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Why Your Hair is Falling Out: Your Ultimate Guide to Hair Loss & Alopecia

This article was written with Dr Ingrid Wilson, a portfolio GP in Cheshire and a Trichologist. She is the Director of Crewe Hair and Skin Clinic

What is hair lossWhen it comes to establishing if you have hair loss (alopecia), the first thing to work out is whether you are seeing more hair shedding than is typical. You may have noticed more hair than usual on the pillow, on your clothes, in the plughole after washing. However, it is usual to use between 50-100 hairs per day and there is usually more hair shedding in the autumn, but it fluctuates through the year.

What Causes Hair Loss?

Hair loss can be temporary or permanent. For someone experiencing hair loss it can be difficult to work out which type of hair loss they are experiencing. There are many causes of hair loss which include:

  • Hormonal changes (such as  pregnancy, childbirth, discontinuing the use of birth control pills, menopause).
  • Medical conditions, scalp conditions and disorders (such as thyroid disease, alopecia areata, scalp infections like ringworm, and indirectly, dry scalp, dandruff, eczema and dermatitis).
  • Medication (side effects from meds that treat things like cancer, high blood pressure, arthritis, depression, heart problems etc).
  • Stress (Trichotillomania – when someone can’t resist the urge to pull out their hair and feel “growing tension” until they do. This may be done in response to a stressful situation, and Telogen effluvium – hair loss due to stress, a shock or a traumatic event).
  • Diet – not getting the nutrients your body and hair needs for healthy growth.
  • Traction Alopecia (repeated tension, excessive styling and processing).

Common Types Of Hair Loss And Triggers Faced By Women Of Colour

Women of colour will experience  many of the same forms of hair loss as men  and women with other hair types. However there will be certain types of hair loss that are more common

  • Increased fragility: The length to which hair will grow is genetically predetermined with ancestry/genetics playing a role. Afro-textured hair because of its multiple twists and turns and areas of weakness also has a tendency to get tangled easily. Afro-textured hair which is very curly tends to break easily when combed dry.  Wetting the hair reduces the combing forces in curly afro-textured hair unlike in straight hair. Conditioners need to be rich and high conditioning. Products like the Swirl, Afrocenchix’s silicone-free conditioner and Moisture Surge Set will help to lock in moisture into your hair. 
  • Traction alopecia. This type tends to happen after tight pulling hair styles and hair pieces which cause repeated pulling (traction) on the hairs. What you see is shortened hairs at the temples and at the front.
  • Hair breakage: (acquired proximal trichorrhexis nodosa – APTN). This is when hair is so fragile that even minor trauma such as combing the hair or putting it in a particular hairstyle may break the hair. It tends to happen after years of using chemicals and heat devices to straighten the hair, and excessive combing with the wrong kind of comb, especially when the teeth are too small and rough or brush. Blow drying lotions and sprays can help with combing during blow drying. Sometimes hair breakage can be the first sign of a problem that is more common in Black women called CCCA.  It can also be a sign of nutritional deficiencies.
  • CCCA (central centrifugal cicatricial alopecia): This condition starts at the top and middle region of the scalp and progresses outward. It is a potentially permanent form of hair loss that primarily affects people of African descent, and usually occurs more in women than men. Last year, it was discovered that there is a gene mutation called PADI3, which typically runs in families. Avoiding traumatic hair care practices particularly those that incorporate heavy braids after a relaxer can help to slow down the loss.
  • Ophiasis alopecia areata. This type is often under-diagnosed in Black women because there is a tendency to diagnose it as traction alopecia. You would tend to see a horizontal band of hair loss at the back and sides of the hairline. Stress can be one of the triggers.

What To Do If You Think You Are Suffering From Hair Loss

  • If you can get someone to look at your scalp, get them to see whether there are areas of thin hair or no hair. If you are not able to do this, take pictures of the top view, side view and back view of your head with your hair parted in different places.
  • Ask yourself whether there have been any significant changes to your usual habits, such as nutrition, medication, stress or hair care practices.
  • Have a look at photos taken within the last year or so to see whether there is a significant difference in the thickness of your hair.
  • Check whether you have had other symptoms such as scaling or crust on the scalp, loss of hair on the eyebrow, armpit, body or any unusual skin problems.
  • Consider whether there have been other changes in your health such as heavy periods, joint pains or tiredness.

Hair Loss Tips, Prevention & Treatment

The first thing to do is remove the cause of the damage. Stop using any harsh chemicals such as relaxers, texturisers and dyes. Avoid tight braids, tightly fitted weaves, poorly constructed weaves, wigs and heavy hair extensions, particularly on relaxed hair, and keep your hair and scalp from excessive strain.

Afrocenchix's scalp oil Soothe contains lemongrass and olive oil and was the first Afrocenchix product. It was created to treat Rachael's traction alopecia caused by years of relaxers, tight braids and weaves. She massaged Soothe into the scalp twice a day, morning and night, to help stimulate blood flow to the scalp. This can help to encourage new hair growth, provided the follicles are still intact.

This method can be helpful in cases where the hair loss/alopecia you are diagnosed with is reversible, meaning that the hair follicles are still intact and well-connected to your hair bulb.

Consider What Your General Health Is Like

Hair loss can sometimes be a sign of a problem with your general health. Hormone problems, anaemia, autoimmune conditions such as lupus can sometimes present as areas of hair loss or hair thinning. You may be experiencing hair loss on other parts of your body or skin rashes.  

The  first port of call should be the General Practitioner. Be aware that GPs receive less than a week’s training in skin problems before they qualify, and even less on hair – so you may not always be speaking to a GP that would consider this a priority. If you are concerned about your hair loss, make sure that you mention this at the beginning of the consultation along with the other things that you have noticed. There have been many times at the end of a consultation when the patient is getting up to leave and then mentions ’by the way doctor – I am losing my hair’.  If this had been mentioned near the beginning of the consultation there would have been more time to conduct an examination, consider whether blood tests are necessary or even a referral to a dermatologist.

Don’t Be Afraid To Wash Your Hair

Many people are afraid to wash their hair when they see hair loss because they are afraid that they will lose more hair by washing it. This isn’t the case as the hair is already dead when it is on the scalp.

The straighter the hair, the more frequently it needs to be washed because oily sebum from the scalp which lubricates hair is able to travel down a straight hair shaft more easily than a coiled one. In addition afro-textured hair grows away from the scalp. 

Swish is a sulphate-free shampoo that gives your hair a crisp clean and removes build up without stripping it of moisture. Scientifically formulated but containing 97% natural ingredients means you’re getting the best of both worlds – it works and it does so by using ingredients that are good for your hair like Aloe Vera and fruity essential oils. 

Think About Your Diet

hair loss: healthy bowl of food

This is often neglected when it comes to hair. A healthy person grows 1.8 metres of new hair across the whole head per hour so it’s not hard to see that if the body is starved of nutrition this process will slow and affect the quality and quantity of hair. It is important to remember that as the hair cycle begins in the hair follicle, deep under the scalp, the best source of nutrients is always a healthy well balanced diet. Women are more susceptible to hair loss due to nutrition depletion. Hair growth slows, hair sheds, it is not as thick and strong, the colour and curl can change).

The good news is that this pattern of hair thinning can be corrected with appropriate diet or appropriate  additional nutritional supplements. Nutrients can provide excellent qualities to hair which become apparent in approximately 6 months of persistent use.

People who have been crash dieting often notice changes in their hair because of the low calorie intake. Low carbohydrate or low fat / high fibre diets are examples where long-term changes in hair have been observed such as lower hair density and decreases in hair diameter however we should also consider that in these diets both macro and micronutrients are changed.  

Don’t Take Supplements (Unless You Are Actually Deficient)

We are bombarded with so many conflicting messages about what foods are good and bad  for us. On top of that, it is hard to ignore the adverts for supplements which claim to be good for your skin, hair and nails. We all want that magic pill which will make our hair grow thicker and longer but think carefully before taking supplements. It is very tempting to take a supplement that indicates a benefit for hair. As we mentioned previously, a healthy balanced diet, with food from all the food groups is best for supporting hair growth. 

However, some people will be deficient in certain nutrients which may be assessed by a trichologist, nutritionist or doctor. Your GP may be able to request a limited range of blood tests based on clinical need. There are blood tests available for vitamins and minerals available in the private sector, but these are very costly. 

Seek Medical Advice

If you have considered the above, make a note and make a routine appointment to see your GP. However it is worth bearing in mind that their main role is to recognise and treat illnesses, and they only have limited time. People with hair loss tend to be ‘well’, so GPs may not consider this to be a priority that they need to deal with.

However, if you are experiencing hair loss and other symptoms such as tiredness, joint pains, hair growth or hair loss in areas other than your scalp a GP may request routine screening blood tests checking for anaemia, kidney function and thyroid function. 

It is also worth asking your GP to check your ferritin levels as low levels can be associated with hair thinning. In this country people with darker skin are also more likely to be deficient in vitamin D because of the absence of sunshine, so it is worth checking that this is included in the blood test as there has been a relationship noted between low levels of vitamin D and some hair loss conditions. Your GP is also in an ideal position to take samples from the scalp if a condition such as scalp ringworm is suspected. 

Unfortunately hair loss has traditionally been viewed as a cosmetic concern by General Practitioners who generally receive very little training before they qualify. We recommend seeing a professional like Dr Ingrid Wilson, who is both a GP and Trichologist.  

Think About Whether You Are Planning A Pregnancy

Not all hair loss products are recommended in pregnancy.  At the moment the only licensed treatment in pregnancy is the laser cap

NB About Hair Loss

Don’t rush to a cosmetic clinic for a quick fix solution. Make sure that you have a diagnosis first. The cosmetic sector is becoming more aware of the value of the hair loss market, and as an aesthetic practitioner I am regularly offered the opportunity to provide new invasive treatments for hair loss. Always approach these new treatments with caution and ensure that the evidence base is in favour of using it with minimal risks. There are some new treatments in which therapies are injected into the scalp that can actually sometimes result in hair loss. If you approach a cosmetic doctor or nurse about hair loss, make sure that they have experience of updating themselves in diagnosing hair loss conditions before you undergo any procedure.

About Dr Wilson

Dr Ingrid WilsonDr Wilson is a portfolio GP in Cheshire and a Trichologist. She is the Director of Crewe Hair and Skin Clinic.  She completed her medical training in Liverpool, qualified as a General Practitioner in 1999, and  qualified as a Consultant in  Public Health Medicine in 2006.  She has a Masters in Public Health and is a Fellow of the Faculty of Public Health. Having had personal experience of hair loss she was struck by how little training GPs received in diagnosing and treating hair loss, and was aware that some hair loss conditions were more commonly experienced in black people. She struggled to find a suitable course for GPs. She decided therefore to study trichology with the Institute of Trichologists between 2010 and 2012. She gained a distinction in both years and won the John Mason Memorial prize. Upon completing the course she realised that there was a need to better connect the  diagnostic, prescribing  and referral resources available for hair loss by GPs and connect it with customers’ cosmetic hair care needs though camouflage and wigs. As a black woman she was aware that there was a need to create an environment that was sympathetic to their specific hair care needs and was able to give people the best chance of slowing down the progression of hair loss at an early stage.  

She took voluntary redundancy from her Public Health consultant post in 2012 and since then has been working towards building her clinic while continuing as a part-time GP. 

She is very aware that there are gaps in the NHS to help people tackle hair loss medically without resorting to surgery – particularly for  black women. Her clinic also caters for people with cosmetic skin care concerns including unwanted hair acne, pigmentation and ageing. The clinic uses home care programmes, electrolysis and skin camouflage. 

She has written articles on hair loss for a number of publications and holds memberships at:

  • British Hair and Nail Society
  • Affiliate Trichologist Member: British Association of Hair Restoration Surgery
  • Member of the International Association of Trichologists
  • Member of the Society of Cosmetic Scientists
  • Medical Member of The Trichological Society

Other articles: 

Hair Loss in Pregnancy

Everything you need to know about afro hair loss

Alopecia: Everything you need to know

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