Hair and Nail Disorders

Hair and Nail Disorders

While few of us are happy with the hair that we have – too fine, too thick or too straight – these minor complaints pale when compared to the misery of watching hair fall out suddenly from where you want to keep it as in alopecia or chronic telogen effluvium. However, these conditions normally resolve themselves, but sometimes drugs are used. The embarassment of growing excessive body hair in areas where you least want it, as in hirsutism, is easier to resolve with electrolysis or the laser. With many nerve endings surrounding nails, disorders that cause splitting or peeling can be painful, but can normally be resolved with topical treatments.

Hair loss

It is perfectly normal to lose up to 100 hairs a day or more if you gave birth a few months ago. But if you are concerned about excessive hair loss you should consult a dermatologist as there may be some underlying medical cause.

If you are otherwise healthy you may consult a hair and scalp specialist, known as trichologists. There are some highly respected members of this profession, but their reputation is often tainted by the number of cowboy trichology clinics which prey upon distraught patients by making promises they can’t deliver on and charging exorbitant sums to boot.

Androgenetic alopecia: This accounts for up to 95 per cent of all hair loss. It is a wholly natural phenomenon suffered mostly by men, but to a degree by all adults (also by some primates).

Cause: Scalp hair is sensitive to the male sex hormone androgen which can cause a follicle to shrink and begin growing a short, fine vellus hair instead of a pigmented ‘terminal’ one. In women androgenetic hair loss tends to take the form of gradual thinning all over instead of the receding hair line or bald crown patterns of men.

Treatment: Approved for androgenetic hair loss, minoxidil (trade name Rogaine or Regaine) is available over-the-counter as a 2 per cent solution, on prescription at 5 per cent. It works by enlarging the shrinking follicle and prolonging the growing phase of each hair. But only about 20 per cent of users will get any really significant hair regrowth and it can be expensive and time-consuming to use. For men, the tablet finastyeride (Propecia) is also proving helpful.

Other causes of hair loss: Major trauma, surgery or illness can interrupt the normal hair growth cycles but there is often a delay of up to three months making it more difficult for sufferers to associate cause and effect. Abnormal thryroid gland function can also cause hair loss as can the use of drugs such as anticoagulants, anti-arthritis medications, antidepressants and some beta blockers. Crash dieting, too, may rob you of hair if your nutrition levels fall so low that there is simply not enough food for your body to devote to hair growth.

Chronic telogen effluviu (CTE)

This condition describes any abnormality in the normal hair shedding phase, which can sometimes be suffered by perfectly healthy women. CTE also describes the sort of postpartum hair loss many women experience a few months after having given spot check birth. Thanks to increased hormonal levels and blood circulation during pregnancy, nails become strong and grow quickly, hair is full and shiny, and the skin glows. But unfortunately while few notice any skin or nail problems after giving birth, many women complain of losing fistfuls of hair three to four months after their baby is born.

Causes: During pregnancy, the anogen, or growing phase of the hair cycle is extended — so that each hair stays in your head for longer which is why your hair may feel and look fuller. But afterwards it’s payback time and the delayed telogen, or resting phases, kick in, all at once, and many months worth of hair shedding occurs within a short space of time.

Recent research by Dr Hugh Rushton PhD suggests that an iron deficiency may be to blame when hair loss is suffered by otherwise perfectly healthy young women.

Treatment: No treatment is necessary as the problem will resolve itself over the next few months. During this time you should eat a well-balanced diet and ensure that you are getting enough iron (the best source is meat rather than dairy foods or vegetables), so that when the next anogen phase begins you are perfectly primed to grow Hair and Nail Disorders Hair and Nail Disorders and Nail Disorders of hair.

Baldness

About 40% of all men between the ages of 18 and 40 show signs of baldness, rising to about 94% in men over 80 years old.

Cause: You have to inherit a predisposition to Male Pattern Baldness (MPB) before the other factors which cause it can come into play, namely the effect of androgen and age. Going bald does not mean you have an excess of androgen (despite the popular myth about bald men being more virile) simply that your hair follicles are more sensitive to it.

Treatment: Other than minoxidil and finastyeride there is nothing else proven to have any effect whatsoever on MPB. Many men, and those around them accept their hair loss gracefully, but some find it very distressing. However, there are new micrografting hair replacement techniques which offer really natural-looking alternatives to the old “dolls’ hair” punch grafts. The surgical technique involves transplanting miniscule slivers of skin containing two to three hairs at a time from the back of the hair to the bald patches. The CO2 laser to cut and ‘shrink’ the bald scalp is faster and involves less blood so the operator can see better and the patient heals faster.

Alopecia

This condition involves sudden and complete hair loss, either in small round patches (areata), the whole head (totalis), or the whole body, eyelashes and vellus hairs included (universalis). It can be extremely distressing; many sufferers become depressed about their condition or stressed by the thought that it may get worse.

Causes: Again, the cause is completely unknown. Some believe it to be an autoimmune response where the body attacks its own follicles, others believe stress has a role to play but neither theory has yet been proved. Sometimes the condition lasts for only a few months, sometimes it comes and goes throughout a lifetime.

Treatment: Because we don’t know why it Traction alopecia describes the sort of self-inflicted hair loss brought about by pulling hair out by the root – either through unconscious ‘nervous tic’ tugging or plaiting hair too tightly. It is particularly common amongst races and cultures where intricate hair weaving is prevalent. Doctors and dermatologists are often nervous about giving a traction alopecia diagnosis; patients are notoriously resistant to the idea that they may be to blame for their problem.

Happens there is relatively little we can do to treat it. Much alopecia resolves itself naturally, but the earlier in life the loss is experienced and the larger the areas affected, the less the chance of recovery. Local steroids are sometimes injected or applied in an effort to calm any inflammatory response which may be inhibiting hair growth. Minoxidil, too, is often worth trying. It must be admitted, however, that spontaneous regrowth is the patient’s best hope.

Hirsutism

Excess body hair growth can be almost as embarassing as hair loss. Women do grow hair all over their bodies, just as do men; it’s just that most of these hairs are vellus rather than strong, pigmented ones. What some women may regard as excessive body hair may in fact be completely normal for their skin type and origin —many Mediterranean and Middle Eastern people naturally have more body hair than some more northern people.

Causes: Certain diseases or drugs can induce the follicles growing vellus hairs to start producing thicker pigmented ones. These include any hormonal imbalance condition such as polycystic ovaries, malfunction of the adrenal glands, or reaction to certain blood pressure-lowering drugs (minoxidil was first prescribed for high blood pressure).

Treatment: Once the problem has been identified, it is sometimes possible to reverse the condition. In the meantime there are many hair removal techniques, the latest and most exciting of which involves some Ruby and Alexandrite lasers. They are primed to target the pigment in the follicle (which is why those with darker hair respond better), the intense beam vaporizes the hair and destroys the follicle but (if done correctly) leaves the surrounding tissues untouched. Although it is as yet very early days and laser  device manufacturers are still tweaking the technology — adding refrigerated tips, for instance, to reduce the risk of thermal damage — it seems that the removal is long term, if not permanent.

Risks: Both electrolysis and laser removal carry the risk of scarring. Laser treatment can also result in the prolonged eradication of skin pigment surrounding the hair. This is more likely if you have dark skin and light hair. For this reason it is wise to choose a practitioner who is experienced with this very recent application for laser technology.

Frail Nails

Nail psoriasis

If your nails grow very quickly but peel, split, part company from their bed, and are ridged and spotted with pits, you may be suffering from psoriasis of the nail.

Cause: like skin psoriasis, it is unknown.

Treatment: Topical or injected steroids, or the newer vitamin D derivative (calcipotriol) preparations or retinoids can help dampen the over-rapid cell turnover but can have a detrimental effect on the skin surrounding the nail.

Grooves and ridges

Such imperfections are usually of cosmetic, rather than medical, concern.

Causes: Horizontal grooves can be the result of injury, illness or drug treatment which temporarily arrests or alters the development of the nail within the matrix. Vertical ridges can appear on nails in later years for no apparent reason.

Treatment: None is needed. It may take 3-5 months, or up to two years to disappear completely, but they usually grow out. No treatment is available for vertical ridges but you can render them less noticeable by using a buffing board or ridge-filling nail polish.