The best way to think of the way hair grows, is to picture a garden. How well it grows is completely a result of what is happening underground. And the factors that interfere with the cycle, such as medication, illness, infection or chemicals, all have the potential to stop hair from being formed properly. At any one time, about 90% of the hair on a person’s scalp is growing. Each follicle has its own life cycle that can be influenced by age, disease and a wide variety of other factors. This life cycle is divided into three phases:
- Anagen: Active hair growth that lasts between two to six years
- Catagen: Transitional hair growth that lasts two to three weeks
- Telogen: Resting phase that lasts about two to three months
At the end of the resting phase the hair is shed and a new hair replaces it and the growing cycle starts again.
The Balding Problem
Hair loss or baldness, technically known as alopecia, is a loss of hair from the head or body. Baldness can refer to general hair loss or androgenic alopecia (male-pattern baldness). Some types of baldness can be caused by alopecia areata, an autoimmune disorder. The extreme forms of alopecia areata are alopecia totalis, which involves the loss of all head hair, and alopecia universalis, which involves the loss of all hair from the head and the body.
Baldness and hypotrichosis can have many causes, including fungal infection (tinea capitis), traumatic damage, such as by compulsive pulling (trichotillomania), as a result of radiotherapy or chemotherapy, and as a result of nutritional deficiencies such as iron, and as a result of autoimmune phenomena, including alopecia areata and hair loss associated with systemic lupus erythematosus.
Symptoms of alopecia include hair loss in patches usually in circular patterns, dandruff, skin lesions and scarring. Alopecia areata (mild – medium level) usually shows in unusual hair loss areas, e.g. eyebrows, backside of the head or above the ears, which are areas that are not typically affected by male-pattern baldness. In male-pattern hair loss, loss and thinning begin at the temples and the crown and hair either thins out or falls out. Female-pattern hair loss occurs at the frontal and parietal areas.
People have between 100,000 and 150,000 hairs on their head. The number of strands normally lost in a day varies, but is on average 100. In order to maintain a normal volume, hair must be replaced at the same rate at which it is lost. The first signs of hair thinning that people will often notice are more hairs than usual left in the hairbrush after brushing or in the basin after shampooing. Styling can also reveal areas of thinning, such as a wider parting or a thinning crown.
A substantially blemished face, back and limbs could point to cystic acne. The most severe form of the condition, cystic acne arises from the same hormonal imbalances that cause hair loss and is associated with DHT production. Seborrheic dermatitis, a condition in which an excessive amount of sebum is produced and builds up on the scalp (looking like an adult cradle cap), is also a symptom of hormonal imbalances, as is an excessively oily or dry scalp. Both can cause hair thinning.
Hair thinning and baldness cause psychological stress due to its effect on appearance. Although societal interest in appearance has a long history, this particular branch of psychology came into its own during the 1960s and has gained momentum as messages associating physical attractiveness with success and happiness grow more prevalent.
The psychology of hair thinning is a complex issue. Hair is considered an essential part of overall identity: especially for women, for whom it often represents femininity and attractiveness. Men typically associate a full head of hair with youth and vigour. Although they may be aware of pattern baldness in their family, many are uncomfortable talking about the issue. Hair thinning is therefore a sensitive issue for both sexes. For sufferers it can represent a loss of control and feelings of isolation. People experiencing hair thinning often find themselves in a situation where their physical appearance is at odds with their own self-image and commonly worry that they appear older than they are or less attractive to others. Psychological problems due to baldness, if present, are typically most severe at the onset of symptoms.
Hair loss induced by cancer chemotherapy has been reported to cause changes in self-concept and body image. Body image does not return to the previous state after regrowth of hair for a majority of patients. In such cases, patients have difficulties expressing their feelings (alexithymia) and may be more prone to avoiding family conflicts. Family therapy can help families to cope with these psychological problems if they arise