Dear Dr Campbell-Chambers,
I live in Canada and my health is otherwise good except for the fact that I have haemoglobin SC (sickle cell). I have had a similar problem (alopecia) as to the letter published on June 13, 2012. Mine, however, seems to have an extra twist to it. I have had this problem for almost eight years. It comes and goes and I usually do a comb over to hide the spots. Lately, it has got to the point where I can no longer hide it. I am constantly wearing a wig, a bandanna or a hat.
I can usually tell when it's about to start falling out. The area becomes extremely hot that I stick my head in front of the fan on full blast (that rarely helps). Then it begins to itch as if I have a thousand biting ants in my head, then the hair falls out in clumps as soon as the burning and itching stops. Also, the strands of my hair have knots on them (not all the strands) as if they were tied.
I have been to my doctor and she recommends using Rogaine 2% Topical Solution twice daily for 30 days. Would you be able to tell me why my hair knots and why my hair falls out in patches the size of a baseball on the right side and the size of a golf ball on the left? The middle is now beginning to heat, itch and thin out, but no falling out in clumps. I need your help, please, before I lose all my hair. I would not like to have to wear a wig for the rest of my life.
Your description of your condition does sound as though you could possibly have alopecia areata. However, there are many other causes of alopecia, which can be diagnosed and treated by your dermatologist. Some individuals with alopecia areata do complain of burning and itching sensations, which can be improved with treatment. The hair tends to fall out in patches, which can be of different sizes like you described. Rarely, the entire scalp and body hair can be affected.
I would not recommend that you stick your head in front of the fan as this can cause knots to form. Other causes of hair knots include genetic hair defects, medical conditions causing extreme hair dryness, poor diet, excessive chemical treatment, exposure of untied hair to the wind, friction with pillow, some hair styles and infrequent combing. These factors should be avoided where possible.
Additionally, detangling preparations, adequate moisturisation, leave-in conditioners and a wide-tooth comb can help with knots. You can review my last article for treatment options for alopecia areata. Minoxidil (Rogaine 2-5 per cent) helps 40-50 per cent of individuals in the long term (after about 12 weeks) and may be combined with other treatments. Alopecia can be unpredictable but can be improved with treatment. Support groups have also been helpful. All the best.
Dr Arusha Campbell-Chambers is a dermatologist and founder of Dermatology Solutions Skin Clinics and Medi-Spas. Email firstname.lastname@example.org.