Hair, Scalp and Nail Conditions

Alopecia Areata

Alopecia areata comes from an autoimmune problem. The hair often grows back in less than a year.

Learning you have a health condition of the scalp, hair, or nails can be itchy, painful, or embarrassing. These conditions can have many causes. Some are genetic, while others stem from autoimmune problems. See and learn about common diseases and conditions that can impact the hair, scalp, and nails, including dandruff, ingrown toenails, and fungal nail infections. Find out the difference between male pattern baldness and female pattern baldness. Learn what alopecia looks and how it can affect hair and nails.

Alopecia areata is an autoimmune condition that results in patches of hair loss. The immune system attacks the hair follicles resulting in baldness. Hair often regrows within 3 to 6 months. Sometimes, the hair that grows back in is white. Alopecia areata is just one type of autoimmune-mediated hair loss. Alopecia totalis results in full scalp baldness. Alopecia universalis results in complete hair loss over the entire scalp and body.

Alopecia Areata (Scalp)

Alopecia areata causes hair loss, especially in young people.

Learning you have a health condition of the scalp, hair, or nails can be itchy, painful, or embarrassing. These conditions can have many causes. Some are genetic, while others stem from autoimmune problems. See and learn about common diseases and conditions that can impact the hair, scalp, and nails, including dandruff, ingrown toenails, and fungal nail infections. Find out the difference between male pattern baldness and female pattern baldness. Learn what alopecia looks and how it can affect hair and nails.

Alopecia areata is an autoimmune condition that results in patches of hair loss. The immune system attacks the hair follicles resulting in baldness. Hair often regrows within 3 to 6 months. Sometimes, the hair that grows back in is white. Alopecia areata is just one type of autoimmune-mediated hair loss. Alopecia totalis results in full scalp baldness. Alopecia universalis results in complete hair loss over the entire scalp and body.

Traction Alopecia

Sometimes your hairstyle may give you a hair loss condition, as in the case of traction alopecia

Traction alopecia is a type of hair loss that occurs with certain hairstyles that pull on the hair roots. Braids, cornrows, and ponytails -- especially if they are too tight -- can tug on the hair and encourage hair loss.

Trichotillomania

Trichotillomania is a psychological condition in which people pull out their hair.

Trichotillomania is a compulsion in which people suffer an extreme urge to pull out their hair on the scalp, eyebrows, eyelashes, or other areas of the body. The disorder is presumed to be related to obsessive-compulsive disorder (OCD). Treatment for the disorder may include medications such as fluoxetine (Prozac) and cognitive-behavior therapy (CBT). The word is derived from Greek: tricho=hair + till(ein)=to pull out or pluck + omania.

Telogen Effluvium

Telogen effluvium is the name for losing hair due to illness or stress, including childbirth.

Telogen effluvium is excessive hair loss that occurs after stress on the body due to childbirth, fever, infection, surgery, restrictive diets, thyroid disease, or severe chronic illness or emotional stress. Certain medications may also trigger the condition. The average person loses about 100 strands of hair per day. Telogen effluvium may result in the loss of almost 70% of the hair on the head. Hair loss occurs in the weeks or months after the stressful event.

Hair has its own lifecycle in which it grows, rests, sheds, and regrows. The resting stage of the hair cycle is called telogen. Telogen effluvium results when a severe stressor causes hair roots to enter the resting state (telogen), and new hair pushes the old hair out, causing hair loss. If the stressor that precipitated the hair loss can be removed, shedding usually slows down within about 6 to 8 months.

Dandruff

Dandruff causes your scalp to flake off, leaving a white or yellow mess on your hair and shoulders.

Dandruff, or seborrheic dermatitis, causes oily, scaly, flaking skin on the scalp and other areas. The condition is caused by overactive oil glands (sebaceous glands). The condition may result in yellow or white skin flakes shedding from the affected area. Although it may be unsightly and uncomfortable, dandruff is not dangerous. Treatment consists of the use of special shampoos that contain dandruff-fighting ingredients including salicylic acid, selenium sulfide, pyrithione zinc, tar, and ketoconazole.

Yellow Dandruff

Yellow dandruff causes flakes of the scalp to fall off and can be very itchy.

Seborrheic dermatitis causes oily, flaky yellowish patches of skin on the head and face. The area may also be affected by skin redness. The condition is benign, but it can produce severe itching. If an affected person scratches the skin too hard, it may break the skin and lead to an infection. If the scalp has silvery scales, psoriasis may be the cause.

Razor Bumps

Razor bumps treatments include various medications.

Razor bumps (pseudofolliculitis barbae), or ingrown hairs, sometimes occur after shaving. Razor bumps develop when hairs curl around and grow back into the skin. Small red bumps resembling pimples form on the skin's surface. Razor bumps are common in people who have very curly or coarse hair.

Razor bumps usually go away on their own, but they can sometimes become infected and may cause scarring. Treatment for razor bumps may include steroid medication, retinoids, or antibiotics.

Alopecia Areata (Nails)

Alopecia areata can harm nails, leaving rough patches and white spots.

Alopecia areata can affect the nails causing pitting, splitting, and other changes. The surface of the nail may appear rough or have lines or white spots. Sometimes nail changes may be the first manifestation of alopecia. One or more nails may be affected.

Onycholysis

Onycholysis causes the nail to separate from the nail bed. It should be kept clean.

Onycholysis is a condition in which the nail separates from the nail bed. The condition may be caused by infection or injury. The separated portion of the nail may turn yellow, white, or green. Treatment consists of clipping off the affected portion of the nail. It is important to keep the affected nail dry. Gloves should be worn when washing or cleaning. Healing occurs within 2 to 3 months.

Onychomycosis (Fungal Nail Infection)

Onychomycosis from fungal nail infection makes nails brittle, thick, and discolored.

Onychomycosis is fungal infection of the nails. Fungal nail infection causes nails to become thick, white, opaque, and brittle. Warm, damp conditions create a favorable environment for fungus to flourish. Locker rooms, swimming pool areas, and showers may harbor fungus. Injury to the nails may increase the risk of fungal nail infection. Wearing acrylic nails that trap moisture may promote fungal nail infection.

Medical conditions that impede blood flow or depress immunity may increase the risk of fungal nail infection. Diabetes and circulatory disorders may impair blood flow to the nail beds, increasing the chance of fungal infection.

Ingrown Toenail

Ingrown toenails can be painful. They usually appear on the big toe. Learn how to prevent ingrown toenails.

An ingrown toenail occurs when edges from a a nail intrudes into the surrounding skin. It most commonly occurs on the big toe as a result of improper nail trimming or wearing shoes that are too tight. The condition may cause pain and, redness, and can lead to infection. Trimming the toenail straight across without tapering at the ends may help prevent ingrown toenails. In some cases, a doctor or podiatrist may perform minor surgery to remove part of the nail, the nail bed, and excess skin to correct the problem.

Clubbed Nails

Clubbed nails can be caused by other diseases, and are sometimes inherited.

Clubbed nails are an exaggerated downward curvature of the nails that may be indicative of systemic disease. Clubbing may occur in cases of cirrhosis, cystic fibrosis, inflammatory bowel disease, congenital heart disease, and other conditions. Some cases of clubbed nails are hereditary.

Discoloration of Nail Plates

When nail plates are discolored, there may be many causes, including silver nitrate.

The nails are susceptible to discoloration by a variety of agents. Potassium permanganate is known to stain nails a brownish-purple color. Silver nitrate will turn the nails black. The pictured stains are due to resorcinol. Nail stains may not look very nice, but they are not dangerous.

Nail-Patella Syndrome

Nail-patella syndrome puts you at higher risk of glaucoma and kidney disease.

Nail-patella syndrome, otherwise known as osteo-onychodysplasia, is a hereditary condition. The mutation responsible for the condition is on the gene that encodes transcription factor LMX1B on chromosome 9 (9q34). People who have the condition display dysplasia of the fingernails, posterior conical iliac horns, radial head abnormalities, and hypoplastic or absent patellae. People who have this condition are at increased risk for glaucoma and kidney disease.

Leukonychia Striata

Leukonychia striata are white streaks on the nails and have many causes.

Leukonychia striata are white streaks that appear on the nails due to trauma, manicuring, or certain systemic diseases. Often, the cause of leukonychia striata cannot be identified and the white streaks resolve without treatment. Some cases of leukonychia striata are inherited.

Leukonychia Totalis

Leukonychia totalis discolors nails and is inherited.

Leukonychia totalis is an inherited disorder that causes discoloration of the nails. Nails affected by the condition are largely white due to abnormal keratinization beneath the nail plate. Inheritance of the condition is through an autosomal dominant pattern.

Trachyonychia

Trachyonychia gives nails a rough, sandpaper-like feeling, and may make them brittle.

Trachyonychia (also called 20-nail dystrophy) is a condition that causes disruption of the nail matrix. Due to this, the nails have a rough, sandpaper-like quality. Despite its name, trachyonychia may affect one nail or all 20. Nails with trachyonychia display long, straight lines of variable height that extend the length of the nail. Other trachyonychia symptoms include lack of nail luster and a rough, grubby, brittle appearance. Trachyonychia may be associated with other conditions such as lichen planus, eczema, psoriasis, and alopecia areata.

Female Pattern Baldness

Female pattern baldness affects about 30 percent of all women, especially after menopause.

Female pattern baldness is a type of hair loss that occurs in about one-third of all women, most commonly after menopause. Hair loss may occur on the top or sides of the head. Cosmetic, medical, and surgical therapies are available for the treatment of female pattern baldness.

Male Pattern Baldness

Male pattern baldness is common, affecting about 65 percent of men by age 35.

Male pattern baldness accounts for the vast majority, more than 95%, of hair loss in men. It is a form of androgenetic alopeceia. Approximately two-thirds of men in the U.S. will have substantial hair loss by the age of 35. By age 50, an estimated 85% of men will have thinning hair. About 25% of men will begin to lose their hair before the age of 21. Hair loss can be psychologically detrimental for men and may encumber their professional lives and interpersonal relationships.

Hair Transplant

There are many surgeries for curing baldness, including hair transplants and scalp reduction.

Several surgical techniques are available to improve the appearance of the hair. Hair transplantation involves removing hair from the back of the head and transplanting it into areas in the front of the scalp. Scalp reduction is another procedure that can make hair appear fuller. The surgery involves removing hairless parts of the scalp and stitching the remaining scalp areas back together. The results of modern day hair transplant procedures are much more natural looking than the results of procedures years ago. Patients who undergo hair transplantation often take finasteride (Propecia) to preserve the hair that is transplanted. Before undergoing hair transplantation surgery, check the background, experience, and credentials of the physician.

Low Level Light Therapy: Laser Comb

A laser comb is used to treat hair loss. They can be bought over the counter.

Low level light laser therapy (LLLT) is a type of therapy that uses red or near-infrared laser light. In 2007 one LLLT device was approved to treat hair loss. The device increases hair growth in both men and women. Devices are available over-the-counter and do not require a prescription from a doctor.

Low Level Light Therapy: Sunetics Device

Sunetics devices apply red light to alter cells and treat everything from tuberculosis to carpal tunnel syndrome. Skeptics believe it does not work on at least some conditions.

Low level laser therapy (LLLT) is a noninvasive treatment where red light or near-infrared light is applied with the intent of altering cell and tissue function. LLLT has been used to treat a variety of medical disorders, including osteoarthritis, carpal tunnel syndrome, tuberculosis, ulcers, Bell's palsy, neck pain, Parkinson's disease, and hair loss. The efficacy of LLLT for certain applications is controversial; however, an LLLT device was approved by the U.S. Food and Drug Administration (FDA) in 2007 for the treatment of male pattern hair loss.

Hair Grafts

One treatment for baldness is hair grafting.

Several surgical hair replacement techniques are available. This photo shows hair grafts ready for transplant.

Unnatural Pluggy Hairline

When a hair graft goes poorly, it can create a pluggy hairline.

Older hair transplant procedures employed larger hair grafts than are not commonly used today. The result was often a conspicuous, "pluggy appearing" hairline, also described as a bristle brush or Barbie doll hairline. The example in this photo depicts 10 to 25 hair grafts. Pluggy hairlines can now be reconstructed using micrografts and minigrafts applied in large numbers. More than 1,000 hair grafts can now be applied in a single session. The results are more natural looking.

Premature Gray Hair

Premature gray hair is typically genetic, but can also be brought on by trauma, stress, or illness.

Hair grays prematurely largely due to genetic reasons. Hair derives its color from the pigment melanin. A decrease in melanin produces gray hair. Stress, illness, and trauma may also increase the risk of premature gray hair. A deficiency in vitamin B12 may also contribute to the condition in rare cases.

Sources:

IMAGES PROVIDED BY:

  1. Images reprinted with permission from eMedicine.com, 2010.
  2. Medscape
  3. Image reprinted with permission from eMedicine.com, 2010.
  4. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  5. “Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology”; Klaus Wolff, Richard Allen Johnson, Dick Suurmond; Copyright 2005, 2001, 1997, 1993 by The McGraw-Hill Companies. All Rights reserved.
  6. Judith Haeusler / Stone / Getty Images
  7. © Interactive Media LLC
  8. Image reprinted with permission from eMedicine.com, 2009
  9. Color Atlas & Synopsis of Pediatric Dermatology Kay Shou-Mei Kane, Jen Bissonette Ryder, Richard Allen Johnson, Howard P. Baden, Alexander Stratigos Copyright 2002 by The McGraw-Hill Companies. All rights reserved.
  10. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  11. Copyright © ISM / Phototake -- All rights reserved.
  12. Credit: Dr P. Marazzi / Photo Researchers, Inc
  13. Color Atlas of Pediatric DermatologySamuel Weinberg, Neil S. Prose, Leonard KristalCopyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  14. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  15. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  16. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  17. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  18. Color Atlas of Pediatric Dermatology Samuel Weinberg, Neil S. Prose, Leonard Kristal Copyright 2008, 1998, 1990, 1975, by the McGraw-Hill Companies, Inc. All rights reserved.
  19. Copyright © ISM / Phototake -- All rights reserved.
  20. Copyright © BSIP / Phototake -- All rights reserved.
  21. Image reprinted with permission from eMedicine.com, 2010.
  22. Color Atlas of Cosmetic Dermatology Marc R. Avram, Sandy Tsao, Zeina Tannous, Mathew M. Avram Copyright 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
  23. Color Atlas of Cosmetic Dermatology Marc R. Avram, Sandy Tsao, Zeina Tannous, Mathew M. Avram Copyright 2011 by The McGraw-Hill Companies, Inc. All rights reserved.
  24. Color Atlas of Cosmetic Dermatology Marc R. Avram, Sandy Tsao, Zeina Tannous, Mathew M. Avram Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
  25. Color Atlas of Cosmetic Dermatology Marc R. Avram, Sandy Tsao, Zeina Tannous, Mathew M. Avram Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
  26. Noel Hendrickson / Blend Images / Photolibrary

REFERENCES:

  • National Alopecia Areata Foundation: "About Alopecia Areata."
  • American Academy of Dermatology: "Alopecia areata: Signs and symptoms."
  • American Osteopathic College of Dermatology: "Onycholysis."
  • American Podiatric Medical Association: "Toenail Fungus."
  • American Academy of Orthopaedic Surgeons: "Ingrown Toenail."
  • American Family Physician: "Nail Abnormalities: Clues to Systemic Disease."
  • AMA Archives of Dermatology: "Discoloration of the Nails: Concomitant Use of Nail Lacquer with Resorcinol or Resorcinol Monoacetate (Euresol) as a Cause."
  • Genetics Home Reference: "Nail-Patella Syndrome."
  • Washington Manual of Outpatient Internal Medicine: "Leukonychia Striatica."
  • Online Mendelian Inheritance in Man: "Nonsyndromic Congenital Nail Disorder."
  • International OCD Foundation: "Trichotillomania Fact Sheet."
  • American Osteopathic College of Dermatology: "Telogen Effluvium Hair Loss."
  • American Academy of Dermatology: "Seborrheic Dermatitis."
  • American Academy of Dermatology: "Dandruff: How to Treat."
  • American Osteopathic College of Dermatology:"Dandruff."
  • American Hair Loss Council: "Female Pattern Hair Loss."
  • American Hair Loss Association: "Men’s Hair Loss."
  • American Society of Plastic Surgeons: “Surgical Hair Transplants.”
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  • The Encyclopedia of Skin and Skin Disorders: "Grey Hair."
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