Patchy Hair Loss

 

What Is Patchy Hair Loss?

If you suffer from patchy hair loss, you’ll notice islands of baldness occurring at different areas of your scalp. They can be single or multiple, large or small. Patchy hair loss can sometimes affect facial hair or eyebrows as well.

If you wear your hair short, you might immediately notice the appearance of an island of baldness. If you have long hair, however, you may only discover these bald spots later on. Patchy hair loss can have a sudden onset with no obvious cause to the sufferer, or can be related to an injury to that area of skin.

The term patchy hair loss is not a medical condition in itself, but a pattern of hair loss that patients identify with.

What Causes Patchy Hair Loss?

There are a few usual causes of patchy hair loss as listed below.

Alopecia Areata

Or AA, for short, is an autoimmune condition that affects hair follicles. Auto-immunity refers to a condition where one’s body produces an immune reaction to healthy tissue, damaging that healthy tissue in the process. This condition can affect both men and women.

Alopecia areata occurs suddenly, and may occur with multiple patches at one go. It is known to be aggravated by emotional stress and can be associated with other autoimmune and skin conditions such as psoriasis.

Singaporean folklore often attributes this sudden patch of baldness to supernatural beings shaving one’s head.

To diagnose alopecia areata, our doctor will take a thorough medical history and perform a scalp examination. Our hair restoration physician will examine the area of hair loss under high-powered magnification to look for characteristics such as broken hairs and empty areas to rule out other causes. If the cause of the patchy hair loss is still not immediately clear, more invasive tests may need to be carried out such as hair root microscopy or a biopsy (sample of tissue).

How do I treat alopecia areata?

As this is an autoimmune condition, the treatment for this sort of patchy hair loss is to suppress the immune response in the area affected. The most common method of this is to inject a medium potency corticosteroid – e.g. triamcinolone acetonide – into the skin that has been affected.

This treatment may need to be repeated more than once. It would be advisable to treat alopecia areata early, as long-standing AA may cause follicles to be permanently damaged, requiring a more invasive form of treatment, e.g. hair transplantationEarly treatment of AA can result in new hairs growing out as soon as 1 – 2 months after treatment.

When there are other medical conditions identified together with this form of patchy hair loss, a concurrent course of medications might be prescribed. This may include oral immunomodulators (tablets that control the immune system) or newer agents from a class of medication called Jak-2 inhibitors.

On areas that recover slowly from alopecia areata, topical minoxidil and scalp rejuvenation treatment courses are used to amplify the effects of the aforementioned treatments.

Read more about medications that are used to treat hair loss here.

Traumatic Hair Loss

Injuries to the scalp such abrasions, surgery (including laser surgery) or burns can result in the formation of scar tissue. This scar tissue that once contained healthy hair follicles may now be unable to produce strands of hair and as a result, a patch of baldness is seen. This patch may or may not have an obvious scar. Sometimes, it looks like normal healthy skin with no overlying hair.

Most of the time, one will recall the injury that resulted in the scarred scalp. Sometimes these injuries occurred when the patient was very young, or during a period of memory loss e.g. a drunken night. The hair restoration physician will examine the scalp for scarring and assess for the possibility of scar correction with hair transplantation surgery. Further testing seldom needs to be carried out if the cause for patch hair loss is skin injury.

How do I treat traumatic hair loss?

Hair loss that is due to a scar that has not regrown hair for more than 6 months is unlikely to recover on its own. Hair restoration surgery in such cases depends on the location of hair loss and the size of the patch of baldness. Other factors will also be taken into consideration by an experienced hair restoration physician, such as degree and rate of senescent hair loss (hair loss due to age) or any concomitant androgenetic alopecia (genetic hair loss).

Hair restoration surgery takes on many forms in such cases, including scalp reduction, flap surgery or follicular unit extraction and transplantation. A detailed discussion regarding the pros and cons of each method will be undertaken during the consultation.

Cosmetic coverage can be done for small areas of scarred patchy baldness. Scalp micropigmentation or embroidery is a form of tattooing that mimics short hair to cover up small areas of patchy hair loss.

Tinea Capitis

Tinea refers to an infection due to fungus and capitis refers to the scalp. In this condition, fungus invades and damages hair follicles. Fungal scalp infections can affect male and female patients of all ages. There may be a rough and thick area of skin and other symptoms such as itching, discharge, redness, swelling and in rare occasions, fever.

Tinea can be confirmed with skin scrapings and high powered microscope assessment. Sometimes, the sample is sent to a laboratory for culture of the fungus. Most of the time, such testing is not required and an examination by the hair restoration physician is all that is needed.

How do I treat tinea capitis?

The treatment for fungal patches on the scalp is oral or topical anti-fungal medication. If one also has an immunity suppressing condition such as diabetes, that should be treated at the same time as treating for fungal patches.

The affected area may take few weeks to months after cessation of treatment to see any form of hair regrowth. In the initial months after anti-fungal treatment has been completed, there is no role for hair restoration surgery, which should be left till the patch of baldness is concluded to be permanent in nature, and is suitable for hair transplantation.

Tinea capitis can be recurrent so techniques for good hygiene should be understood and followed. Parents should monitor their children for recurrence and treat early to avoid embarrassing patchy hair loss.

Trichotillomania

Pronounced “TRY-KOH-TEA-LOW-MAY-KNEE-AH”, this long word actually refers to a mental health condition where one repeatedly pulls his or her own hair.

This can be associated with emotional stress, depression or anxiety conditions. Often, the patient will deny these symptoms and cover up hair loss by changing hairstyle, wearing a hairpiece/wig or head wear. Some sufferers pick at their skin and/or eat the hair that is pulled out.

Trichotillomania is seen in younger people around adolescence, but can affect both men and women of any age. The hair loss is progressive in nature and typically affects only areas that are repeatedly pulled.

This condition can cause hair follicle damage due to repeated force acting on this fragile organ. Hair loss can be temporary or permanent, and can be associated with skin infections and scarring. Depending on the severity of disease, hair loss in trichotillomania can be patchy or diffuse.

The hair restoration physician will clarify the history of hair pulling and assess the degree of hair loss. The doctor will suggest hair restoration only after the mental health condition is concurrently treated.

For more resources on trichotillomania in Singapore, please visit this website.

How do I treat trichotillomania?

This condition needs to be co-managed with a professional mental health practitioner. The aim of treatment is to control and eventually stop hair pulling and to restore hair in any permanently damaged areas of scalp.

Medication may be prescribed to curb the urge to pull at the hair or pick at the skin. Therapy sessions, such as cognitive-behavioural therapy, might be suggested by the attending psychiatrist to help sufferers control their behavioural response to emotional stress.

Skin infections on the afflicted area need to be treated accordingly – with dressings and antibiotics.

Temporary cosmetic coverage can be helpful to prevent embarrassment and improve one’s self-image until the hair pulling stops.

In severe conditions, hair restoration surgery may be required to restore large patches of baldness or sparseness. In dire cases, hair restoration surgery may not even be an available option and cosmetic coverage with hair pieces or wigs may be required.

Consult your hair restoration physician to discuss what options are available for restoring areas affected by trichotillomania.

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