What’s normal hair loss, and what’s not? Understanding alopecia

IT is commonly said that a woman’s hair signifies her beauty, and when she loses her hair because of medical issues it can seriously impact how she views herself. This is true for Simone, a 33-year-old teacher, who learnt that she had alopecia areata when she was in primary school.

Alopecia areata is an autoimmune disease that causes hair to fall out in small patches, as the immune system attacks the hair follicles. Approximately 147 million people suffer from this type of alopecia worldwide.

Simone’s story

Simone told All Woman that after learning that she had alopecia areata, she was saddened and she wondered why it had to happen to her.

“I learnt that I had it from primary school you know, I felt a way. I didn’t know what it was, I just wondered why it had to happen to me,” she recalled.

Simone explained that after she got older and did her own research, she understood that what she had was an autoimmune condition.

“I heard it can be hereditary [and] I have uncles, aunts and cousins with it. When I realised that people in my family actually had it, I felt a little better because it was not something that was unique to me. Other people in my family have had that challenge and their hair grew back and it was OK,” she stated.

Though she had a flare up as early as last year due to her pregnancy, Simone said she knows that the condition returns whenever she is going through a very stressful period.

“When I’m not under stress or have any hormonal imbalances, I don’t have it. Coming into adulthood I thought I’d gotten rid of it altogether, but that wasn’t the case, because when I started studying and working I realised that I was seeing one and two spots sometimes.

“When I see the flare up now, I go to the hairdresser and she has her treatments that she will use and it will help. I also visit my doctor and he will put me on iron tablets or multivitamins that would help my stress, and would also help my hair, because you know, multivitamins help your hair as well,” she continued.

Simone, however, stated that having a supportive family has helped her minimise her stress levels, which in turn helps to control the condition.

“My mom, my son’s father, my sister and my cousin, they are all around me so I have that kind of support. So I don’t get too stressed,” she stated.

Poor hair care also a contributor…

July is International Women With Alopecia Month. Trichologist and owner of Shades of Elegance Salon, Treacha Reid-McCalla, noted that many autoimmune diseases are triggered by stress, and once the person is under stress, the condition will manifest itself.

She explained that there are different types of alopecia and these include traction alopecia, alopecia universalis or alopecia totalis, and alopecia areata.

According to Dr Jennifer Mamby Alexander, founder of the Hair Loss Clinic of Jamaica, over the last decade or so, hair loss in women has reached epidemic proportions in Jamaica due to over-processing and styling of the hair.

She told All Woman a few years ago that it really comes down to poor hair care.

“Black women are paying the price for beautiful hairstyles. While the latest hairstyles and hair colours may look great, women are subjecting their hair to harsh chemicals, heated styling devices, glued-on extensions, tight weaves and braids done in a salon or at home by friends and family without proper training. These processes, when done too frequently or incorrectly, lead to significant scalp damage and hair loss,” she said.

The most common form of hair loss in both men and women is androgenic alopecia, which is related to ageing and genetic factors. This condition leads to thinning of the hair in the crown and frontal regions of the head and in many cases evolve into baldness in those areas.

The second most common type of hair loss that occurs in women of colour is traction alopecia, which is a result of stress on the roots of the hair following the tightening of braids or locs, glued on wigs, heavy locs, tight wigs and ponytails or lace-front wigs.

“We have found that in many cases the hairstyles just mentioned were used to conceal hair loss, but eventually made the problem worse,” said Dr Mamby Alexander. “It is also interesting to note that traction alopecia can occur in men who also braid their hair or wear heavy/long locs.”

The good news is that if hair loss resulting from ageing and genetic causes is diagnosed early, the process can be stopped and reversed in many cases. The longer the process has been going on, the more irreversible it becomes.

Traction alopecia is usually totally corrected by transplant procedures that are offered at the Hair Loss Clinic of Jamaica. This, of course, is determined by the extent of the damage done.

Other causes of alopecia include burns to the scalp, or are related to the use of medications which is usually corrected once the medication has been discontinued or changed.

“I am not saying that women should stop wearing braids, twists, or wigs, but it’s important to wear them the right way. Even with the natural hair movement, proper hair care and protective styling is pivotal to the maintenance of the style and at the first sign of hair damage, treatment should be sought. It is only through proper education about hair care and know-how in treating damaged scalps that this almost silent epidemic of hair loss will be brought under control,” Dr Mamby Alexander explained.

Other treatment options locally

Reid-McCalla went on to say that some patients use serums and hair follicle boosters to manage their alopecia.

“Sometimes alopecia areata is caused by medications as well, as the medication would have placed the body under stress. Some medications for high blood pressure [or] if you’re a diabetic, [will cause you] to have hair challenges,” Reid-McCalla said.

While traction alopecia is caused by tight hairstyles that put a lot of tension on the scalp, she noted that, “alopecia universalis, which means the hair disappears from the entire body, and androgenetic alopecia, which is caused from ageing, have no preference in who it affects more. It’s rare, because you don’t find it happening to a lot of people”.

Reid-McCalla explained that her process for taking care of alopecia patients include a consultation period to confirm whether it is stress induced or not, full examination of the scalp to determine the level of treatment that is needed, and ultimately, the treatment process.

“Remember when you’re seeing a client on a consistent basis, you would know the changes that are taking place in the client’s life that would cause something to happen with the client’s hair. As it relates to some clients you have never seen, they come to you because they have that particular problem, then that’s how we have to go into a lot of questions,” she added.

She said the scalp may itch and feel tender to the touch, and advised that using the proper products in your hair and relaxing when necessary is the key for controlling alopecia.

COVID also a factor in growing cases

“Especially now with the pandemic and the fact that we have to be working overtime, we need to take a break [and] unwind. Visit a psychologist, get your consultation [and] do what they recommend. Since the pandemic I’ve seen a lot of hair loss, I’ve seen a lot of hair breakage, I’ve seen a lot of hair loss from the crown and I know that it is the stress that is the cause,” she said.

What’s normal shedding?

For those who might be wondering what is considered normal hair shedding, Reid-McCalla stated that humans lose from 100 to 150 strands of hair per day, and anything that is noticeably over that number may need professional attention.

“If you see the hair coming out with the bulb in long strands significantly, then that’s acute hair loss,” Reid-McCalla stated.

“The hair goes through three different stages — the anagen stage, the catagen stage and the telogen stage. When your hair grows it rests and then it sheds. We have new hair pushing out the old strand, so once the new stands are coming up, the old strands will come out in their entirety,” she noted.