What is Hair Loss

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Hair Loss, Causes & Treatment for Women, Men

Hair loss is an extremely common problem that concerns many women and men, regardless of age.

Hair loss can be normal (seasonal hair loss during the autumn months) or pathological and can be due to hereditary, hormonal and environmental factors. In any case, thinning of the scalp, one of the most important elements of male and female appearance, often has a significant impact on the psychology of the individual.

Treatments for hair loss include medication, Autologous Hair Mesotherapy, and Hair Transplantation with the most advanced FUE method. Proper diagnosis of hair loss is the be all and end all for choosing the right treatment.

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What is Hair Loss

All of our body hair is made up of a protein called keratin, which is produced by hair follicles located in the dermis of the skin. The follicles produce new keratin and so the old hairs fall off and are naturally replaced by new ones. Hair loss is divided into normal and abnormal hair loss. In normal hair loss, a number of hairs are lost every day. In this case, the hair is replaced and grows back. A person normally loses about 100 – 150 hairs per day. In pathological hair loss, some of the hairs that fall daily are not renewed, resulting in thinning of the scalp.

Each hair on the scalp has its own life cycle and is divided into three phases:

  • Τhe anagen phase: It lasts 3-5 years and is the development phase. At this stage the root cells actively proliferate resulting in an increase in hair length. However, this rate decreases as we grow older.
  • Τhe catagen phase: It lasts about 1-2 weeks and is the phase of weakening and “preparing” the hair for its fall. At this stage the hair stops growing.
  • The telogen phase: It lasts about 2-4 months and is the phase of hair fall. The hair follicle still exists and so the hair regenerates after a while.

Under normal conditions, 90% of the hairs are in the regenerative phase, while 10% are in the telogen phase. The first signs of hair loss occur when the percentage of hairs in the telogen phase exceeds 20%.

Causes

The hair life cycle is divided into 3 phases: anagen, catagen and telogen. Hair loss is caused by the rapid transition from the anagen phase to the telogen phase, resulting in a higher rate of hair loss than hair regeneration. The causes of hair loss are varied, the most common being the following:

  • Ageing
  • Inheritance
  • Stress
  • Hormonal Imbalances
  • Taking certain medications
  • Infections
  • Environmental factors

The male hormone, testosterone, also plays a major role in hair loss, as in certain concentrations it affects hair growth. It has also been shown that hair dyes also have a negative effect on hair loss.

The genders

  • Μale hair loss

    The main factors responsible for men’s hair loss are the following:

    • Androgenetic alopecia, most common in men
    • Chronic diseases
    • Skin diseases
    • Reaction to certain medications
    • Poor diet
    • Stress and anxiety
    • Environmental pollution
    • Seasonality
  • Female hair loss

    The following factors have been implicated in female hair loss:

    • Polycystic ovary syndrome
    • Thyroid and parathyroid diseases
    • Pituitary adenomas such as prolactinoma
    • Adrenal and ovarian neoplasms leading to Hyperandrogenism
    • Chronic medication with systemic corticosteroids
    • Use of oral contraceptives
    • Cushing’s syndrome

Women’s hair loss as explained by Dermatologist – Venereologist Dr. Amalia Tsiatoura is mainly diffuse, that is, it appears with thinning and thinning of hair throughout the scalp, while rarely “empties” an area completely. It occurs mainly after puberty, after childbirth or during menopause. There is also so-called ‘seasonal hair loss’, which occurs during the autumn months, when hair loss is increased.

Diagnosis

Diagnosis and finding the cause of hair loss plays a key role in the treatment of hair loss. As Dermatologist – Venereologist Dr. Amalia Tsiatoura emphasizes, the diagnosis of hair loss should always be made by a specialized physician – Dermatologist. In particular, for the diagnosis of Androgenetic Alopecia, which is the most common form of hair loss, it is important to take the patient’s medical history and perform a proper clinical examination.

Diagnosis with a phototrichogram

In Advanced Hair Clinics, a member of the Cosmetic Derma Medicine Medical Group, the diagnosis of hair loss is made with a phototrichogram, using a special microcamera and special software. In particular, the Follysis software is used, which is one of the most complete and accurate diagnostic tools for hair loss. With the Follysis tool, precise measurements of hair density per area are made, as well as the measurement of hair thickness.

During trichoscopy, as this method is otherwise called, the following are recorded:

  • The number of hair follicles per square centimeter
  • Number of hairs in relation to the number of hair follicles per square metre
  • The number of hairs in number of hairs in the number of hairs in the number of hairs
  • The number of hair follicles, the number of hair follicles, the number of hair follicles, the number of hair follicles
  • The lesions on the cuticle

Diagnosis with a gene test (DNA test)

A specialized gene test (DNA test) is also carried out which identifies and maps 5 different genetic loci on the X chromosome. With this method, a diffuse alopecia of dubious cause can be accurately diagnosed, as well as predicting the development of androgenetic alopecia in the future. In some cases, the diagnosis of hair loss may require blood tests to check the levels of iron, vitamins and hormones in the blood. Biopsy for the diagnosis of hair loss may be required in certain forms of autoimmune hair loss and scarring alopecia (e.g. follicular lichen, lupus erythematosus) and in cases where neoplasms are the cause of scarring alopecia. Microbiological tests with culture may be required in infectious hair loss, such as scalp bursitis, syphilitic alopecia, fungal scalp infection.

Categories of Alopecia

  • Androgenetic Alopecia – Male Hair Loss

    For male hair loss, androgenetic alopecia plays a dominant role, as it is responsible for 95% of cases. The genes that lead to androgenetic alopecia are the subject of research by scientists, but it has been shown that most of them are located on the X chromosome and are recessive. This is why it is thought that the mother is responsible for the development of hair in men.

    For the same reason, the occurrence of androgenetic alopecia in women is rarer as it requires the presence of the abnormal (recessive) genes on both X chromosomes for them to be expressed and for the disease to occur. In men, where the sex chromosomes are XY, the presence of only one abnormal X is sufficient for the genes of androgenetic alopecia to be expressed.

    The genes of androgenetic alopecia located on the X chromosome determine, among other things, the way the alopecia develops, as well as the speed of its progression. Women are less predisposed to androgenetic alopecia than men, but in women it usually occurs in the form of diffuse hair loss and does not lead to complete hair loss.

    The most common pattern of male pattern of androgenetic alopecia is anterior and temporal thinning with a tendency to extend towards the top of the scalp. As Dermatologist – Venereologist Dr. Amalia Tsiatoura points out, 25% of men will develop thinning by the age of 30 and 50% by the age of 50.

    Androgenetic alopecia in men is due to inherited sensitivity to the hormone dihydrotestosterone (DHT), which shrinks hair follicles and suppresses their growth, leading to a telogen phase that leads to hair loss.

    Male pattern hair loss progresses rapidly at ages 20-30 years, with a gradual slowing down at ages 30-35.

  • Androgenetic Alopecia – Female Hair Loss

    Androgenetic alopecia also occurs in women, but it is much rarer than in men and is due to hereditary factors. Its aetiology is polygenic and both parents must be affected for it to occur, as it is inherited in the clonal recessive mode. The pattern of occurrence in females is diffuse with retention of the hairline, receding at the temples and diffuse thinning and thinning of the hair mainly at the top. There is a predisposition and it usually occurs after the age of 40 years and intensifies during menopause.

  • Alopecia Areata

    Alopecia Areata occurs with hair loss in patches and as explained by Dermatologist – Venereologist Dr. Amalia Tsiatoura, it is a hair loss of autoimmune etiology in which the immune system recognizes the hair follicles as foreign bodies and attacks them. It can occur on various parts of the body, as well as on the eyebrows and eyelashes, although the most common site of occurrence is the scalp at a rate of about 70%. Sometimes it can also lead to complete loss of the scalp and body hair. In this case it is called universal alopecia pedis. It does not cause any other symptom, but leads to serious psychological and social problems.

    Many times, alopecia areata is associated with other diseases such as atopic dermatitis, vitiligo, thyroid diseases or more serious ones such as Down syndrome.

  • Cicatricial Alopecia

    Lichen planus:

    This is an autoimmune disease characterized by Cicatricial Alopecia in the form of patches that may remain stable or increase in size and number. Lichen planus is a manifestation of smooth lichen that can affect the skin, hair and nails. The bare follicles show swelling and erythema around them and are hyperkeratotic. The remaining hairs look like doll hair due to the swelling and hyperkeratosis of the hair follicles. The main sites of lichen planus hair loss are the frontal area (frontal fibrotic alopecia) and the top of the scalp.

    Discoid lupus erythematosus:

    It is the second most common Cicatricial Alopecia after lichen planus. It is characterized by circular, red, phlegm-like plaques that coalesce and lead to white atrophic scars.

    • Lesions, skin aplasia, wounds, burns, radiation can lead to cicatricial alopecia
    • Microbial, viral, fungal infections (e.g. syphilis, leprosy, bursitis, herpes zoster, scalp fungal infections) also lead to scarring or non-scarring alopecia
    • Malignant neoplasms such as basal cell carcinoma, squamous cell carcinoma, melanoma may lead to scarring alopecia
  • Diffuse Alopecia

    Other factors that cause diffuse hair loss in men and women as explained by Dermatologist – Venereologist Dr. Amalia Tsiatoura are the following:

    This is an autoimmune disease characterized by scarring alopecia in the form of plaques that may remain stable or increase in size and number. Follicular lichen is a manifestation of smooth lichen that can affect skin, hair and nails. The bare follicles show swelling and erythema around them and are hyperkeratotic. The remaining hairs look like doll hair due to the swelling and hyperkeratosis of the hair follicles. The main sites of follicular lichen hair loss are the frontal area (frontal fibrotic alopecia) and the top of the scalp.

    • Stress
    • Poor diet
    • Iron deficiency anemia
    • Use of chemicals and hair styling products
    • Strong pulling back (especially in women) – Traction Alopecia
    • Hairdressing techniques – straightening etc.
    • Excessive exposure to the sun without protection
    • Endocrine and metabolic diseases
    • Chronic diseases
    • Taking drugs such as chemotherapeutic drugs
    • Cancer

Treatment

Hair loss can be treated conservatively and surgically, depending on the causes and the extent of the problem.

  • Conservative hair loss treatment

    It finds application as a hair loss treatment in all forms of hair loss. It is used in androgenetic alopecia in men and women both for stabilization of the condition and after hair transplantation to preserve the patient’s untransplanted hair.

    Conservative hair loss treatment in androgenetic alopecia includes the use of minoxidil, oral or topical antiandrogens in the form of gels, Autologous Hair Mesotherapy, serum growth factors, and special shampoos to help maintain and stabilize the condition.

    In cases of pollen alopecia, Autologous Hair Mesotherapy has excellent results and can lead to complete regrowth even in universal forms of pollen alopecia. As an adjuvant for the treatment of hair loss of this type, minoxidil or topical corticosteroids and calcineurin inhibitors are used.

    In follicular lichen where the alopecia is scarring, Autologous Hair Mesotherapy and minoxidil will help prevent hair loss extension rather than regrowth in desquamous ones, as these will only benefit from hair transplantation. Corticosteroid systemic, immunosuppressive or other disease specific drugs may be required to treat hair loss.

    In discoid lupus erythematosus, Autologous Hair Mesotherapy and minoxidil will help prevent the extension of hair loss. Corticosteroids and immunosuppressants may also help in some cases.

  • Surgical treatment of hair loss

    Surgical treatment of hair loss with FUE hair transplantation is the definitive solution to some forms of hair loss.

    It is the treatment of choice for the treatment of advanced androgenetic hair loss in both men and women. We also treat cases of female and male Androgenetic Alopecia, as well as stabilized forms of Cicatricial, Areaat & Diffuse Alopecia with this method.

    It is also used as a treatment in cases of plaque hair loss such as Lichen planus, alopecia areata and discoid lupus erythematosus provided that the hair loss plaques are stable for years and there is no progression of the phenomenon.

    The FUE hair transplantation method is also applied in the implantation of eyebrows, geniuses as well as the restoration of body hair on the chest, back, etc. Hair Transplantation can be combined with conservative treatment against hair loss in order to prevent the fall of existing hairs.

    CDM Medical Group is a center of reference in Hair Transplantation both in Greece and abroad, thanks to the extensive knowledge and experience of the Plastic Surgeon and Medical Director of the Group, Dr. Anastasios Vekris and his highly trained team.

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