Hair loss is a condition that occurs from the root. These hair roots are situated and attached to pore-like structures called hair follicles, which lie within the scalp. Each hair follicle goes through a hair growth cycle which involves the growth phase, the transition phase, the resting phase, and lastly shedding phase. The time duration of the hair cycle varies among different hair follicles. Hence, all hair follicles don't undergo hair shedding at the same time. Club hair strands are something which is formed when the hair follicles reach their final stage of the normal hair growth cycle.
These are bunches of those hair strands which have reached the end of the transition phase and remain dormant since they detach themselves from receiving blood supply from the hair root. They stop growing and may remain in the hair follicles for at least 2-3 months. The bottom end of the hair strand which is within the hair follicle develops a white bulb that holds it firmly in place despite being detached from the blood supply. This process of forming club hair strands takes 2 weeks and at least 15-20% of the scalp hair is club hair strands or is developing into a club hair.
These clubbed hair strands are shed normally either due to washing or brushing the hair. Running fingers through the hair strands also tends to shed much-clubbed hair. The presence of clubbed hair can vary due to several underlying clinical conditions.
Identifying Club Hair
The white-colored bulb at the hair roots can be identified as those of clubbed hair strands. As the hair follicles reach the end of their transition phase, there is a decrease in the production of the melanin pigment which leads to the discoloration of the roots. Melanin is the color pigment that provides the characteristic black or brown color to the hair strands. This decrease in melanin production causes a white bulb to form at the root of the hair strand which attaches itself to the hair follicle and keeps them in place despite the strands being detached from the blood supply.
This white-colored bulb helps to identify the club hairs which are shed easily after 2-3 months when brushing or washing hair strands through a comb or fingers. Club hair strands are formed for up to a duration of 2 weeks and remain in the hair follicles for 2-3 months when they stop growing and experience the shedding phase.
A study was conducted on hair samples of patients with telogen effluvium and patients with alopecia areata. Telogen effluvium is a type of hair loss that is characterized by excessive shedding and mainly occurs due to hormonal imbalances or underlying clinical conditions. Alopecia areata is a type of hair loss that is an autoimmune condition, characterized by balding in small patches on the scalp. The study showed the presence of atypical club hair was characteristic of the telogen effluvium type of hair loss.
Club hair grows 18-30 inches in length or can be even longer since they have reached the end of the growth phase. A club hair is also called dead hair since they don't have any live cells in them.
Clinical Conditions Causing Club Hair
The formation of clubbed hair can increase in cases of several clinical conditions which tends to push a large number of hair follicles in the resting phase of the hair growth cycle from the growth phase leading to telogen effluvium. This type of hair loss sees increased hair shedding of up to 150-200 strands for a short period. Below mentioned clinical conditions can increase the presence of club hair on the scalp.
The hypothyroid condition involves the decreased production of thyroid hormones which regulate metabolism and maintain homeostasis. Thyroid hormones also play a role in stimulating hair growth by modulating the hair growth cycle of the hair follicles. When thyroid hormones aren't sufficiently produced as in hypothyroidism, the hair growth cycle becomes shorter, leading to the formation of club hair strands and more hair shedding.
Research studies have shown that vitamin deficiencies especially Vitamin B12 and Vitamin D3 give rise to more hair loss and shedding and several other nutrients such as zinc, selenium, Vitamin A, E, and C if received in inadequate amounts through diet, can lead to club hair strands and hair loss.
Menopause is the time characterized by the discontinuation of regular menstrual cycles and reproductive abilities among females which usually occurs during the mid-40s or early 50s. This period sees a shift in the hormonal levels such as a decrease in estrogen and progesterone levels and an increase in androgen levels. Estrogen and progesterone have protective abilities against the hair follicles hence maintaining good hair health. But as their levels decrease during menopause and the levels of androgens increase, it causes a lot of hair thinning and the formation of clubbed hair.
Childbirth is a stressful event and is characterized by a surge in certain hormones such as prolactin and oxytocin which are essential for lactation or enhancing milk production in the mother. Estrogen and progesterone levels drop. These hormonal changes also lead to mood swings, hair thinning, and clubbed hair.
Crash Dieting or Fad Diets
Following drastic weight loss diets or fad diets that involve avoiding important food groups from the diet and are low in protein content can often lead to poor hair quality. This is because the diet is providing an insufficient amount of nutrients for carrying out normal bodily functions. Hence, there isn't a surplus supply of nutrients provided through diet for nourishing organs the hair, skin, and nails. Hence, the skin, hair, and nails turn dry and brittle having poor quality.
Intake of medications can also affect the rate at which club hair can be formed. Medications for controlling high blood pressure, controlling seizures and fits, blood thinners, and hormonal therapy can all contribute to hair loss.
Tests/Diagnose Club Hair
When an unusual amount of club hair strands are observed while hair shedding, it can be caused due to an underlying condition. This underlying condition needs to be addressed to improve the quality of hair and reduce the incidence of club hair. To determine the underlying cause of club hair or hair loss, the physician may ask for any one of the following hair tests to be conducted which shall help ascertain the number of club hair on the scalp. These tests also help in the diagnosis of hair loss conditions.
- Hair Pull Test
- Scalp Biopsy
- Hair Loss Count
The presence of a larger number of club hair than the usual count can indicate an underlying clinical condition or chronic hair loss condition. Both need to be investigated for addressing the main cause which can be a chronic clinical condition or simply a genetic predisposition. Following a balanced diet and supportive lifestyle can lead to prolonging the hair growth cycle and reducing in presence of club hair.