When a doctor is consulted by a patient,
especially a younger one, complaining of the
sudden loss of hair, the most important part of
the examination is taking the history.
In a young person the likely cause of patchy
hair loss is alopecia areata, trichotillomania
or the fracture of the hair shafts such as may
be caused by braiding that has resulted in the
hair being pulled to such an extent that it
breaks off.
Trichotillomania is the name given to the
compulsion to play with the hair, often
involving twisting and pulling, to such an
extent that it comes out in chunks. It is a
variation of the damage that can be done to hair
by an over-zealous hairdresser braiding hair.
Alopecia areata is the term used to describe
patches of baldness that can affect the hair of
the scalp, eyebrows, eyelashes or body hair. Any
hair-bearing area can be affected by alopecia
areata.
It is often precipitated by stress but
although the patient has no obvious other
symptoms of skin or general disease, many
doctors think that it is likely that the
underlying cause is one of the autoimmune
conditions.
Complete recovery may occur and the prognosis
is much better if the bald patches are confined
to a smaller area.
When it is severe and generalised, as in this
case, the problem is less likely to clear up.
This would seem to be a classic case of
severe alopecia areata. It could be that it was
triggered by the stress of the hair braiding but
it would not be the basic cause.
This condition needs treatment with
psychotherapy, sometimes helped by a mild
anti-depressant.
