Hair loss is a concerning problem for a large number of women and men. Female hair loss affects about 15% of females; 40% of these cases are manifested after one’s 40th year of life.
The hair cycle consists of the following phases: anagen, catagen and telogen. In hair loss a rapid transition from the anagen to telogen and catagen phase is observed.
The main ages of hair loss onset in females are puberty (particularly if the woman has polycystic ovarian syndrome), the post partum period and menopause.
The normal daily hair loss is 100 ‑150 hairs. When more than 150 hairs per day are lost, there is a problem of hair loss and a suitable treatment should be followed.
Causes of hair loss
Hair loss can be natural, as a seasonal hair loss occurs during the autumn months. However, it can also be a pathological problem and can be due to hereditary factors, stress, as well as hormonal changes that occur during menopause and pregnancy. Other hormonal disorders, such as thyroid disease, Cushing’s syndrome, pituitary adenomas leading to hyperprolactinaemia, can result in female hair loss.
In most cases, female hair loss is due to female pattern androgenetic alopecia. This form is hereditary and the mode of inheritance is polygenic. The contributing genes are transferred by autosomal recessive way, which means that a woman that develops the trait has inherited it from both of her parents who suffer from the condition. On the contrary, men inherit androgenetic alopecia via the dominant form of genetic transfer.
This form is typically characterized by hair thinning throughout the scalp and does not resemble the typical alopecia observed in the case of men. Moreover, the frontal hairline in women tends to be maintained, as opposed to men where hair loss begins from the forehead and continues to the top of the head and temples.
Other causes of diffuse female hair loss is stress and anxiety, poor diet, crash diets, iron deficiency, the use of many chemical products on the hair, the strong back pulling and combing of the hair and not wearing a hat.
Telogen effluvium is a form of diffuse hair shedding during which the hair directly transition from the anagen to the telogen phase. It is caused by poor nutrition, pregnancy, chronic diseases, heavy metals and malignant diseases.
Apart from diffuse hair loss, women can develop patches of baldness (spot baldness). In this form the cause is different and may be due to autoimmune diseases (cutaneous lupus erythematosus, follicular lichen planus, alopecia areata), trauma, fungal infections or inflammations.
Scarring alopecia is also one of the most difficult forms of alopecia in women and men, as hair loss is caused by scarring of areas of the scalp. In these cases, the hair can not automatically re-grow since the hair follicles have been destroyed at the sites of scarring alopecia. The most common cause of scarring alopecia is lichen planopilaris whereas discoid lupus is the second in frequency cause of scarring alopecia. Other causes include trauma, burn and carcinomas of the scalp.
Diagnosis of hair loss
Correct diagnosis of hair loss includes a detailed medical history of the patient, laboratory, hematology and hormonal screening. In some cases biopsy of the skin of the scalp may be required or direct immunofluorescence in cases of skin lupus erythematosus.
Prognosis – Course of hair loss
The prognosis of hair loss depends on its cause. When hair loss is due to some underlying cause, treatment of the cause would result in reversing the problem of hair loss, e.g., improving nutrition, iron deficiency correction. The prognosis of alopecia areata and scarring alopecia is often uncertain. These diseases require immediate initiation of treatment. Moreover, androgenetic alopecia usually presents gradual progressing course and requires immediate conservative or surgical treatment.
Hair loss treatment
The treatments used for androgenetic – pattern hair loss in men and women are the following:
- Minoxidil 2‑5%. It is a safe drug that improves microcirculation on the scalp resulting in stabilization of the condition and increase of hairs’ diameter. It is administered both in men (5%) and in women (2%)
- It is an antiandrogen that is administered in men up to 40years old or in women following menopause.
- Autologous mesotherapy PRP. This is an innovative hair loss treatment that uses the power of blood platelets derived from the patient himself/herself. A small volume of blood sample is taken and, following centrifugation, the platelet rich plasma is isolated (PRP). This is then activated and injected into the scalp. The stabilization and dramatic reduction of hair loss is impressive, while the method does not have any side effects. PRP is applied in 4‑8 sessions depending on the magnitude of the problem and can be combined with other hair loss treatments, either conservative or surgical.
- Hair transplantation with the FUE method. Hair is implanted into the affected area, leading to significant densification and permanent restoration of the problem. It is mainly applied in female and male androgenetic alopecia, as well as to stabilized forms of scarring alopecia (lichen planopilaris and skin lupus erythematosus). It has also been successfully applied in alopecia areata when the disease has been stable for many years.