Hair Restoration Blog

Q:

hey doctor:

is it true i can lose hair by wearing a baseball cap a lot of the time? if that’s the case, then i guess baseball players are good candidates for hair transplants! =P. but really, is there any truth to that? I read that it doesn’t have an effect on a person’s hair, but i wanted to verify with an actually hair loss doctor.

A:

We can lose hair due to environmental trauma to the hair shaft and, consequently, to the hair follicles. The name of this condition is traction alopecia; it can be seen when people braid their hair very tightly. One type of traction alopecia is called turban alopecia, for people who wear turbans on their head for long periods of time and when they wear it tightly. Baseball caps are regularly used by people, and I have not seen it in those people who wear them. However, you can guess that a tight cap of any kind may mimic the turban effect and may cause traction alopecia in which hair follicles are being pulled over time, which destroy them eventually.

Hi
I am 36 year old from Faridabad.  I have had Alopecia Areata (AA) since12, I took Ayurvedic treatment & after about 5 years alopecia areata appeared again since then it is continuous almost. Hairs goes in patches from all over the body including eye brow and eye lashes, but additional thing with me is that I feel itching on the place from where hairs are going to fall with pain on the itching area too, then consequently within 1-2 days hairs falls and leaves red patch behind pains also gets disappeared.  After that I start using Diprovate lotion twice daily on affected area.  Hair comes within month then I stop using Diprovate.  But normally hair length goes to only 8-10 inches and then again hair loss same process going on since 1980. One thing I observed is that places of hair loss patches are almost fixed.  One thing I also used some hormonal injections too but as usual no permanent remedy.  Do you also feel pain before falling of hair on the place of hair fall on the scalp?  Generally I felt pain on scalp only though hair loss periods.  Pain is only on scalp.

A:

It seems like you are experiencing episodes of patchy baldness.  Although hair loss in a patchy form is usually considered alopecia areata or AA, your condition is not a typical one.  Alopecia areata is usually painless and the changes in skin shape and color is not that noticeable except for the hair loss.  There are some other hair loss conditions that may present themselves as patchy hair loss such as Cicatricial Alopecia in which an inflammatory reaction causes hair loss.  A diagnosis could be established through direct examination and biopsy of the scalp from hair loss lesions.  My recommendation to you is to see a good dermatologist and confirm the diagnosis of your condition.  Hair transplant is not indicated in many types of patchy hair losses, but your hair transplant doctor can discuss it further after reviewing your scalp biopsy results.

Cicatricial alopecia refers to a group of rare skin diseases in which hair follicle get destroyed and replaced by scar tissue. It is one of the rare causes of hair loss. Hair loss could be gradual or sudden. Hair loss could be without any symptoms or it could present with sever itching, burning and pain. There is usually no visible scar, because the inflammation is below the level of skin. Cicatricial alopecia could occur in otherwise healthy men and women of all ages.

Cicatricial alopecias could be primary or secondary. This discussion is confined to the primary cicatricial alopecias in which the hair follicle is the target of the destructive inflammatory process. In secondary cicatricial alopecias, a non-follicle-directed process or external injury, such as severe infections, burns, radiation, or tumors could cause destruction of the hair follicle.

The causes of the cicatricial alopecias are not completely known. However, all cicatricial alopecias involve inflammation directed at the hair follicle, the upper part of the follicle where the stem cells and sebaceous gland are located are generally involved. Permanent hair loss occurs when the stem cells and the sebaceous glands are destroyed. This type of hair loss is usually irreversible.

Cicatricial alopecias can affect both men and women. The majority of patients with cicatricial alopecia have no family history of a similar condition. Central centrifugal cicatricial alopecia is a type of cicatricial alopecia that is more prevalent among black woman. Frontal fibrosing alopecia on the other hand is seen most commonly in post-menopausal women and could be seen in association with chronic skin conditions such as lupus erythematosus and in people with personal or family history of autoimmune disorder. A scalp biopsy is necessary for diagnosis of cicatricial alopecia. Presence of inflammatory cells and scarring could be diagnostic and essential for determining the type of treatment.

Treatment of the lymphocytic group of cicatricial alopecias involves use of anti-inflammatory medications such as steroids, cyclosporine, hydroxychloroquine. When hair follicle destroyed, hair will not grow back. However in some cases using minoxidil solution can help to stimulate growth of some of the remaining hair.

Hair transplant could only be used in the patients who have normal healthy hair on donor area without any microscopic or macroscopic evidence of cicatricial alopeica activity.  If hair multiplication becomes a reality it might potentially be a good option for patients who lost their scalp hair extensively as result of cicatricial alopecia.