Alopecia

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What is Alopecia

Alopecia is the medical term for the loss of hair on the scalp as well as on the beard, eyebrows and other parts of the body. It can have various causes and forms and can affect people of any age, gender or ethnicity. It often has a significant impact on a person’s quality of life, self-esteem and psychological well-being.

The most common type of hair loss worldwide is androgenetic alopecia
The triptych of treatment: Autologous mesotherapy, minoxidil and in forms of androgenetic alopecia, antiandrogens
Cortisone and immunosuppressive drugs are recommended for autoimmune forms of alopecia
Trichoscopy and scalp biopsy can complement the clinical diagnosis
The DNA test is used to diagnose androgenetic alopecia versus other forms
3 months after the start of treatment the effect starts to show

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The possible causes of alopecia

Heredity. This is the cause of androgenetic alopecia, which affects both men and women. It usually occurs gradually in a predictable pattern with receding frontal hairline in men and thinning of the hair on the scalp in women.

Hormonal disorders and diseases. Hormonal changes due to pregnancy, childbirth, menopause, thyroid disease or polycystic ovary syndrome.

Medications. Hair loss can be a side effect of certain medications, such as for cancer, heart disease, rheumatoid arthritis, gout, contraceptives, antidepressants and antihypertensives.

Severe stress. Can lead to diffuse hair loss, which is transient, although it can last for several months.

Styling. Excessive hair styling or hairstyles that stress your hair, such as ponytails, are implicated in traction alopecia. Hair treatments that use chemicals or dyes or heat treatments can also cause hair loss.

Treatment Options and Effectiveness

Minoxidil is the most widely used drug as it has high efficacy and has a low chance of side effects in both men and women. It is applied to the scalp, beard or eyebrows to prevent further hair loss and enhance hair growth in a wide range of alopecia types. [6] Minoxidil enhances blood flow around hair follicles, resulting in an increase in follicle size, enlargement of the diameter of the hair shaft and lengthening of the anagen phase.[7][8] Minoxidil is available orally, by topical solution or in an injectable intradermal form. The results of minoxidil are visible after 3 to 6 months and are effective on all areas of the body.

Finasteride is used to treat androgenetic alopecia on the scalp. The drug is an inhibitor of the enzyme 5a-reductase, which is responsible for converting testosterone into dihydrotestosterone (DHT), a hormone responsible for hair loss. Reducing the amount of DHT leads to increased hair regeneration and prevents further hair loss. Hair growth in other parts of the body is not affected by finasteride. It is available orally or by topical solution. It should only be used by adult men. Use of the drug is prohibited in women of childbearing age because it may cause side effects in the male fetus.

Dutasteride is a drug that is a 5a-reductase inhibitor, making it a kind of antiandrogen. As with finasteride, the drug acts by reducing the production of DHT. Both drugs are effective in treating androgenetic alopecia. Dutasteride inhibits both type I and type II 5-alpha-reductase, while finasteride inhibits only the type II enzyme. As both isoenzymes are present in hair follicles, dutasteride appears to be more effective than finasteride.[9][10] Like finasteride, the use of dutasteride should be avoided in women of childbearing age.

Melatonin is a hormone that regulates the sleep-wake cycle and has antioxidant and anti-inflammatory properties. Low levels of melatonin in the body can cause hair loss. A sufficient number of studies show that melatonin improves scalp hair density by increasing the diameter of the hair shaft. Melatonin may even improve hair growth and quality in some cases of alopecia gyrus, especially in women with low melatonin levels. [11]

PRP (platelet-rich plasma) is, by consensus, the leading non-invasive treatment option for hair loss with high efficacy in almost all types of alopecia. [12] The treatment is safe and involves injecting platelet-rich plasma from your own blood into the scalp. Platelets are cells containing growth factors that enhance healing, regeneration and hair quality, even in cases of alopecia gyrus. It can be used either as a monotherapy or as an adjuvant to conservative treatment or hair transplantation.

Low energy laser therapy (LLLT) is a treatment that involves exposing the scalp to low-intensity red light. The treatment is preferred by people who do not want to take medication or are afraid of injections. The energy emitted by the Laser stimulates blood flow, reduces inflammation and stimulates hair follicles. LLLT helps to fight hair loss and improve hair volume and appearance. LLLT also helps to improve the volume and appearance of hair. [13][14]

Olumiant is an oral medicine containing the active substance baricitinib and belongs to a class of medicines called Janus kinase inhibitors (JAK). JAK inhibitors block signaling pathways that trigger inflammation and autoimmune conditions. Olumiant has been shown to be effective in treating severe cases of pollen alopecia that do not respond to other treatments.

Corticosteroids are anti-inflammatory drugs that can suppress the immune system and reduce inflammation. They can be applied topically, injected into the application sites or taken orally. They are widely used in mild to moderate conditions of pollen alopecia. Topical corticosteroids are most commonly used in children. They include substances such as anthralin, diphencyprone or dibutyl ester of tetraacetic acid. These substances stimulate hair growth by distracting the immune system away from the hair follicles. Injections are usually given every 4 to 8 weeks depending on the patient’s needs.[15][16]

Combining topical and oral medications with non-invasive treatments, such as PRP or laser, can enhance the effectiveness and reduce the side effects of any treatment. For example, minoxidil can be used with corticosteroids, finasteride or dutasteride to increase hair growth and prevent hair loss. PRP can be used with corticosteroids, minoxidil or baricitinib to improve hair quality and density. Your dermatologist will recommend which is the best combination depending on your medical history, age, type and severity of alopecia and other factors to determine which is the most effective and safe treatment for you.

Hair transplantation is the only definitive solution to hair loss. Hair implantation with the FUE method is the most modern technique. Hair follicles are extracted one-by-one from the donor area of the scalp using tiny instruments less than 1 mm in diameter and implanted one-by-one in the recipient area that is experiencing thinning. The results are completed in 12 months and are permanent and completely natural. The procedure is minimally invasive, leaves no linear scars or marks and allows the patient to return to work and activities immediately.

The diagnosis of alopecia

In addition to the clinical examination, additional tests may be used, such as:

– Blood tests: Rule out conditions associated with hair loss, such as thyroid disorders, iron deficiency or autoimmune diseases.

– Scalp biopsy: Gives evidence of inflammation, infection or excludes other conditions if differentially diagnosed.

– Trichoscopy: Gives information about the morphology of the hair follicles, as well as the quality and density of the hair.

– Phototrichosogram: A digital method of trichoscopy for accurate information of hair characteristics to help the physician in diagnosis, assessment of the course of the disease and selection of appropriate treatment.

– Traction test: The physician gently pulls small bundles of hair from various areas of the scalp to determine the stage and type of hair loss.

The main types of alopecia

Androgenetic alopecia

Androgenetic alopecia is also known as male or female pattern hair loss. This condition is caused by genetic and hormonal factors that affect the hair growth cycle. Men usually experience receding frontal hairline and thinning at the top of the head, while women usually experience thinning hair at the top of the head and enlargement of the parting. Note that approximately 50% of men and 10% of women are affected by androgenetic alopecia by the age of 50 years.[3]

Gyroid alopecia

Alopecia pedis is an autoimmune condition that affects the hair follicles on the head and body. It is an abnormal reaction of the body that results in localized hair loss, mainly on the scalp, eyebrows or beard, but can also occur on other parts of the body. The size and number of spots may vary, with an increasing trend over time. Sometimes there is hair regrowth, while other times it develops into total alopecia. The exact cause of alopecia pedis has not been fully clarified by scientists, but there are indications that it may be caused by stress, infections, genetic or environmental factors. It affects about 2% of the general population.[4]

Diffuse alopecia

Diffuse hair loss is a form of non-scarring alopecia characterized by severe hair loss and diffuse thinning and thinning of hair throughout the scalp. It is divided into anagen and telogen hair loss, depending on whether anagen or telogen hairs are affected, respectively.

Regenerative hair loss

Anagenous hair loss is characterized by sudden onset and a more severe clinical picture than telogen hair loss, with abrupt inhibition of growth and shedding of anagen hairs. It is the most frequent side effect of chemotherapy. The picture is dramatic with up to 90% of hairs falling off, as the majority of hairs are in the anagen phase. Causes include chemotherapy, radiotherapy, chemical poisoning, hormonal imbalances, trauma or alopecia gyrus.

Telogen hair loss

Telogen hair loss is characterized by sudden onset and early transition from the anagen phase to the telogen phase, resulting in increased shedding of telogen hairs. It occurs at all ages, even in infants, and is the second most common form of alopecia. The incidence in women is higher than in men, which is due to the fact that most of the causes are related to the female sex.

The main manifestation is the loss of more than 200 hairs per day and is perceived by the patient in the tufts of hair found in the bathtub or in the comb. It usually resolves on its own within 6 weeks, but may last 3 – 6 months (acute form) or longer (chronic form).

It is caused after physical or psychological stress, such as childbirth, emotional distress, serious medical conditions, surgery, certain medications, vitamin and mineral deficiencies such as zinc or iron, hormonal changes, thyroid disease, or a crash diet.

Traction alopecia

Traction alopecia is a type of hair loss that occurs due to excessive pulling or pushing of the hair over a long period of time. It can damage the hair follicles and cause permanent scarring if left untreated. It is often caused by very tight or heavy hairstyles such as braids, ponytails or extensions. It can also be caused by frequent use of heat styling or chemical treatments on the hair.

Frontal fibrotic alopecia

It is a type of scarring alopecia that mainly affects postmenopausal women. It causes a gradual regression of the hairline along the forehead and temples, sometimes accompanied by loss of eyebrows or eyelashes. The causes of frontal fibrotic alopecia have not been fully elucidated, but some research suggests that it may be related to genetic and environmental factors, hormonal changes, or immune system dysfunction.[5]

Trichotillomania

Trichotillomania is a mental disorder in which a person has a recurring, uncontrollable urge to pull hair from the scalp, eyebrows or other areas of the body, despite trying to stop. Pulling hair from the scalp often leaves localized gaps of hair spots, which cause significant psychological problems, especially at young ages. Once the person manages to stop hair pulling, there are treatment options for hair restoration.