Hair is related to beauty in both the genders and not everybody gets comfortable with the fact that they are going to be bald in some time. Hair fall has become very common these days among people between the age group of 18-50. As the body ages it is common to lose some hair as the body gets through numerous medical conditions by that time but losing hair and developing bald patches at a younger age leads to depression and low confidence.
So why does hair fall happen?
Types of hair fall
There are three types of hair loss:
- Cicatricial alopecia (irreversible)
- Non-cicatricial alopecia (reversible)
- Hair shaft abnormality
The common causes of hair fall are:
This is one of the common causes of hair fall. It is characterized by diffuse hair fall due to disturbance in the hair cycle. The patient can lose somewhere between 500-1000 hair in a day in this condition.
It is mostly caused by some stressful event which triggers the hair fall. There are other factors also such as iron deficiency, use of anticoagulants, thyroid dysfunction, fever, postpartum (period after childbirth), prolonged operation or anesthesia, and chronic renal failure.
Telogen effluvium is also known to carry forward androgenetic alopecia in both males and females.
The Most important part is to find the underlying cause of the hair fall and eliminating that cause. The Clinician must evaluate whether the patient has thyroid dysfunction, hormonal disruption, or some nutritional deficiency.
The source of the problem must be isolated and treated. Patients should be handled psychologically and reassured that the chances of losing hairs are remote.
Androgenetic alopecia may occur among genetically susceptible people. It can start from puberty with a gradual reduction in hair follicle size and therefore the hair growth period curtails. The Pattern of hair loss in men and women varies mostly. M-pattern type hair loss is similar in both genders in which hair reduces from both left and right temples.
Several factors likely play a role in causing androgenetic alopecia. These can be genetic or environmental. Most people with a family history are more likely to get affected by this type of hair loss.
Androgenetic alopecia and androgen hormones
Research shows that androgenetic alopecia is related to a group of hormones called androgens, to be specific dihydrotestosterone which is an androgen hormone. Androgens are commonly thought of as male hormones but females also have them and they regulate the sexual drive(libido) and many other functions such as normal growth of hair in both the genders.
Hair grows in the hair follicle located under the skin. These hair follicles undergo a continuous cycle of birth, rest, and death which is temporary and they regrow again. Excess androgen levels in the hair follicles lead to hair thinning, shorter hair, and delayed hair regrowth.
Androgenetic alopecia is also related to some serious health conditions such as heart disease, polycystic ovary syndrome in women, and prostate cancer in men.
The diagnosis involves clinical trials to check the presence of excess androgen, hormonal imbalance, and any family history related to this type of hair loss.
Treatment of androgenetic alopecia revolves mostly around one of the androgens called dihydrotestosterone. The main drugs that are available in the market are finasteride and minoxidil solutions.
Oral finasteride acts by inhibiting the enzymatic action of 5-alpha-reductase which is an enzyme that converts testosterone to dihydrotestosterone. The drug reduces the amount of DHT at the scalp which results in better hair growth. Research has shown positive results of finasteride on men but these are not much effective in women suffering from androgenetic alopecia.
Minoxidil has demonstrated positive results for both men and women. 2% and 5% solutions of minoxidil are prescribed to patients suffering from hair loss.
Spironolactone, flutamide, birth control pills, and hormone replacement therapy are other options that are also considered in women patients.
This condition is also known as spot baldness because bald spots or patches start to occur either on some part of the whole body. The patches also sometimes overlap with each other making the bald area seem even bigger. Only 2% of people are suffering from alopecia areata at any point in time. However, alopecia areata generally starts in childhood and both genders have equal chances of suffering from this type of baldness.
Alopecia areata is a rare condition and does not affect life expectancy.
In alopecia areata, the immune system cannot identify its cells and starts attacking the hair follicles which is followed by inflammation at scalp due to which hair starts thinning and ultimately shedding with no regrowth thus creating bald patches on some parts or the whole body.
No exact cause is known but research suggests that it is an auto-immune disease facilitated by T lymphocytes. Psychological stress may cause alopecia areata.
Mostly the speed or frequency of hair regrowth is the area where work is done in the treatment of alopecia areata.
Alopecia areata treatment using intralesional corticosteroid injections
Intralesional corticosteroid injections are used to minimize the inflammation in the affected area. Corticosteroid is a class of steroid hormones present in the human body and they are responsible for various physiological processes some of which are an immune response, stress control, and inflammation regulation.
Minoxidil topical solution is largely used for hair loss treatment. It promotes hair growth at the site of application but it should be applied only to the affected areas and face or any other unaffected part of the body must be protected while applying as it can cause unwanted hair growth. Although its effects in androgenic alopecia are positive its effect in alopecia areata is still unclear.
Topical immunotherapy ciclosporin is used to suppress the activity of T-cells. Ciclosporin is an immunosuppressant medication and suppresses the activity of the immune system which slows down the attack of the immune system on the hair follicles and allows hair to regrow.
Mometasone which is used to treat skin conditions, steroid creams to reduce inflammation at affected area and anthralin which treats immune system disorders. These are some other medications for the treatment of alopecia areata in the market.
It is a result of continuous strain on the hair which pulls them out of their roots. Traction causes breakage at the frontal area.
Tightly binding hair can exert a lot of pressure on the hair which may result in traction alopecia. Women tend to suffer more from this condition as braids, ponytails, dreadlocks, and pigtails put a lot of pressure on the hair which may result in traction alopecia. Repetitive traction can result in cicatricial alopecia which is hair loss with scars on the scalp due to repetitive traction.
It can also be caused by various hair solutions, shampoos, and soaps that have harmful chemicals in them.
Scattered hair at the frontal line of the head and hair loss from frontal hairline is the first sign of traction alopecia.
Changing hairstyle which tends to put a lesser strain on the scalp can help to stop the hair fall.
substituting hair solutions, shampoos, and soaps containing harmful chemicals with a natural or organic product.
The effects of traction alopecia can be permanent if not treated.
It is a disorder that causes an irresistible urge to pull out hair which may often lead to bald patches. People with this disorder pull out hair from the scalp, eyebrows, eyelashes, and other hairy areas.
The cause is not definite and the disorder can be a result of mental depression or anxiety. The problem is also seen among children facing some kind of insecurity but this does not signify any kind of psychiatric illness.
Psychological counseling can help a lot to patients facing depression or anxiety. Treating underlying psychological disorders can help calm the patients and stop the urge to pull the hair.
Selective serotonin reuptake inhibitors (SSRI) which are anti-depressing medications are prescribed for trichotillomania which works by increasing serotonin levels which is also referred to as “feel-good hormone”. It fights against disorders like anxiety and depression which helps with the recurrent urge to pull off the hair. Some of them are fluoxetine (Prozac), fluvoxamine (Luvox) sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), and paroxetine (Paxil).
It is an irreversible medical condition where hair loss is followed by scars. The stem cells which are responsible for tissue repair are destroyed in this condition which makes this condition irreversible.
In cicatricial alopecia, there is inflammation at the scalp near the sebaceous gland. The destruction of the sebaceous gland and stem cells causes permanent hair loss. Cicatricial alopecia is not contagious and is not related to any illness or family history. It affects both men and women of all age groups equally.
Types of Cicatricial alopecia
cicatricial alopecia has two classes i.e. primary and secondary. Primary cicatricial alopecia is the condition in which the hair follicles are the primary target and get destroyed due to scalp inflammation. Secondary cicatricial alopecia involves an indirect attack on the hair follicles due to various external injuries such as traction, burns, infection, or radiation. Primary cicatricial alopecia is further classified based on the cells that are causing the inflammation. The involved cells can be lymphocytes or neutrophils.
Pseudopelade, central centrifugal alopecia, frontal fibrosing alopecia, and lichen planopilaris are all cicatricial alopecia types that are caused by lymphocytes.
Tufted folliculitis, folliculitis decalvans, and dissecting scalp cellulitis are the types that are caused by neutrophils.
Acne keloidalis nauche involves scars as well as infection of the scalp and is mostly seen in people of African origin.
Scalp biopsy is very necessary to know the site of inflammation, the amount of damage that has been caused, and changes in the scalp. Itching, burning sensation, pain, and soreness in the affected area are some symptoms that can be seen. After scalp biopsy, appropriate treatment is suggested.
A Hair pull test is also considered by pulling out hairs from their roots to check whether the hairs are in the resting or growing phase.
The Presence of pustules on the scalp points to the presence of some microbes.
Trichoscopy which is a new diagnostic technique to evaluate scalp and hairs is also used. It involves many folds magnification to evaluate scalp and hairs.
Cicatricial alopecia is a rare disease and affects scalp therefore diagnosis should be made by a dermatologist before starting any kind of treatment.
Treatment of cicatricial alopecia depends on the type of alopecia.
Primary cicatricial alopecia such as Pseudopelade, central centrifugal alopecia, frontal fibrosing alopecia, and lichen planopilaris caused by lymphocytes are treated with oral or topical medications which have anti-inflammatory properties to stop the lymphocytic cells that are causing inflammation.
Neutrophilic cicatricial alopecia treatment is aimed at stopping the neurtophilimicrobes that are causing the inflammation at the scalp therefore antibiotics are prescribed in this case.
In the treatment of Acne keloidalis nauche anti-microbial and anti-inflammatory drugs are given as it is a mixed type of cicatricial alopecia.
Cicatricial alopecia is an irreversible condition and treatment can only stop further hair loss therefore it’s better to start the treatment as soon as possible.
Hair shaft abnormalities
In hair shaft abnormalities abnormal growth of hair is seen such as white ends, shorter hair at some points of the scalp, fragile and brittle hairs, uncombable hair.
Bleaching, using a blow dryer, excessive chemical usage, and harsh brushing can affect the hair externally and it can also show negative effects at the scalp.
Trichorrhexis nodosa is the most common hair shaft abnormality which origins from a genetic disorder, metabolic disorder, or external damage. These causes can alter the way a hair is formed which is hair keratinization and ultimately producing abnormalities in the hair.
Magnified examination of the hair shaft can reveal the changes such as nodes, split ends, whitening, and thickness of the hair.
Hair shaft abnormalities can be treated by adopting healthy habits such as :
- Combing the hair gently.
- Limiting the use of chemicals containing dyes, shampoos, and oils.
- Avoiding hair straighteners and using irons to straighten hair.
- Eating a proper diet to avoid any metabolic disorder.