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MALE HAIR LOSS

A number of scalp disorders form scarring with hair loss and these are described below with advise as to treatment.

Accident scars

Pseudo pelade

Folliculitis decalvans

Herpes zoster "shingles"

Accident Scars

Nearly everyone has at least one or more scars on the scalp. Scar tissue is connective or repair tissue and contains no hair follicles, oil glands, sweat glands or muscles.

All of us, often as children, have cut our heads causing a small scar to form. More seriously accidents or burns at work particularly in industry and building or head injuries and burns from road accidents may cause more severe scarring. Normally these cause no problems once healed but if they are too large or in positions particularly on the hairline where they may be visible, cosmetic surgery either by removing the scar tissue or transgrafting hair is highly effective as long as the operation is carried out by a suitably qualified and experienced surgeon. Hair weaves are frequently a better system if damage is not too severe.

Pseudo Pelade
Pseudo pelade is a slowly spreading disorder in which small areas of the scalp are replaced by scar tissue. The scarring areas are slightly depressed, cause no pain or irritation. It may affect either sex or any age group but usually women in their mid to late forties. Often starting at the crown area, the patches spread very slowly and even after many years may not cause any cosmetic or hairdressing problems. Very rarely the spread of the scarring may be more rapid.

The cause of this disorder is not known. The results of the scarring are not reversible but most cosmetic surgery can usually produce excellent results.

Folliculitis Decalvans
Folliculitis Decalvans is similar to Pseudo Pelade described above but is far more of an inflammatory disorder, the spreading scar tissue is very red and inflamed, although not very painful it may be very itchy particularly at the margins of the patches.

No cause has been proven. Staphylococcal bacteria have often been found but not always. It could be a defect of the body's immune response or a dysfunction of white cells in the bloodstream. These two factors should always be investigated as they may help treatment.

As with Pseudo Pelade it affects either sex, rarely affects children, and is more likely to affect middle aged men.

Correction of the factors mentioned above may help to stop the spread of the disease. In some cases long term antibiotic therapy taken internally (systemic) may help. In other cases reduction surgery is effective but each individual would have to be assessed by the surgeon to see if a worthwhile successful result could be obtained.

Herpes Zoster "Shigles" or Varicella
Herpes zoster scars may sometimes affect the scalp, particularly if infected due to scratching during the attack.

The small circular scars follow the path of a nerve branch, are very small and usually cause no cosmetic problem.

Diseases such as impetigo, boils or carbuncles may occasionally leave scares but these are very rare.

About two dozen other scarring diseases exist but these are extremely rare and many form part of a disease syndrome in which different parts of the body are affected and do not affect the scalp alone. As the physical effects of these very rare disease syndromes are usually quite severe, you would not consult your Doctor, Dermatologist or Trichologist about the scalp problem.

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