss. Avoid shampoos and hair conditioners with harsh chemicals. Also, regular oil massage of the scalp at least once in a week or every 10 days is useful,” says Habimana.

He adds that coconut oil or olive oil is good in this regard and that the diet should have adequate proteins. If hair loss has already started, correction of any known underlying cause can stop it. Drugs like minoxidil and hair implants are other options for treatment, notes Habimana.

Hair loss in men

According to research done by WebMD, about 85 per cent of men will have major hair thinning by the time they are 50. Some men start to lose theirs before they turn 21.

Research from Healthline also indicates that one cause of male pattern baldness is genetics, or having a family history of baldness. Research has found that male pattern baldness is associated with male sex hormones called androgens. The androgens have many functions including regulating hair growth.

Inherited male pattern baldness usually has no medical ill effects. However, sometimes baldness has more serious causes, such as certain cancers, medications, thyroid conditions, and anabolic steroids, the research continues to indicate.

Health conditions may be a cause of baldness when a rash, redness, pain, peeling of the scalp, hair breakage, patchy hair loss, or an unusual pattern of hair loss accompanies the hair loss. A skin biopsy and blood tests also may be necessary to diagnose disorders responsible for the hair loss.

*****

EXPERTS SHARE TIPS

Iba Mayale, gynecologist
During pregnancy, women can experience falling hair. This is due to increase in the levels of estrogen hormone which causes hair to remain in the growing phase later leading to its loss. Most of the time it also happens during and after three to four months after delivery. In this case, one need not to worry as its normal and the hair follicles rejuvenate themselves after some time.

Elias Ntwali, general practitioner
Loss of hair in some people can be a sign of some diseases, which if left untreated can cause bigger problems in future. For instance, extreme dieting or problems with the body’s digestive and absorption processes can lead to hair loss due to malnutrition. That’s why it’s important to get checkups to find the real cause when one experiences loss of hair.

Boniface Nsekanabo, physician at Avega Clinic Remera
Aging and certain sickness such as ringworms are factors that increase the risks of one loosing hair. On the other hand, for the women, avoiding heat styling as much as possible is important as it prevents hair breakage.

Celestine Karangwa, physiotherapist
Sometimes it’s hard for one to notice that they are losing hair, this is because their hair starts by thinning then falling out slowly. Generally, to avoid such cases, avoiding different types of chemicals and sticking to the right diet is important.

Complied by Lydia Atieno

31-Year-Old Woman With Chronic Daily Headache and Alopecia

A 31-year-old woman with a history of temporomandibular joint syndrome presented to our internal medicine consultation clinic with daily headache of 7 months’ duration. Symptoms began with a 3-week illness of low-grade fever, nonproductive cough, and gradual onset of persistent daily headache with occasional neck pain and stiffness. The headache was described as diffuse, dull and nonthrobbing in nature, scoring 5 on a scale of 1 to 10, but 8 at it’s worst. The headache was aggravated by exertion and improved with rest. One month after onset of the illness, she experienced episodes of blurry vision without photophobia, eye pain, or lacrimation. Ophthalmology evaluation at an outside facility was unrevealing. At 5 months after the illness began, she was treated for presumed sinusitis by local providers with 1 dose of ceftriaxone intramuscular injection and a course of azithromycin, which produced minimal relief of her headaches. Her other symptoms included progressive fatigue, mental fogginess, weight loss of 11 kg, nausea, and paresthesia of the hands and feet without focal weakness. She had been in a monogamous relationship for 4 years that involved unprotected intercourse, but prior to that she was not involved in high-risk sexual activity such as multiple partners. She had no history of tobacco, drug, or alcohol use, sexually transmitted diseases, foreign travel, or tuberculosis exposure. She had no family history of headaches and no personal or family history of thrombophilia, recurrent miscarriages, bleeding disorders, or autoimmune disorders. Findings on magnetic resonance imaging (MRI) of the brain without gadolinium performed elsewhere were considered normal.

On physical examination at our clinic, her pupils were reactive to light and accommodation, and extraocular movements were intact. Fundoscopic examination revealed flat optic discs with normal vasculature. Her neck was supple with full range of motion and no tenderness. Responses in cranial nerves II through XII were intact. She had full motor strength throughout her body, normal findings on sensory examination, and no skin lesions. The outside brain MRI was reviewed by a neuroradiologist, who reported subtle dural thickening up to 2 mm along both cerebral convexities that was consistent with hypertrophic pachymeningitis.

  • 1.

    Which one of the following is the most likely cause of this patient’s chronic daily headache?

    • a.

      Chronic migraine

    • b.

      Hemicrania continua

    • c.

      Idiopathic intracranial hypertension

    • d.

      Carcinomatosis

    • e.

      Chronic meningitis

Chronic daily headache is defined as headache that occurs more than 15 days per month for a duration of at least 3 months.1x1Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders. 2nd ed. Cephalalgia. 2004; 24: 1–150 (Available at:)
Google ScholarSee all References Primary headaches such as migraine, tension-type, and cluster cephalgias may only be diagnosed after secondary causes have been ruled out. Secondary causes include trauma, infection, anatomic defects (eg, Chiari malformation), neoplasms, and high or low cerebrospinal fluid (CSF) pressure among others. A chronic migraine is defined as daily headache with at least two of the following: unilateral location, pulsating quality, moderate or severe pain intensity, or aggravation by routine physical activity. It also must include at least one of the following: nausea and/or emesis, photophobia and/or phonophobia, pain relieved by triptan or ergot, and no other explanation such as medication overuse or other cause.1x1Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders. 2nd ed. Cephalalgia. 2004; 24: 1–150 (Available at:)

Google ScholarSee all References Although chronic migraine is possible in this patient, her symptoms are concerning for secondary headache with new onset at age 30, no family history of migraine, and abnormal MRI findings. Her symptoms are not consistent with hemicrania continua, given the bilateral distribution of pain and lack of cranial autonomic symptoms such as lacrimation, nasal congestion, conjunctival injection, and facial flushing.1x1Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders. 2nd ed. Cephalalgia. 2004; 24: 1–150 (Available at:)

Google ScholarSee all References Idiopathic intracranial hypertension is unlikely; the presentation can vary widely but often includes papilledema on fundoscopic examination, a severe and lateralizing pulsatile headache, intracranial noises, double vision, and nausea.1x1Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders. 2nd ed. Cephalalgia. 2004; 24: 1–150 (Available at:)

Google ScholarSee all References Hypertrophic pachymeningitis, noted on review of the MRI, has a broad differential diagnosis including chronic meningitis (eg, infectious or autoimmune), intracranial hypotension, and carcinomatosis (eg, lymphoma or skull-based metastases). Our patient had weight loss but no other B symptoms such as fever or night sweats to suggest carcinomatosis. Chronic meningitis should be highly suspected given the MRI findings as well as her symptoms of headache, neck pain, blurry vision, nausea, and paresthesia. There are multiple infectious causes of chronic meningitis including tuberculosis, human immunodeficiency virus (HIV) infection, syphilis, listeriosis, brucellosis, and fungal, parasitic, and other chronic bacterial and viral etiologies. Noninfectious causes include sarcoidosis, systemic lupus erythematosus, granulomatous angiitis, Sjögren syndrome, or Behçet disease.

A detailed review of symptoms was negative for additional symptoms except hair loss. She first noticed clumps of hair falling out 1 month after the onset of the illness, reporting nearly 50% volume loss in a diffuse pattern over the front and mid scalp; the hair loss had continued throughout her illness. On further examination, her hair was diffusely thinned, but no scaling or skin rash was observed. A hair pull test was positive for telogen. The challenge now was to determine the link between her alopecia and chronic meningitis.

  • 2.

    In view of the findings thus far, which one of the following is the most likely cause of the patient’s hair loss?

    • a.

      Alopecia areata

    • b.

      Connective tissue disease

    • c.

      Androgenetic alopecia

    • d.

      Infection

    • e.

      Telogen effluvium

Alopecia can be described as scarring or nonscarring and further classified as diffuse or focal. In general, alopecia can be caused by hormonal and genetic causes, medications, thyroid disorders, autoimmune disease, hypervitaminosis A, nutritional deficiencies (eg, zinc or biotin), and infection.2x2Harrison, S. and Bergfeld, W. Diffuse hair loss: its triggers and management. Cleve Clin J Med. 2009; 76: 361–367
Crossref | PubMed | Scopus (49) | Google ScholarSee all References Alopecia areata is unlikely because it presents with focal patches of nonscarring hair loss in children and young adults. Our patient did not report rash or arthralgia, so a connective tissue disease would not be likely, although serologic tests would still be advised for a complete evaluation. Androgenetic alopecia presents with frontal sparing and thinning over the central part of the scalp. This pattern was not present, and the patient had no history of menstrual irregularities, acne, or hirsutism. Therefore, given the lack of another compelling explanation and the concern for chronic meningitis, an infectious etiology is considered most likely. The most common infectious causes include fungal (tinea capitis) and systemic (eg, HIV or syphilis) infections. Tinea capitis is a focal, scaling hair loss seen in children. Alopecia syphilitica presents in 4% to 12.5% of patients with secondary syphilis and hair loss.3x3Bi, M.Y., Cohen, P.R., Robinson, F.W., and Gray, J.M. Alopecia syphilitica—report of a patient with secondary syphilis presenting as moth-eaten alopecia and a review of its common mimickers. Dermatol Online J. 2009; 15: 6
PubMed | Google ScholarSee all References It is characterized by noninflammatory and nonscarring hair loss with either a moth-eaten or diffuse pattern. Telogen effluvium is a stress-related cause of diffuse hair loss. Although it may have contributed to her hair loss, the concern for chronic infection and the ongoing hair loss diminish the primacy of this diagnosis.

Laboratory assessment (reference ranges provided parenthetically) revealed negative results for antinuclear antibody, an elevated C-reactive protein level (14 mg/L; ≤8 mg/L), and negative serologic results for HIV, West Nile virus, and Epstein-Barr virus. The rapid plasma reagin (RPR) titer was elevated at 1:64, and subsequent testing yielded positive results for syphilis. The patient was diagnosed as having secondary syphilis with alopecia syphilitica.3x3Bi, M.Y., Cohen, P.R., Robinson, F.W., and Gray, J.M. Alopecia syphilitica—report of a patient with secondary syphilis presenting as moth-eaten alopecia and a review of its common mimickers. Dermatol Online J. 2009; 15: 6
PubMed | Google ScholarSee all References

  • 3.

    Which one of the following is the criterion standard for the diagnosis of syphilis?

    • a.

      Darkfield microscopy

    • b.

      RPR

    • c.

      Fluorescent treponemal antibody absorption

    • d.

      Treponema pallidum particle agglutination

    • e.

      Serum IgG syphilis serology

Treponema pallidum cannot be isolated in culture. The criterion standard, when feasible, is direct visualization by trained personnel. The thin corkscrew-shaped spirochete organisms (found in mucous membranes) can be seen with darkfield microscopy or direct fluorescent antibody test. However, in clinical practice, screening has typically been performed with nontreponemal serologic tests, including the Venereal Disease Research Laboratory (VDRL) test and RPR. If results are positive, confirmation by treponemal tests such as fluorescent treponemal antibody absorption or T pallidum particle agglutination would be performed. This traditional testing method is slow and labor intensive. High throughput laboratories have now adopted the reverse testing algorithm,4x4Centers for Disease Control and Prevention (CDC). Syphilis testing algorithms using treponemal tests for initial screening—four laboratories, New York City, 2005-2006. MMWR Morb Mortal Wkly Rep. 2008; 57: 872–875
PubMed | Google ScholarSee all References which uses a Treponema-specific antibody screen by enzyme immunoassay or a multiplex flow immunoassay. A positive test result indicates exposure, and subsequent RPR helps determine disease activity. Rapid plasma reagin reports a titer that can help determine treatment effect or reinfection (4-fold titer decrease or increase, respectively). There are a few pitfalls to testing, including occasional false-negative results in severely immunosuppressed patients (eg those with advanced HIV infection).5x5Zetola, N.M., Engelman, J., Jensen, T.P., and Klausner, J.D. Syphilis in the United States: an update for clinicians with an emphasis on HIV coinfection. ()Mayo Clin Proc. 2007; 82: 1091–1102
Abstract | Full Text | Full Text PDF | PubMed | Scopus (82) | Google ScholarSee all References Furthermore, both syphilis IgG and IgM serology results may be negative in very early syphilis or, rarely, when patients have been treated successfully more than 10 years previously.6x6Workowski, K.A., Berman, S., and Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. ()MMWR Recomm Rep. 2010; 59: 1–110
PubMed | Google ScholarSee all References

The patient’s symptoms were consistent with neurosyphilis, which is strongly correlated with RPR titers greater than 1:32. A lumbar puncture showed a normal opening pressure of 21 cm H2O, and CSF analysis revealed 13.9 nucleated cells/μL (range, 0-5 cells/μL) with 92% lymphocytes and 8% monocytes; protein, 44 mg/dL (0-35 mg/dL); and glucose, 59 mg/dL with a serum glucose level of 94 mg/dL. A CSF VDRL test result was negative, and there was no bacterial or fungal growth from culture. Up to 70% of CSF VDRL test results are falsely negative in patients with neurosyphilis.7x7Jaffe, H.W., Larsen, S.A., Peters, M., Jove, D.F., Lopez, B., and Schroeter, A.L. Tests for treponemal antibody in CSF. Arch Intern Med. 1978; 138: 252–255
Crossref | PubMed | Scopus (88) | Google ScholarSee all References This patient’s previous treatment with ceftriaxone and azithromycin may have confounded the results of the CSF VDRL test as well. A patient with positive findings on syphilis serology and symptoms consistent with neurosyphilis may be diagnosed on the basis of pleocytosis (CSF lymphocyte count >5 cells/μL or >20 cells/μL with HIV coinfection due to an inherent pleocytosis from HIV)5x5Zetola, N.M., Engelman, J., Jensen, T.P., and Klausner, J.D. Syphilis in the United States: an update for clinicians with an emphasis on HIV coinfection. ()Mayo Clin Proc. 2007; 82: 1091–1102
Abstract | Full Text | Full Text PDF | PubMed | Scopus (82) | Google ScholarSee all References or by a protein concentration greater than 45 mg/dL.8x8Wharton, M., Chorba, T.L., Vogt, R.L., Morse, D.L., and Buehler, J.W. Case definitions for public health surveillance. MMWR Recomm Rep. 1990; 39: 1–43
PubMed | Google ScholarSee all References Our patient had borderline CSF protein levels, but the lymphocytic pleocytosis with high serum RPR titer indicated neurosyphilis.

  • 4.

    In this patient with neurosyphilis, which one of the following would be the most appropriate treatment?

    • a.

      Penicillin G, 50,000 U/kg intravenously (IV) every 8 to 12 hours for 10 to 14 days

    • b.

      Penicillin G, 2.4 million U intramuscularly (IM) once

    • c.

      Penicillin G, 2.4 million U IM weekly for 3 weeks

    • d.

      Doxycycline, 100 mg orally twice daily for 4 weeks

    • e.

      Penicillin G, 3 to 4 million U IV every 4 hours or 24 million U continuous IV infusion for 10 to 14 days

Penicillin G, 50,000 U/kg is the treatment of choice for congenital syphilis.6x6Workowski, K.A., Berman, S., and Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. ()MMWR Recomm Rep. 2010; 59: 1–110
PubMed | Google ScholarSee all References Penicillin G, 2.4 million U IM once, or the alternative doxycycline, 100 mg orally twice daily for 14 days, is the recommended treatment for early (primary, secondary, or latent for less than 1 year) syphilis.6x6Workowski, K.A., Berman, S., and Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. ()MMWR Recomm Rep. 2010; 59: 1–110
PubMed | Google ScholarSee all References Penicillin G, 2.4 million U IM weekly for 3 weeks, or alternatively doxycycline, 100 mg orally twice daily for 4 weeks, is the usual treatment for latent (tertiary) syphilis. Penicillin G, 24 million U continuous IV infusion for 10 to 14 days, is the most appropriate therapy for neurosyphilis. If adequate treatment duration is a concern, patients may be given additional penicillin G at 2.4 million U IM weekly for 1 to 3 weeks. Limited evidence suggests that ceftriaxone, 2 g/d IM or IV for 10 to 14 days can be used as an alternative in patients with penicillin allergy. Penicillin desensitization may be required if ceftriaxone is ineffective or if major cross-reactivity is present.

The patient was admitted to the hospital the next day for administration of a loading dose of penicillin and initiation of continuous penicillin infusion. She received 2 doses of dexamethasone both to relieve her headaches and to minimize the risk of Jarisch-Herxheimer reaction. She tolerated these treatments well. She was treated with penicillin G, 24 million U/d by continuous infusion for 14 days, followed by benzathine penicillin, 2.4 million U IM once weekly for 3 weeks.9x9Ghanem, K.G. Neurosyphilis: a historical perspective and review. CNS Neurosci Ther. 2010; 16: e157–e168
Crossref | PubMed | Scopus (126) | Google ScholarSee all References

  • 5.

    Which one of the following is the most common feature of neurosyphilis?

    • a.

      Cognitive and behavioral disorders

    • b.

      Condylomata lata

    • c.

      General paresis

    • d.

      Tabes dorsalis

    • e.

      Argyll Robertson pupils

In the postantibiotic era, mental and cognitive disorders have become the most common features of neurosyphilis, occurring in 85% of cases.10x10Mitsonis, C.H., Kararizou, E., Dimopoulos, N. et al. Incidence and clinical presentation of neurosyphilis: a retrospective study of 81 cases. Int J Neurosci. 2008; 118: 1251–1257
Crossref | PubMed | Scopus (39) | Google ScholarSee all References These symptoms may develop within months of treponemal inoculation and include irritability, forgetfulness, personality changes, insomnia, and impaired memory. It is possible that the broad usage of antibiotics for unrelated conditions may lead to partially treated syphilis and an even more indolent course of disease. Condylomata lata is not a feature of neurosyphilis but can manifest during the secondary stage of syphilis with gray papules or plaques on the genitals, anus, and other moist areas. General paresis progresses between 15 and 20 years after initial infection and is manifested by confusion with delusions, depression, delirium, mania, and psychosis.9x9Ghanem, K.G. Neurosyphilis: a historical perspective and review. CNS Neurosci Ther. 2010; 16: e157–e168
Crossref | PubMed | Scopus (126) | Google ScholarSee all References Tabes dorsalis occurs in 3% to 9% of untreated patients, usually 20 to 25 years after initial infection.9x9Ghanem, K.G. Neurosyphilis: a historical perspective and review. CNS Neurosci Ther. 2010; 16: e157–e168
Crossref | PubMed | Scopus (126) | Google ScholarSee all References It involves ataxic gait, paresthesia, sharp (lightning) pain, bladder dysfunction, and optic atrophy. Neither general paresis nor tabes dorsalis are commonly seen in the postantibiotic era. Argyll Robertson pupils, with the classic findings of accommodation but no reaction to light, are also rarely seen in the current postantibiotic era.

Additional testing for sexually transmitted infections was also negative for hepatitis B, hepatitis C, gonorrhea, and chlamydia. Ophthalmology examination revealed no evidence of iritis. The patient’s boyfriend, who was asymptomatic, was tested for syphilis and was found to have a positive RPR at a titer of 1:32. He has since undergone treatment. By 6 weeks after treatment, our patient reported complete resolution of her headaches and cessation of hair loss. Her follow-up will include CSF examinations every 6 months until CSF abnormalities resolve and serum RPR titers show a 4-fold decrease, which correlates with resolution of neurosyphilis.9x9Ghanem, K.G. Neurosyphilis: a historical perspective and review. CNS Neurosci Ther. 2010; 16: e157–e168
Crossref | PubMed | Scopus (126) | Google ScholarSee all References

Discussion

The stages of syphilis are broadly categorized as early, latent, and late. Early syphilis can be primary, which is manifested by chancre and regional lymphadenopathy, or secondary, which variably involves a diffuse macular or papular rash affecting the palms and soles, condylomata lata, fever, headache, alopecia, and anorexia. Syphilitic meningitis typically occurs in early syphilis and has either an acute or chronic presentation, the latter perhaps being more common in partially treated infection. Latent syphilis, occurring after initial infection, involves an asymptomatic phase with ongoing serologic evidence of infection. Finally, late or tertiary syphilis includes gummas, cardiovascular involvement such as aortitis, and central nervous system disease including general paresis and tabes dorsalis.

The highest rates of syphilis in the United States are in urban areas and southern states, along with a resurgence in HIV.11x11Centers for Disease Control and Prevention (CDC). Primary and secondary syphilis—United States, 2003-2004. MMWR Morb Mortal Wkly Rep. 2006; 55: 269–273
PubMed | Google ScholarSee all References Men who have sex with men account for 65% of all cases of syphilis.11x11Centers for Disease Control and Prevention (CDC). Primary and secondary syphilis—United States, 2003-2004. MMWR Morb Mortal Wkly Rep. 2006; 55: 269–273
PubMed | Google ScholarSee all References Coinfection with HIV is alarmingly high at 25%.12x12Centers for Disease Control and Prevention (CDC). Primary and secondary syphilis among men who have sex with men—New York City, 2001. MMWR Morb Mortal Wkly Rep. 2002; 51: 853–856
PubMed | Google ScholarSee all References Coinfection with HIV and the overuse of antibiotics, with subsequent partial treatment of treponemal infection, may be contributing to changes in the presentation of syphilis.5x5Zetola, N.M., Engelman, J., Jensen, T.P., and Klausner, J.D. Syphilis in the United States: an update for clinicians with an emphasis on HIV coinfection. ()Mayo Clin Proc. 2007; 82: 1091–1102
Abstract | Full Text | Full Text PDF | PubMed | Scopus (82) | Google ScholarSee all References Human immunodeficiency virus infection may accelerate and change the general course of syphilis, including an increased incidence of neurosyphilis and ocular syphilis.5x5Zetola, N.M., Engelman, J., Jensen, T.P., and Klausner, J.D. Syphilis in the United States: an update for clinicians with an emphasis on HIV coinfection. ()Mayo Clin Proc. 2007; 82: 1091–1102
Abstract | Full Text | Full Text PDF | PubMed | Scopus (82) | Google ScholarSee all References The classic late presentations of neurosyphilis have migrated toward a predominance of cognitive impairment and behavioral symptoms.10x10Mitsonis, C.H., Kararizou, E., Dimopoulos, N. et al. Incidence and clinical presentation of neurosyphilis: a retrospective study of 81 cases. Int J Neurosci. 2008; 118: 1251–1257
Crossref | PubMed | Scopus (39) | Google ScholarSee all References The reverse screening method detects antibodies to determine exposure, but subsequent RPR is required to determine disease activity and monitor successful treatment. Negative results on CSF VDRL testing are common and do not exclude neurosyphilis in a patient with syphilis-positive serology and suggestive symptoms; thus, CSF pleocytosis and a high protein level also indicate neurosyphilis. Brain MRI can be helpful by demonstrating pachymeningeal enhancement in syphilitic meningitis or signs of stroke or broader parenchymal involvement in late syphilis.

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