What is making my hair fall out?

Q

Last year was grim for me – I lost my father suddenly just as I was going through a divorce. I was really hoping 2017 would be better, but I’m horrified to discover my hair falling out in clumps. It’s really getting me down.

A

You don’t say whether your hair is generally thinning or if you’ve lost some patches completely. This is important because it makes a difference to the likely diagnosis, and to treatment.

Your hair usually grows for three to five years – the so-called anagen phase – at about 1cm a month. At the end of this time, it transitions to a resting telogen phase for about three months, where it stays in the hair follicle but doesn’t grow any more. It can fall out or be pulled out by brushing, or it can be pushed out when the hair follicle starts to grow another hair. In many animals, the phase is synchronised, resulting in moulting, but humans tend to lose smaller amounts of hair all year round.

All sorts of factors – major stress, severe illness, crash dieting, childbirth and some medication – can push all your hairs into the telogen phase together. You will suddenly notice you lose more hair all over your scalp. If it’s caused by a sudden event, the most noticeable hair loss will be about three months later, as new hair grows from the hair follicles. It can also be a slower process, which results in general thinning of the hair, sometimes due to iron deficiency or an underactive thyroid. I can’t help wondering if all the stress you’ve been under may have triggered this. If this is the cause, the good news is that you’re not going to go bald and your hair will regrow without treatment.

Alopecia areata is an autoimmune condition in which the white blood cells of your body’s own immune system turn on your hair follicles. This leads to inflammation around the follicles and, in turn, to patches of hair loss. These patches are classically the size of a large coin, and the scalp underneath is usually perfectly normal. Several patches can merge together and occasionally all scalp (and less commonly body) hair is lost. Hair often returns within a year, especially in milder cases, but otherwise steroid cream or injections into your scalp may help.

Q

I’ve had back pain on and off for years. My GP has now told me not to take paracetamol for it. What about complementary medicines?

A

The new NICE guideline on low back pain has been a bit of a shock for both doctors and patients. Many treatments that work to damp down nerve pain – such as paracetamol, antidepressants and anti-epilepsy drugs – are no longer recommended, except in sciatica. Stronger opioid painkillers (for example, those containing codeine) aren’t recommended for chronic back pain either, and acupuncture and corsets are off the menu, too. Instead, it’s all about group exercise, psychological therapy to help you cope with pain, and keeping active. Nonsteroidal anti-inflammatory tablets are recommended, but they can cause significant side effects.

There are several complementary tablet options, but evidence is conflicting. Most brands of glucosamine appear to be no better than a placebo, and there’s little robust proof that omega-3 fish oils help either. GOPO, a supplement based on rosehip, has more positive data, with studies suggesting a reduction in pain and stiffness in the lower back.