Why your hair keeps falling out

Hair loss, also known as alopecia, is a common and distressing clinical complaint for both adults and children. Given the psychological stress that may arise from hair loss, it is important that a diagnosis of the probable cause is identified and where necessary treatment or preventive strategies instituted. 
While some causes may be the same across the divide (adults and children), there are some that are different. Therefore, generalisation may not be a great idea. 

Dr Boniface Otto Ssegujja, a paediatrician, says the cause of hair loss in children can be medical or non-medical. “While many causes of hair loss in children may require treatment, others will resolve on their own with time. It is, therefore, important that a pediatrician or dermatologist examines the child to identify whether treatment is necessary or not.”
Hair loss in newborns:
This occurs during the first few months of life when the baby hair is replaced by permanent hair. “No treatment is required,” Dr Ssegujja says.
Rubbing: It occurs between three and six months of age due to friction with the crib mattress or car seat. “This results in babies having bald spots, especially at the back or lateral side of the head. No treatment is required,” he says.
Hair abuse
This is due to vigorous brushing or pulling of the hair into tight ponytails or braids. “It results into the hair falling out. To prevent it, parents need to be gentle with the child’s hair,” Dr Ssegujja advises.
Brenda Kamurasi, the proprietor of Uzuri Saloon, adds that the use of chemicals in children’s hair in the name of softening it may also lead to hair loss. “These are harzadous as the scalp is tender and also alter the hair texture hence breakage. Chemicals also burn the scalp leading to scars that do not allow for hair growth. This hair also looks moist even without oiling which means a dry scalp hence easy breakage.”
Tinea cavities
These are commonly known as ringworm of the scalp and is a fungal infection which often appears as white round or oval scaly patches of hair loss on the head. “It requires seeing a dermatologist who will administer treatment with antifungal oral medications and shampoo,” Dr Ssegujja says. Since it is a contagious disease, to prevent it, he says children should be careful not to share objects that touch the head such as hats, pillow cases, brushes and hair clippers. 
Alopecia areata
This is a non-contagious condition of hair loss thought to be caused by the body’s immune system attacking the hair follicles. “The patches are round or oval, and smooth without scaling or broken hair. Despite lack of cure for this condition, there are treatments that can control the disease in some children,” he shares.
Trichotillomania
 This is hair loss caused by the child pulling, plucking, twisting, or rubbing their hair. “It is often triggered by stress or anxiety in a child’s life such as loss of a loved one, birth of a sibling. Counselling rather than scolding will help the child to deal with the cause of the habit hence helping stop it,” he shares.
Nutritional deficiencies
Under-nutrition remains a common problem in Uganda and hair loss can be a symptom of deficiencies in certain nutrients including Biotin (a part of Vitamin B complex), Vitamin A and Zinc. “With good nutrition, most children will not experience nutritional deficiencies that lead to hair loss,” Dr Ssegujja shares.
Endocrine problems
Lack or insufficiency of some vital hormones such as the thyroid hormone can result in hair loss in children. “Assessment is required for this condition to be diagnosed and treatment with hormone replacement often corrects the condition.”
Among adults, while some of the causes of hair loss are quite different between men and women, some are similar and they include:
Harsh combing
Most women experience hair breakage on the side where the hand has got lots of strength. “For example, if one’s right hand is strong, that side will suffer severe hair loss. We need to love our hair enough to be gentle with it if we are to keep it lush,” Bella Nakato of EnvirizaNacho says.
Comb type
Many women are accustomed to using small toothed combs for their hair. Nakato says these combs lead to hair loss seeing that most of our hair is course yet small toothed combs work best with straight hair. “Before using a comb, of which a wide toothed comb is advised, use your fingers to detangle the hair.”
More to that, you do not need to comb your hair all the time. “Get into the habit of doing protective hair styles such as cornrows, twist right after washing your hair. You could also plait weaves but ask your hair dresser not to plait the tender hair line,” Josephine Ntale, a beautician shares.
Blow drying and hot combing 
Maxima Nsimenta, of Livara, says when one has natural hair, excessive heat use causes damage which leads to hair damage such as breakage and loss. “Trying to straighten our hair leads to damage. However, if you must, use a heat protector and use medium or cool setting. While it takes time, it will prevent hair damage.” 
Balding
Men usually experience male pattern balding which Dr Edward Ogwang a dermatologist with Skin Specialist, says is a genetic condition that affects men due to a hormone called androgen. It could start as early as when one is in their teens or early 20s. “Under the influence of hormones, the hairs at the corners and the temple start to shrink to the point of looking like body hairs before disappearing completely.” 
It can be treated using anti-androgens, and Dr Chirang Kotecha of Avane Cosmetic Clinique and MediSpa says, while it is difficult to treat hereditary causes, there are topic creams and sprays that one uses daily or weekly for a life time to keep the hairline okay. ”
Dr Francis Asiimwe, a dermatologist with Ultra Care Medical Services, says that after assessment, hormone resistant hairs can be located and transplanted to the balding place. 
“However, that depends on whether there are any hormone resistant hairs, and if they are enough to cover the place. More to that, it is quite costly.“ This treatment can also work on women experiencing pattern balding.
Medication
Apart from chemotherapy, there are several medications that might cause hair loss. Dr Malik Ssempereza, a dermatologist with Unity Skin Clinic, says these include anti-thyroid medications, hormonal therapies (such as birth control), anti-convulsants (for epilepsy), anti-coagulants, beta-blockers, immuno-suppressant treatment (for the heart, lung kidney), and antipsychotics.” Besides that, high-cholesterol and/or high blood pressure drugs exacerbate hair fallout and thinning as they can deplete CoQ10, which can result in hair loss.  These drugs affect both men and women, save for birth control drugs and if someone can, they should stop taking the offending drug.
Severe chronic disease
The kidneys and liver of one suffering from diseases such as cancer tend to get overwhelmed hence failing to cope up with the high toxin levels within the body. “The body then turns to the skin to emit these toxins. While the palms and feet seem unaffected, the hair on the scalp cannot handle the toxins, hence  it starts falling off,” Dr Asiimwe says.
Infections 
When one suffers from diseases such as syphilis, fungal infections (more so fungus from animals), Dr Asiimwe says the infection-causing organisms infect their hair follicles causing the hair to fall off. 
Scalp inflammation
When some organisms invade our bodies, such when there is excessively sebum production, they respond in many ways such as inflammation. Dr Ssempereza shares that this can clog hair roots and result in itchiness or flakiness. 
“Research has it that inflammation at the level of the scalp interrupts and impairs healthy hair growth. Overgrowth of fungus or yeast at the scalp that feed on the natural hair oils can turn into redness and irritation. ”