The medical term for hair loss is alopecia. Every one of us will notice hair loss of some kind in later life. Each hair has a life cycle, which can be affected by age, various diseases and many other factors. The three main phases of the hair cycle are:
- Anagen: At its duration, hair grow gradually at a rate of about 1-1, 5 cm per month
- Catagen: It is a transitional phase in its zone cycle. Its duration is 2-3 weeks and it is the phase of weakening and “preparing” the hair for its fall.
- Telogen: During this face hair cease to grow and eventually falls. Up to 10% of hairs in a normal scalp. Falling hairs are replaced by new healthy ones that start in the same life cycle.
Normally we lose every day an amount of 50 to 100 hairs that we can observe in our bathroom or when brushing our hair.
- Non-scarring hair loss
Androgenetic alopecia: Androgenetic alopecia is known as baldness. It occurs in both men and women. The appearance of this type of alopecia is linked to the inheritance of an enzyme. Obviously those who have inherited the presence of the enzyme in the hair follicles will develop alopecia sooner or later. However, psychological factors influence both the appearance and the development of alopecia. In men, androgenetic alopecia mainly occurs in temporal, parietal and frontal areas. On the contrary in women, androgenetic alopecia usually has a more general form and does not affect specific areas as in men.
Alopecia areata: Alopecia areata is an autoimmune disorder affecting both men and women at any age. It begins when the body’s immune system attacks the follicles themselves, which eventually results in suppression of hair growth. It presents with one or more round bald patches appearing suddenly. It most often occurs in people with a family history of autoimmune diseases such as rheumatoid arthritis and celiac disease. There is also alopecia areata totalis which is a more advanced form of alopecia and all or nearly all scalp hair is lost. Finally, alopecia areata universalis is the most advanced form and all hair or nearly all hair on the entire body is lost.
Telogen Effluvium: Telogen effluvium is a common phenomenon that occurs mainly in women in their adulthood. Temporary hair loss is noted due to the excessive shedding of resting or telogen hair after some shock to the system. Triggering factors include: childbirth, acute or chronic illness, surgical operation, accident, psychological stress, weight loss, unusual diet, or nutritional deficiency and certain medications
- Scarring hair loss
It is a rare type of disorder that not only causes permanent hair loss but also scars on the scalp. It is usually caused by complications of another condition. It can affect both men and women, but is not usually present in children. The difference with alopecia areata is that hair loss is irreversible.
In the beginning, the problem will probably arise when a bald patch or thinning hair is noted incidentally, often discovered by a hairdresser. Other patients report hair tufts on their pillow or in the bathroom. Diagnosis of any type of alopecia is made by a dermatologist through clinical examination, digital trichoscopy and evaluation of patient’s medical history. The process of diagnosis may also include blood tests.
Choices of treatment
The type of treatment varies depending on the diagnosis:
- For non-scarring hair loss topical applictaions (steroids, minoxidil, anthralin), intralesional and systemic steroid treatments are available. Autologous therapy with PRP is often used as adjuvant therapy. If appropriate the repair of the receded hairline area of the scalp can be treated with a hair transplant.
- For scarring hair loss such as in cases of lichen planus and lupus, corticosteroids are usually topically or intralesionally. Systematic therapies may be used where appropriate. In cases of infection-type inflammation, treatment includes antibiotics and isotretinoin.