Celiac Disease associated Alopecia

Celiac or celiac disease is an autoimmune condition in which affected individuals have an adverse immune reaction to gluten in their diet. The most reliable treatment approach is a gluten free diet. However, those who fail to strictly adhere to a gluten free diet can develop hair loss problems. The hair loss can be due to two different mechanisms.

As an autoimmune condition, celiac disease can be associated with an increased risk of developing other autoimmune diseases. People with the condition have also been reported as also developing the autoimmune hair loss condition alopecia areata.

In addition, and probably more common in affected people, there can be thinning of hair fibre and general diffused hair loss. This is probably most likely due to the inflammatory response of gluten in the gut inhibiting the absorption of other nutrients from food which hair follicles require.

Similar poor hair growth can be seen in other people with inflammatory bowel syndromes. Erratic hormone production in people with the condition may also be a contributing factor to hair loss. In celiac disease the strict adherence to a gluten-free diet resolves the gut inflammation and in so doing also usually resolves the poor quality hair growth.

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Diffuse Hair Loss

Another form of hair loss that affects women is termed 'diffuse hair loss' which involves an increased rate of hair fall and subsequent thinning from all over the scalp. In these cases a detailed clinical history must be taken. In particuar, the diet should be checked for adequate intake of nutrients. Clinical investigations should be made for thyroid, haemoglobin and hormonal problems. Stress may also be a contributing factor in diffuse thinning. Hair weaves and braiding of hair can contribute to this form of hair loss.

A high proportion of our female clients suffer from this form of hair loss. Our non-surgical hair attachments have given them their hair back.

Female Pattern Hair Loss (Androgenic Alopecia)

Whilst genetic thinning and baldness is more common in men, tens of thousands of women in the USA and worldwide also suffer from the condition. However, it affects the genders differently. While men experience 'vertex balding' and/or 'receding frontal hairline'. Women generally experience 'diffuse thinning', generally throughout the top of the head or crown.

Androgenic Alopecia in women usually begins at around the age of 30 (but can occur as early as in the 20’s). The thinning hair usually becomes noticeable around the age 40, and may be even more noticeable after the menopause. By the age of 50, approximately 50% of women will experience some degree of hair thinning.

Female hair loss is often an overall thinning, e.g. two hairs where five used to be, rather than a bald area on top of the head like men. Women sometimes have a receding hairline too. As in males, hair follicles simply shut down with hormones playing some role in the process.

Pregnancy, stress, some medications, or a poor diet can cause hair thinning, but 70% of women who experience this can attribute it to Androgenic Alopecia, or Female Pattern Baldness (FPB). The signs and symptons of FPB are general thinning of hair all over the head and moderate loss of hair on the crown or hairline.

Within these follicles, biologically active testosterone is converted by an enzyme into a much more potent testosterone called 'Dihydrotestosterone' (DHT). It is this powerful hormone, which inhibits the metabolism for the forming of the genetically pre-disposed hair cells, resulting in the gradual process of finer, weaker hairs, as the follicle continues to shrink. Eventually these hair follicles die, resulting in irreversible baldness.

The thinning process

As you age, the effects of hormones and age cause certain hair follicles to get smaller and smaller. This prevents the hair from fulfilling its regular growth process. Hair follicles gradually become smaller and the period of time in which the hair grows is reduced causing each hair to become finer and shorter with each hair growth cycle.

Hormonal Changes

Hormonal changes are a common cause of female hair loss. After pregnancy or discontinuation of birth control pills, many women experience hair thinning to varying degrees, usually on a temporary basis.

While a women is pregnant, and hormonal changes are occuring, more hair follicles enter the growth phase than normal. About two to three months after childbirth, the normal hair cycle returns and many hairs re-enter the resting phase causing excessive shedding. When this happens, a women will start to shed more hair than usual. As a result she will usually notice large amounts of hair in her brush and bath. This is usually a temporary condition and as hormone levels in the body return to pre-pregnancy levels after about six months, the excessive shedding normally ends. If this condition continues after six months, a women may be experiencing hereditary hair thinning which was masked by childbirth.

Elite Hair Alternatives have helped thousands of women who suffer hair loss. We have several different non-surgical methods of attachment available.

Lupus

Systemic lupus erythematosus (SLE or lupus) is a rare chronic disease manifested by inflammation of multiple organ systems including joints, skin, kidneys, heart, lungs, vessels and brain. The ratio of women to men affected is around 10:1.

While the cause of lupus remains unknown, blood test abnormalities tend to implicate an auto-immune mechanism where antibodies are produced against one's own cells and tissues. Unlike alopecia areata, where antibodies are found specific for components within the hair follicle, the characteristic laboratory finding in lupus is the oresence of antibodies to our basic genetic material, DNA, and other substances found within the nuclie of all cell types in the body. In addition to these antinuclear antibodies (ANA), there may be antibodies to blood cells and various proteins present in the blood circulatory system.

Skin rashes appear in the majority of patients. The classic manifestation is a pink, butterfly-shaped eruption over the nose and cheeks that is aggravated by sun exposure. Similar rashes, bruising, hives, blisters or ulcers may be present in other areas. In association, there may be diffused hair loss as a result of generalized immune response throughout the body.

Hair loss can temporarily recover or it may wax and wane with changes in disease severity, but in many cases the hair loss becomes permanent as a result of scarring. The hair loss is associated with a heavy infiltrate of immune cells in the skin. As with many antiimmune diseases there may be spontaneous remission for some people.

Treatment may involve the use of corticosteroids or other immunosuppressants. Hair transplants may be used to cover small patches of scarring alopecia resulting discoid lupus erythematosus.

Elite Hair Alternatives have helped many lupus sufferers and have several different completely natural skin foundations that can be used as a permanent or daily wear solution, we offer several different attachments depending on the degree of hair loss.

Male Pattern Baldness (Androgenetic Alopecia)

Male pattern hair loss, otherwise known as Androgenetic Alopecia, is caused by the effect of the male hormones, called androgens, on genetically predisposed hair follicles (passed down the family tree). Within these genetically programmed hair follicles, testosterone, the male hormone is converted into the androgen Dihydroestosterone, or DHT, by an enzyme called 5 alpha-reductase. It is the effect of this DHT that inhibits the growth of new hair cells, which in turn leads to hair thinning and in many cases, eventual baldness.

The conversion from testosterone to DHT is driven by an enzyme called 5-alpha reductose, which is produced in the prostate, various adrenal glands, and the scalp. Over time, the action of DHT causes the hair follicle to degrade and shortens the anagen phase. Though the follicle is technically still alive and connected to a good blood supply (i.e. it can successfully nurture a transplanted follicle which is immune to the effects of DHT), it will grow smaller and smaller.

Some follicles will gradually die, but most will simply shrink to the size they were when you were born. With a steadily shorter anagen growth cycle, more hairs are shed, the hairs becoming thinner and thinner until they are too fine to survive daily wear and tear. Balding hair gradually changes from long, thick, coarse, pigmented hair into fine, unpigmented vellus sprouts.

However, the sebaceous gland attached to it remains the same size. As the hair shafts become smaller, the gland continues to pump out the same amount of oil. So as your hair thins, you will notice that your hair becomes flatter and oilier.

But the hormonal link in balding is complex. Eunuchs, who produce no testosterone never go bald, even if carrying a baldness gene. However, if castrated men with a family history of baldness are given testosterone, they lose hair in the classic horseshoe-shaped pattern.

Studies show that while balding men don't have higher than average circulating testosterone levels, they do possess above-average amounts of a powerful testosterone derivative DHT in the scalp follicles. In male balding, genetically primed follicles convert circulating testosterone to DHT, which successively diminishes or minaturises follicle size, producing ever weaker hairs.

The amount of sebum in the scalp has been linked to hair loss. Sebum contains a high amount of DHT, and clogs pores in the scalp, both of which cause malnutrition of the hair root.

The amount of sebum in balding hair is related to the amount of oil in the hair, and most experts agree that frequent shampooing is advised in hair loss causes with oily scalps.

Androgenetic alopecia accounts for 95% of men's hair loss. It is caused by heredity hormones, and age. Scientific research has proven that the gene for hair loss comes from either or both sides of the family, and contrary to popular belief, is not traced only to the mothers side. The best indicator you have is your immediate family. If your family members are experiencing hair loss, you may also be at risk.

Male pattern hair loss is usually confined to the area at the top of the head and that is why men who go bald are often only left with hair at the sides and back of their heads. Why these hair follicles are left completely unaffected and the hairs on the top of the head are sensitive to DHT is one of the mysteries of life not yet solved.

Scarring Alopecia

When inflamation of the hair folicles occurs due to infection it can lead to scarring alopecia. It is easy to indentify a case of severe scarring alopecia because there will be rough patches on the surface of the scalp made up of small blood vessels and connective tissue. Scarring alopecia can have many causes some of these causes and different types of scarring alopecia are discussed below.

Scarring Alopecia caused by Discoid Lupus Erythematosus

Discoid Lupus Erythematosus (DLE) is a diffuse connective tissue disease which can result in hair loss on the scalp. In DLE lesions occur around scaling papules 5-10 mm across with follicular plugging. There may or may not be scaling. Eventually the skin becomes smooth, atrophic and scarred. Lupus is a photosensitive disease therefore exposure to sunlight should be minimised.

Follicular Degeneration Syndrome (Traction Alopecia and Scarring Alopecia)

Follicular Degeneration Syndrome (FDS) goes under a variety of names including 'central progressive alopecia' and 'hot comb alopecia'.

Hot comb alopecia was first identified in African-American women and thought to be due to the overuse of hot combs and oil pomades. It was thought that oils applied to the hair were heated up by the hot comb and liquified. The liquid oil then dribbled down the hair fibre into the hair follicle opening and irritating the skin causing inflammation around the upper hair follicle. However, it is now that, while hot combing might elicit the condition in some individuals, it can also occur in the absence of any cosmetic procedure. With this discovery the condition has been renamed Follicular Degeneration Syndrome.

It is a form of scarring alopecia which is most often first visible as a well defined patch of diffused hair loss. The affected region usually, although not always, extends centrifugally from the scalp vertex. The affected region may slowly expand in size with time. Skin biopsies show that the condition involves inflammation of the affected hair follicles and premature desquamation of the hair follicle inner root sheath.

Usually treatment focuses on removing the hair follicle inflammation using topical corticosteriods or intradermal corticosteriod injection. No reliable or proven treatment is known.

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Pseudopelade (Cicatrisata)

Pseudopelade is also known as cicatrisata. It is a very rare condition primarily affecting women and sometimes children.

Initially, well-defined patches of hair loss develop which for some people may deteriorate to near total scalp hair loss with individual surviving hairs. The history of the condition for affected individuals is usually slow, lasting many years and for every male affected, three females get pseudopelade.

Pseudopelade is a poorly defined condition and frequently it is confused with hair loss caused by lichen planopilaris or lupus erythematosus. Indeed some claim that lichen planopilaris and pseudopelade are one and the same condition. Diagnosis of pseudopelade can be quite difficult, but some basis clinical pointers to look for in the early stages include irregular shaped and confluent patches of alopecia and some inflammation (erythema). A skin biopsy can help significantly.

It is not understood how or why pseudopelade occurs, although some experts suspect that it is another autoimmune-based mechanism of hair loss. Alopecia areata is widely regarded as an autoimmune-based mechanism of hair loss. However, pseudopelade is not the same as alopecia areata as the inflammation is typically around the upper hair follicle whereas the inflammation in alopecia areata is primarily around the lower hair follicle bulb region. In addition, while alopecia areata can persist indefinately, pseudopelade progresses, sometimes over several years, and then stops. The result is patches of hair loss where the hair follicles are generally destroyed. The inflammation in the skin subsides at the same time as the hair loss stops.

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Telogen Effluvium

Telogen Effluvium occurs when sudden or severe stress causes an increase in the shedding of the hair througout the whole scalp. In telogen effluvium a sudden or stressful event can cause certain hair follicles to prematurely stop growing and enter into the telogen (resting phase). The hairs affected will then stay in the resting phase for about 3 months after which time they will shed. Often the person involved will have recovered from the event before the hair loss occurs.

In most cases the hair loss is temporary and the hair soon recovers. However in some cases the hair loss continues until the underlying cause is resolved. Telogen effluvium appears to affect more women than men because the precipitating events such as childbirth are experienced by women.

Some of the things that can cause temporary hair loss are:

• Child birth
• Pregnancy terminations
• Gastric dietary surgery
• Starting or stopping birth control pills
• Dieting drugs
• Therapy
• Severe emotional stress

Hair loss after child birth

It is quite common for some women to experience some hair loss approximately 3 months after childbirth. This hair loss is triggered by the sudden changes in hormone levels. Some statistics suggest that 20% of mothers lose hair after childbirth and others suggest a figure closer to 45%. Fortunately in most cases the hair will return to normal 9-12 months after the child's birth.

Many women notice that their hair is thicker and healthier during pregnancy, this is due to the increased levels of the hormones oestrogen and progesterone which cause more hairs than normal to remain in the growth phase. However, when the child is born many of the hair follicles that had delayed entering the resting phase suddenly enter the resting phase due to the rapid drop in hormone levels. As a result of this, these hairs are then shed about 3 months after birth.

Hair loss resulting from pregnancy terminations

Similar to the way in which sudden hair loss can occur after giving birth, sudden hair loss can also occur after an abortion or miscarriage when the hair loss is triggered by sudden changes in hormone levels. Hair that has remained in the growth phase due to increased hormone levels will suddenly enter the resting phase and will shed approximately 3 months after the event.

Gastric dietary surgery

This surgery is taken by individuals who are excessively over weight. The operation is very stessful for the body and it's immune system. The rapid weight loss due to the shrinking of the stomach in the gastric area results in a reduced supply of natural nutrients which in turn affects the individuals complexion and body hair. Thinning of the coranial hair (top area) is normal after a 3 month period. The hair loss is normally temporary and after the weight loss stabilizes (which is normally 18-24 months) the hair returns to normal. Individuals that have this surgery, that are of the age of 40 and above, may experience permanent hair thinning.

Hair loss resulting from taking the birth control pill

Birth control pills affect the hormone levels within the body and these hormone levels can affect hair growth. In some cases hair thinning may occur due to male hormones present in some types of contraceptive pills. This type of hair loss is similar to pattern baldness or androgenitic alopecia. However discontinuation of ‘The Pill’ can result in hair loss similar to that which occurs in child birth due to the drop in hormone levels.

Surgery

The shock involved in a major operation (gastric dietry surgery included) can result in sudden hair loss.

After micrograft and minigraft surgery where follicles are transplanted on the scalp, telogen effluvium almost always occurs. Due to the shock of surgery the hair follicles will fall out within 3 months after which the new hairs will grow from transplanted follicles.

Prescribed drugs that can cause hair loss

Some drugs have been reported as causing hair loss in some individuals. While not everyone will experience hair loss, some drugs are more likely to cause hair loss than others.

If you suspect that prescription drugs that you are taking are causing hair loss you should discuss this with your doctor.

Hair loss caused by severe emotional stress

Some people experience telogen effluvium or sudden diffuse hair loss after a traumatic event such as death of a family member or someone close, an accident, divorce, abuse or any other severely traumatic event. These events may trigger hair follicles to enter the resting phase prematurely, in which case an increase in the amount of hair shed will be noticed about 3 months after the event.

The above types of hair loss are usually temporary and in most cases hair will grow back normally soon after it has fallen out. However in some cases the hair loss may continue until the cause is treated. These cases include; thyroid gland malfunction , diabetes , anemia, systemic lupus erythematosis.

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Trichotillomania

Trichotillomania is based on an obsession with the hair. People with trichotillomania tug and pull their hair making bald patches or areas of diffused hair loss. The hair for plucking is selected from other hair based on it being different in some way, perhaps feeling rough to the touch or more curly than other fibres. Once a bald area has been made it becomes even more enticing to pull at the hair around it making the alopecia patch larger. Sometimes the hair plucking is more generalised and looks like Diffuse Alopecia. This is generally a non-scarring and non-inflammatory form of hair loss, although long term repeated plucking over several years may result in irreversible scarring damage to some hair follicles.

Trichotillomania affects 2-3% of people with hair loss making it a fairly common condition. Studies have indentified the scalp as being the most commonly affected area. Approximately 70% of cases involve scalp hair loss, 50% involve eyebrows or eyelashes, 30% include pubic hair, 20% body hair and about 10% involve facial hair.

As well as plucking the hair, affected individuals may then chew or eat the hair. Hair eating is known as trichophagia while hair chewing may result in hair balls (trichobezoars). About 40% of cases involve hair chewing while 10% of affected individuals eat their hair. Eating hair is rather unwise as it is irritating to the stomach and may lead to digestion problems and ulcers.

Many individuals that suffer from trichotillomania are often unaware of what they are doing and do not realise the reason for their hair loss.

Trichotillomania can affect both children and adults although the adult version almost always affects women.

Psychiatrists regard hair pulling as a psychological disorder and treatment will usually involve therapy.

At Elite Hair Alternatives we successfully treat trichotillomania by covering affected areas with a hair intergration system which is worn permanently. This fantastic product helps the sufferer resist the temptation for continual hair plucking.