Home ServicesHair Shaft Defects |
| Hair Shaft Defects |
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There are a multitude of conditions where physical damage to the hair fiber results in hair loss. Sometimes this damage to the hair fiber is due to the hair being improperly formed by the hair follicles. These conditions are usually determined by genetic defects. There are also conditions where physical damage of the hair fiber is caused by something environmental, most often poor or inappropriate hair care. Hair loss as a result of physical hair defects is rare compared to other causes of alopecia, but the most common ones are listed below.
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Loose anagen syndrome |
Loose anagen syndrome
Loose anagen syndrome or loose hair syndrome involves exactly what the name suggests, growing hair that is "loose" and easily pulled out of the hair follicle. It is a non-inflammatory, non-scarring form of hair loss. It is a condition that has been defined very recently and it generally affects the children, more so in girls than boys. In this type of hair shaft defect the hair never seems to grow and so the sufferers do not require a haircut. The hair fibers on the scalp are generally thin, especially at the back of the scalp.
The hair is loose and easily pulled out helps explain why the back of the head is most affected. The repeated rubbing of a person's head on a pillow at night pulls out more of the hair on the back of the head, whereas the front of the scalp has less contact with the pillow and so the hair is more likely to remain in place. The remaining hair usually does not grow very long and it can be unruly and difficult to comb and style.
Mechanism
The mechanism of hair loosening in loose anagen syndrome is uncertain. But the researchers generally suggest the unhealthy root sheaths to be the reason. Though the hair follicles affected by loose anagen hair syndrome remain in growth phase, the root sheaths that normally surround and protect the hair shaft are not produced properly.
Also, the hair fiber is poorly anchored with the hair follicle. The poor attachment of the hair fiber is due to the lack of adhesion between the hair shaft and the inner root sheath. It is suggested by the experts that there is premature keratinization of the inner root sheath. The early keratinization reduces the adhesion of the inner root sheath with the hair shaft. So the hair fibers are weak and can be pulled out easily from the scalp.
Treatment
The treatment or hair care secrets for this defect are to handle the hair gently. Gentle handling can decrease the shedding of fibers to a fair extent. No other treatment or hair care is necessary, as the defect usually reverts spontaneously to its normal healthy stage in mid or late teens.
There may be a genetic problem behind loose anagen syndrome and the condition can run in families, but there are also many isolated case reports with no family history. There are no known effective treatments for loose anagen syndrome.
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| Trichotillomania |
Traction alopecia and trichotillomania
In terms of the mechanical action that causes hair loss, traction alopecia and trichotillomania are exactly the same. The hair is plucked out of the skin leaving clear bald patches or diffuses thin hair. With traction alopecia the cause may involve things like tight hat bands, pulling the hair into a tight pony tail, cornrow hair styles, and anything else that pulls on the roots of the hair. If traction alopecia continues for a long time and the same hair is repeatedly pulled out then the hair follicles in the skin can become so damaged that they stop growing hair permanently.
Trichotillomania is a condition in which the affected individual plucks out their own hair. Often the hair on the scalp is plucked to leave bald patches, but the individual may focus on the eyelashes, eyebrows, pubic hair, or any other hair bearing region.
Once a bald area has been made it becomes even more enticing for an individual to pull the hair around it and make the alopecia patch larger. Sometimes the effect of hair pulling is more generalized and looks like diffuse alopecia. Diffuse alopecia tends to affect the whole scalp, rather than specific areas of it.
Cause
The general cause of Trichotillomania may be anxiety disorders or mood problems. The hair pulling disorder is considered as a neurobiological condition.
There is much argument about whether trichotillomania is a habit like nail biting, or a more psychological problem. Either way, affected individuals are usually not aware that they are plucking their hair and when they are made aware of it they often find it very hard to stop. Some individuals who pluck their hair also then eat it, a condition called "trichophagia". This is a very dangerous condition that needs to be treated with some urgency. Hair is not digestable in the stomach; it can build up into a hair ball. This can severely irritate the stomach lining leading to severe ulceration. It is possible to die from trichophagia.
Trichotillomania is generally a non-scarring, non-inflammatory form of hair loss. But long term repeated plucking over several years may result in scarring alopecia to some hair follicles. Scarring Alopecia manifests itself with the onset of rough patches on the surface of the scalp.
Treating trichotillomania is difficult; There are 2 approaches for treating trichotillomania. One approach is to visit the psychiatrists and the other is to the dermatologists.
Children with trichotillomania may be made to wear gloves. The gloves stop the sensation of touch and this makes it impossible for the child to identify suitable hair for plucking. Sometimes the affected child's hair may be covered with vaseline which makes it difficult to get hold of the hair and also the hair becomes unpleasant to touch. In extreme cases the scalp may be bandaged so that the child can't touch the bald area.
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| Traction Alopecia |
Unlike trichotillomania, traction alopecia treatment is simple if treated in the early ages. An effective treatment is to simply avoid hair styling that puts excessive strain on the hair roots. Even after avoiding the causes of the traction alopecia it may take a period of several months for the hair to recover from this severe hair pulling disorder. Areas of scalp subjected to chronic traction alopecia may never fully recover. Chronic traction alopecia may be sometimes treated by hair transplants.
If the treatments of these severe hair pulling disorders are taken up at an early stage, there is enough probability that the hair will regrow in these areas. The only factor that should be carefully maintained is a strict hair care regimen. So even if you are suffering from this severe hair pulling disorders remain disciplined in your hair care regimen and have patience to watch your hair growing vigorously.
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| Monilethrix |
Monilethrix
The condition monilethrix makes hair fiber look like a string of beads. This hair shaft disorder can occur alone or in association with trichorrhexis nodosa. Along the length of a hair fiber there are nodes and constrictions making the edge of the fiber undulate. This hair beading weakens the fiber and people with monilethrix have diffuse hair loss.
Most frequently the hair loss is at the back of the scalp and neck and can leave the front of the head relatively unaffected. Monilethrix can also affect hair in other regions of the body.
Under a microscope, the hair fibers can be seen to have lost their cuticle covering over the nodes while the constrictions keep their cuticle. The brittle hair easily breaks once it is exposed above the skin and the fibers rarely grow very long as a result. Breakage occurs in the weak constriction points along the fiber.
Causes:
Monilethrix most often occurs in childhood but young adults can also develop it. It is a genetically inherited disease and can run in families, although different family members may be affected to different degrees of severity. The severity of monilethrix can also change with the seasons. It is often worse in winter and improves in summer.
Treatment:
There are no effective treatments or professional hair care products for this severe hair disorder, but hair loss can be camouflaged with a wig. Topical applications may be helpful in some cases. It has been observed that the hair disorder can spontaneously improve with age, although many people have monilethrix for their entire lives.
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| Pili Torti |
Pili torti(trichokinesis, corkscrew hair) is the general name for rigidly twisted hair. The twisting of the hair fiber occurs at focal points along its length. There may be several twists in one hair fiber.
In this hair shaft disorder the cuticle layer remains intact and is not stripped away as in Trichorrhexis nodosa. But the rigid twisting of the hair fiber through 180 degrees creates stress, which leads to fractures in the cuticle and internal cortex layer of the hair shaft.
Causes
The common cause of pili torti is genetics, and usually develops in early childhood. Genetic pili torti is most frequently found in people with thin, blond hair.
However, occasionally an individual may develop the hair disorder later in life.
The acquired causes of twisted hair fibers are due to damage of the skin from burns or other forms of scarring. Pili torti is sometimes diagnosed in some people who are suffering from anorexia nervosa or taking some drugs, like retinoids.
Effects
Scalp hair is most commonly affected by pili torti. But in extreme cases the hair disorder is seen in eyebrows, eyelashes and other hair growing areas of the body. A single twisted hair cannot be termed as pili torti, but when there are innumerable twisted hair fibers in the scalp or other region of hair only then is the condition called pili torti.
The pili torti hair disorder can be seen in a number of hair dystrophies and is associated with several syndromes such as Menkes kinky hair syndrome or twisting hair dystrophy.
In Menkes kinky hair syndrome apart from the formation of twisted hairs, the hair tends to be lightly pigmented and may demonstrate unusual colors in young people, such as white, silver, or grey. In twisting hair dystrophy there are half and three-quarter twists of the hair at irregular intervals rather than the 180º turns as seen in true pili torti.
Treatment
There are no treatments or professional hair care products for pili torti, but sometimes the condition can improve spontaneously after a period of time.
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| Trichorrhexis nodosa |
One of the most common hair shaft defects a dermatologist encounters is trichorrhexis nodosa (also called trichonodosis). Trichorrhexis nodosa is a focal defect in the hair fiber. When observed under the microscope most of a hair shaft looks entirely normal. However, in isolated spots along the length of a fiber swelling and/or fraying can be seen. These focal defects develop where there is an absence of cuticle.
The causes of this major hair shaft defect can be divided into two categories:
• Congenital
• Acquired
1. Congenital trichorrhexis nodosa is very rare, but some people have naturally weak hair where the cuticle is not properly produced. Congenital trichorrhexis nodosa is usually hereditary, it runs in families, and it first develops at a very young age. Abnormal production of hair fiber that is irregular and brittle can also occur in metabolic disorders such as those that involve abnormal urea synthesis, abnormal copper or zinc metabolism, or defective cysteine or sulfur incorporation into hair fiber (trichothiodystrophy).
2. Acquired trichorrhexis nodosa is much more common and develops as a result of excessive hair manipulation and over-processing. Too much brushing, hairstyles that put constant stress on the hair, excessive washing, dying, and perming may disrupt the cuticle in focal areas along a hair shaft. Trichorrhexis nodosa is particularly seen in people who overuse hot combs or permanent waves to style their hair. Once the cuticle is removed from hair fiber then the hair cortex swiftly breaks down.
Types
Trichorrhexis nodosa can be of two types:
• Proximal trichorrhexis nodosa
• Distal trichorrhexis nodosa
Proximal trichorrhexis nodosa is the most severe and most often occurs in Afro-Caribbean people. Hair of this ethnic group is subjected to greatest trauma due to their tight, curly hair. Proximal nodes in the hair shaft indicate increased hair fragility. Apart from trichorrhexis nodosa other scalp hair disorders like acne keloidalis nuchae are also common in black populations.
Distal trichorrhexis nodosa occurs in straighter hair. In this shaft defect, only a few whitish colored nodules are seen in the hair fiber. The surface of hair may become dry, dull, or brittle. Distal trichorrhexis nodosa is more commonly seen in Caucasian and Asian populations. This hair fiber defect damages the cuticle layer resulting in the disruption of the cortex. Also longitudinal and transverse fissures can occur in the fiber giving it a paintbrush-like look.
Treatment:
Treatment depends on the considered cause of the focal defects. If the hair production is believed to be abnormal then treatment will focus on the hair follicle and improving the strength of hair fiber.
Where the defect is the result of excessive grooming the obvious action is to reduce the amount of hair manipulation. People are encouraged to stop using brushes, avoid hair styling that involves chemicals and use only very mild shampoos.
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| Overprocessing |
Overprocessing the hair is the most common cause of physical hair damage by far. Perming, straightening, bleaching, and dyeing the hair all involve quite harsh chemicals that can significantly affect the integrity of hair fiber. Using these cosmetic approaches too frequently or inappropriately can lead to irreversible damage to the hair fiber. The more hair fiber is damaged by these processes the weaker it will be and the more likely it will break off.
The hair cuticle is a very strong outer sleeve of dead and highly keratinized cells that overlap each other like fish scales along the length of the hair fiber. The cuticle helps protect the softer inner cortex structure of the hair fiber from damage. The overlapping scales of the cuticle may become damaged and "flake up" if they are exposed to too much processing.
For perms, straighteners, bleaches, and dyes to work the cuticle has to be opened up so that other chemicals can get to the hair cortex and either rearrange the chemical bonds in the hair structure, as occurs with perms and straighteners, or to remove or add hair pigment, as occurs with bleaching and dyeing. If the chemicals to open the cuticle are applied for too long, in an unsuitably high concentration, or too frequently the cuticle may be irreversibly damaged and even stripped away completely. When this happens the softer cortex is exposed to the environment. The cortex does not have the same properties of the cuticle , it has a rough surface, so at this stage the hair can look dull, "dry" and frizzy. Chemicals in shampoos, in the water, in air pollution, combined with UV light exposure can all contribute to further damage and weakening of the hair cortex. Eventually, the hair may become so weak that it splits or breaks off completely.
More usually, this splitting and breakage occurs to old hair, that is, towards the end of the hair fiber. However, if the chemical processing is very severe, it alone can do so much damage to the hair fiber that the fiber at the root is severely weakened. If this happens, the hair may break off at the skin surface. The result is a diffuse "alopecia".
As well as chemical induced damage, physical processes can also damage the hair. Aggressive brushing, back combing, and other grooming techniques that put a lot of physical stress on the hair fiber can cause the cuticle to flake and strip away. Inappropriate use of the hair dryer can cause a lot of damage. When you wash your hair, some water gets under the cuticle and into the cortex. If you dry your hair with a high heat you heat up the water. This makes the water expand inside the hair and this literally pushes outwards to leave spaces in the hair fiber. In severe cases the hair develops little bubbles inside, a condition appropriately called "bubble hair". These bubbles make the hair much weaker and likely to break off. If damaging physical processes are combined with damaging chemical processes then the problem is compounded.
Physical damage to the hair through over processing is difficult to treat. The best approach is to cut off as much damaged hair as possible, avoid further chemical processing, be gentle with your hair and wait for new, undamaged hair to grow in. While there are cosmetic treatments to help "glue" damaged hair back together, they only work for a short time and have to be reapplied regularly. The end result is never as good as the original, undamaged hair.
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| Triangular Alopecia |
The cause of triangular alopecia is not known, but the condition can often be treated medically or surgically. The characteristic pattern of hair loss in triangular alopecia is thinning or complete loss of hair in the scalp area around the temples. If hair loss is not complete, the remaining hairs are often "miniaturized"-fine-textured hairs of thin diameter. Triangular alopecia sometimes begins in childhood with unexplained hair loss in the temporal areas of the scalp.
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