Infections That Cause Hair Loss

Introduction

Scalp infections are regarded as minor but should never be ignored. A healthy scalp contributes to healthy hair growth. Hair loss can occur in two ways. The first reason can be when the hair falls out from the affected scalp and is incapable of growing new hair until the condition has resolved. The second reason can be due to an itchy scalp. Excessive scratching due to itching can result in hair breakage, falling out, and causing irreversible damage to the hair follicle.

What Is the Hair Growth Cycle?

A hair growth cycle comprises three phases:

• Anagen Phase: This is the active phase of hair growth and can last for years.

• Catagen Phase: In this phase, the hair stops growing and detaches from the follicle, which is present beneath the skin and is responsible for holding the hair in place. This phase lasts for nearly 10 days.

• Telogen Phase: During this phase, the hair follicles rest for 2-3 months and then fall out.

As a part of this natural cycle, most people lose about 50 to 100 hairs daily. Hindrance in this cycle or damage to the hair follicle during this period can accelerate hair fall, resulting in conditions like receding hairline, overall thinning, or hair falling in patches.

What Are the Factors That Cause Hair Loss?

Partial or complete loss of hair is termed alopecia. The factors causing hair loss are:

• Heredity.

• Physical or emotional stress.

• Alopecia areata (bald patches that form on the scalp, beard, and sometimes even eyebrows and eyelashes may be affected).

• Telogen effluvium (a reversible condition in which the hair falls out as a result of stressful experience).

• A side effect of certain drugs like beta blockers, Heparin, Warfarin, Amphetamines, Levodopa, and Lithium.

• Anemia.

• Autoimmune conditions (conditions in which the immune system attacks the healthy cells) like Alopecia areata.

• Burns.

• Infectious diseases.

• Deficiency of protein, zinc, iron, or biotin.

• Hormonal changes.

• Thyroid diseases.

• Nervous habits like hair pulling or scalp rubbing.

• Radiation therapy.

• Ringworm of the scalp (Tinea capitis).

• Ovary or adrenal gland tumors.

• Hairstyles that exert too much pressure on the scalp.

• Bacterial infections of the scalp.

What Are the Bacterial Infections That Cause Hair Loss?

The bacterial infections that cause hair loss are as follows:

1. Bacterial Folliculitis: Folliculitis refers to the inflammation of hair follicles. It resembles acne surrounded by little rings of inflammation around the opening of the hair follicle. In the initial stages of folliculitis, the hair fibers may be intact but may fall out as the condition progresses. In case of severe infections, inflammation can be intense such that it can cause permanent damage to the hair follicles resulting in small bald patches.

Though non-infectious forms of folliculitis exist, like those caused by the application of oils and greases to the skin that can clog the hair follicles, folliculitis is predominantly caused by bacteria, especially Staphylococcus aureus. ‘Hot tub folliculitis’ is caused by Pseudomonas aeruginosa, which manifests in inadequately treated chlorinated water.

Symptoms: The symptoms of bacterial folliculitis include:

• Oval-shaped or round bald spots.

• Tight scalp accompanied by pain.

• Small sacs filled with yellowish pus at the back of the head or anywhere on the scalp.

• Pustules can ooze and result in the formation of scabs, scaly skin, or crusts.

• Hair can grow in tufts with numerous strands originating from the same follicle. The follicle can die, leaving behind a bald spot and scar.

Treatment: Bacterial folliculitis can be treated in the following ways:

• Minor folliculitis can be treated with non-prescription topical antibiotics like Neomycin, Bacitracin, and Mycitracin.

• Serious infections are treated with oral antibiotics like erythromycin.

• Corticosteroids can help reduce inflammation.

• Isotretinoin can clear the pustules.

• Methyl aminolevulinate photodynamic therapy (MAL-PDT) is an effective remedy in which a chemical applied to the scalp reacts to a specific light that eliminates the infected cells and bacteria.

• The doctor may suggest a hair transplant if the hair follicle is severely damaged.

• Protein-rich plasma is a non-invasive procedure that can be done to promote hair regrowth. In this procedure, blood is taken from the patient, which is then subjected to a centrifugal process and then transformed to protein-rich plasma and injected at the site of infection. New hair tends to grow quickly with this procedure.

2. Syphilis: Syphilis can cause hair loss in both men and women if left untreated. Syphilis is a sexually transmitted disease that is caused by Treponema pallidum and is contagious. It is commonly transmitted through unprotected sexual routes. Hair loss due to syphilis is treated with antibiotics.

3. Impetigo: Identifying impetigo at the right time is vital before undergoing a hair transplant surgery since this contagious infection can impact hair implantation results. It is caused by Staphylococcus aureus and Streptococcus bacteria and commonly occurs in warm and humid conditions, as these conditions are favorable for the growth of these bacteria.

Since the immune system is already weakened in this condition, a delay in treatment could worsen the hair loss condition and result in side effects following a hair transplant procedure. Impetigo is usually treated with antibacterial soaps or hair growth shampoo to prevent the further spread of infections.

What Are the Fungal Infections That Cause Hair Loss?

The fungal infections that cause hair loss are as follows:

1. Tinea Capitis (Ringworm): Ringworm infection in the scalp initiates as a small pimple that progresses in size and leaves behind scaly patches of temporary baldness. The fungus that affects the scalp gains entry into the hair fibers, making them brittle and making the hair susceptible to breaking easily, resulting in a bald patch of skin.

Symptoms: The symptoms of tinea capitis infection are:

• Affected areas are itchy, red, and inflamed with scaly patches that can blister and ooze.

• The patches appear red on the outside than the inside, which creates an appearance of a ring hence called a ‘ringworm’ infection.

Causative Agents: The fungi that can cause tinea capitis are:

• Microsporum audouinii (a common cause of ringworm).

• Trichophyton tonsurans (common in the US and Latin American countries).

• Trichophyton schoenleinii (common in Southern Europe and Africa).

• Trichophyton megninii (common in Southern Europe and Africa).

• Trichophyton violaceum (common in the Middle East).

• Microsporum gypseum.

These can spread to humans through contact with infected animals or can be transmitted through contaminated combs, shower or pool surfaces, and unwashed clothing.

Treatment: The treatment for tinea capitis includes:

• Treatment depends on the type of fungus that causes the condition. Usually, they resolve on their own, and no treatment is required.

• Griseofulvin is an anti-fungal drug that is effective against the fungi in the hair and skin but not against yeast and bacteria. This drug slowly accumulates in the skin and hair, binds with keratin at these sites, and prevents the fungus from infecting the keratin.

• Recently, tinea capitis has developed resistance to Griseofulvin, which dictates the need for prolonged treatment and higher doses. Hence, alternatives like Itraconazole, Fluconazole, and Terbinafine are used.

2. Piedra: The term piedra means ‘stone’ in Spanish and is characterized by the development of hard nodules on the hair fiber. It is also called trichomycosis nodularis. Piedra is of two types, namely black and white piedra. Black piedra is caused by Piedraia hortae and is common in tropical countries. White piedra is caused by Trichosporon beigelii and is common in Europe and Southern parts of the United States. This infection can affect the body, scalp, and genital areas. In severe infection, the hair fibers turn weak and break off, resulting in patchy, diffuse hair loss. Treatment involves the use of antifungals like Terbinafine or Ketoconazole and shaving off the affected areas.

3. Seborrheic Dermatitis: It is primarily a skin infection but can cause infection and hair loss if it affects the scalp. It results in scaly, occasionally oily, inflamed skin that can cause itchiness or even be tender to the touch. Severe cases can result in baldness. It is not contagious. With the increase in the intensity of seborrheic dermatitis, yeast Pityrosporum ovale (also called Malassezia furfur) also increases, which can cause increased inflammation and irritation.

Treatment: The common treatment is the use of a medicated anti-dandruff shampoo. The shampoos usually contain selenium sulfide, sulfur, zinc pyrithione, salicylic acid, or tar. Recently, azole-based shampoos like Ketoconazole have been available over-the-counter.

What Is Demodex Folliculorum?

Demodex is a little worm-like creature that dwells on skin and hair follicles. Demodex feeds on oils and dead skin. Hence, they are common in hair follicles with abundant oils and dead skin. Humans acquire Demodex infestation in childhood through person-to-person contact. They may cause itchy eyelashes and irritate them. Demodex is not involved in hair loss.

How to Diagnose Hair Loss?

Hair loss is diagnosed in the following ways:

• Assessing the health history, which includes any recent illnesses, surgeries, family history, or life stressors, accompanied by physical examination.

• Biopsy of the scalp if any autoimmune condition is suspected. Small sections of skin are carefully removed and sent to the laboratory for testing.

• Blood tests to identify any nutritional deficiencies or any underlying condition.

How to Prevent Hair Loss?

A few ways to prevent hair loss are as follows:

• Manage stress since stress can trigger a temporary hair loss condition called telogen effluvium. An infection can also trigger it.

• A scalp-soothing serum should be used to remove frequent scalp buildup and to soothe the damaged scalp.

• A nourishing and replenishing conditioner should be used to avoid hair getting dry or damaged.

• Hairstyles should be kept loose so that much pressure is not exerted on the scalp.

• Touching the hair frequently should be avoided.

• Personal items should not be shared. Combs should be cleaned frequently.

• Hair should be gently patted to dry, not rubbed or twisted with a towel.

• Ensure a nutrient-rich balanced diet that is particularly rich in iron and protein.

• The use of styling products and tools like blow dryers, hair straighteners, heated combs, bleaching agents, coloring products, perms, and relaxers should be avoided. They should be used only when the hair is dry, and the tool should be kept in the lowest possible setting.

• Hair can be washed on alternate days or less until the hair is extremely oily.

Conclusion

Hair loss is a common cause of concern, especially among youngsters. Besides certain medical conditions, infections caused by bacteria and fungi can also result in hair loss. Leaving the infections of the scalp untreated can lead to uncomfortable symptoms, hair damage, thinning, and hair loss. In case of any unexplained, sudden, or excessive hair loss, one must visit a dermatologist (skin doctor) at the earliest.