Both hair and nails are derived from the epidermis, and both consist of the same dead tissue—the protein, keratin. Because of their derivation from the epidermis it is not surprising that diseases affecting the skin may affect the hair and nails as well. In addition, there are a number of disorders which are peculiar to the hair (including the scalp) and nails.
Hair loss may be temporary, when it is usually called alopecia; or it may be permanent, when usually called baldness. The most common form of temporary diffuse alopecia is that associated with the following conditions or circumstances:
acute mental stress
severe illness or injury
stopping the oral contraceptive pill iron deficiency various hormonal deficiencies certain drugs rapid weight loss In these cases the hairs in the resting phase are the ones which are usually lost. As such the hair loss is temporary, and will right itself once the precipitating cause has been corrected.
Alopecia areata, where the loss is localized to one or more well-defined areas, is the most common type of hair loss seen in medical practice. There is sometimes a family history of it, and there appears to be a genetic association with some other conditions (known as auto-immune diseases) such as vitiligo (pigment loss), pernicious anaemia, and either over or under active thyroid disorders. There is often psychological stress or some emotional deprivation some weeks prior to onset. Although alopecia areata occurs at all ages the majority of cases are in children and young adults. It is estimated that there are about 100000 sufferers in Australia.
With this disorder patches of hair may be lost from any part of the body, although hair loss is typically limited to the scalp and beard areas. Symptomless bald areas up to a few centimetres in diameter develop, which may coalesce and produce the loss of all scalp hair (alopecia totalis) or even of the whole body [alopecia universalis). In the stage of active hair loss, very short, broken hairs shaped like exclamation marks may be found. These are not seen in the conditions which may, otherwise, be taken for alopecia areata (such conditions as ringworm and secondary syphilis). The prognosis for alopecia areata is good in the majority of cases, with most patients growing new, often initially white, hair within six to nine months. The longer the alopecia lasts and the larger the areas affected, the worse are the chances of satisfactory regrowth.
Small areas of hair loss which show evidence of regrowth are best left untreated. When improvement is slow or where areas are large, topical corticosteroids may be useful. Occasionally, they may be injected into the areas to promote regrowth, but this effect may be transient. Recently, various irritants and sensitizers—such as DNCB—have been used in an attempt to stimulate hair growth. It is important for patients or parents to fully understand what is known about the condition and its varied course. Considerable reassurance is frequently necessary, and recently a number of self-help groups have been set up to enable those involved to help one another and to seek further help both from the Government and the medical profession.
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