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Hair Loss Facts! What you need to know about hair loss

What is Hairloss?

Hair loss refers to a condition where there is absence of or thinning of the hair on one or more areas of the scalp. Hair loss can be classified largely into male pattern baldness (MPB)/ androgenic alopecia (AA) or Female Hair Loss. Hair loss commonly occurs as a result of a reaction between male hormones and hormone sensitive hair follicles. 

Causes of Hairloss

The exact causes of hair loss is yet unknown, however the following causes have been known to contribute towards hair loss.

Stress: Causes autonomic imbalance
Alkaline based products: perming hair, blow drying, hair dye etc.
Diseases: Thyroid diseases, phase 2 Syphilis, Hansen’s disease etc
Mentality: High fever, Bleeding, Fatigue, drastic weight loss, Chemotherapy etc
Hormones: Male ‘Androgenic’ Hormones

Most common cause of Hair loss - Male Pattern Baldness (MPB)
Male pattern baldness (MPB) or androgenic alopecia (AA) occurs in both males and females. MPB is an inherited condition from either the mother or the father. MPB results from a reaction to circulating androgens. Androgenic hormones, often referred to as ‘male’ hormones which includes testosterone, adrosteinedione and Dihydrotestosterone (DHT), production is found both in healthy males and females. However, the Androgenic hormonal levels are much higher in males than in females.

Pattern Baldness occurs in men and women when testosterone is converted to DHT which then reacts with the hair follicles. High concentrations of the 5-alpha-reductase enzyme is responsible for the conversion of testosterone to DHT. DHT is known to mediate much of the male pattern hair loss however, it is not the only culprit in MPB. The process is far more complex and is not fully understood.
Hair transplants may treat MPB successfully because not all of the follicles on the scalp are sensitive to the circulating androgens. Hair transplant grafts retain their genetic characteristics when transplanted to balding areas. This is known as donor dominance. Also, MPB can be managed by taking Propecia (Finasteride), which is used to combat the effects of the 5-alpha-reductase enzyme, thus reducing the DHT concentration in hair follicles.
The pattern of hair loss is different in males and females. While most men exhibit a Norwood pattern of loss, females typically follow a Ludwig pattern of loss.

Types of Hairloss

Male Pattern Baldness (MPB)

About 70 percent of adult males will experience some degree of balding whereas over 50% of the male population will suffer advanced male pattern balding. Although hair loss to some extent is considered normal in adult males, this form of hair loss is unrelenting, as once it begins, it will continue either slowly or rapidly depending on the genetic predisposition of the individual.

Male pattern baldness is dependent on three factors; age, genetic pre-disposition and male hormones and it is often due to an inherited condition called Androgenic Alopecia.

Androgenic Alopecia is often called Androgenetic Alopecia because this form of hair loss results from the influence of male hormones in genetically affected males. One cause of hair loss is the male hormone ‘Dihydrotestosterone’ also known as DHT.  DHT is formed through enzymatic conversion of testosterone into DHT. The enzyme responsible for this conversion is called the 5 alpha-reductase.

There must be other influences or causes of androgenic alopecia because blocking the formation of DHT does not always halt or impair the progression of Androgenic Alopecia. The initial process of hair loss begins with miniaturization and pigment reduction in the affected hair on the top of the scalp.  As the condition progresses, the growing phase reduces and the resting phase increases. Eventually, the hair becomes very fine, microscopic in appearance, and lacks pigment. As this loss of hair continues, individuals will experience one of many common patterns of hair loss. 

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 Fig 1. The incidence of any advanced degree of hair loss increases with age. The solid line indicates the incidence by age of pattern types III, IV, V, VI, and VII.  The dotted line represents the incidence by age of pattern types V, VI, and VII. The advanced degrees of hair loss become more common in the maturing population. 

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Progressive miniaturization of the hair follicles occur in Androgenic Alopecia. They become shorter and finer with each cycle until eventually, they disappear.  

Male Pattern Baldness Scale (Norwood Scale)

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Female Pattern Baldness

Females like males suffer different forms of hair loss. Significant hair loss may occur in females after experiencing significant stress to one’s life such as child birth, surgery, serious illness and psychological or social stress. Hair loss may occur about 1 – 6 month after such event and this conditions is referred to as the ‘Telogen Effluvian’. This type of hair fall cannot be treated, but the hair fall will eventually stop after a dormant phase.

Females can also suffer from hair loss resulting from wearing their hair tightly pulled up or in very tight braids for long periods of time. This is known as traction hair loss. The constant pulling of the hair root will eventually kill the follicular system resulting in no hair growth in such regions. Such hair loss can be treated with hair transplantation, however, the individual needs to change her hair style to prevent the same condition recurring.

True female pattern baldness is common in women. It has been researched that 3% of women in their twenties and 30% of women in their eighties experience such balding. Women experiencing female pattern baldness will notice a diffused hair loss pattern in their mid-scalp while retaining their hairline. Some women will experience balding in a male pattern as well with their hair receding over their temples and hair loss all over the vortex of their scalp. However, it is not common for women to become completely bald as females have more female hormones ‘estrogen’ than male hormone ‘testosterone’ which induces hair loss and balding. 

Female Pattern Baldness Scale (Ludwig Scale)

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Alopecia Areata

This is a condition which usually results in hair loss in the shape of a coin on the scalp or the beard, especially in the first stages. Due to the shape of the balding, it is sometimes referred to as ‘spot balding’.

If the affected area is not large, the progression of the illness is often left under observation as the problem often spontaneously regresses and the hair grows back. Medical treatment of Alopecia Areata may involve the use of corticosteroids, clobetasol or fluocinonide, corticosteroid injections, or cream. The illness tends to recur following treatment and uncommonly progresses to a more severe form. However, although not common, the condition may spread to the entire scalp (1-2%).   This condition usually is not treated with hair transplant surgery.

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Other conditions resulting in hair loss
Dermatological skin conditions can cause hair loss also. Your dermatologist or hair loss specialists should diagnose these conditions. Heavy metal poisoning such as lead poisoning can also result in hair loss.

Psychological trauma may cause self-inflicted hair loss with some patients pulling out their hairs often in response to some sort of psychological trauma. This condition is called trichotillomania. Hair loss from Trichotillomania is treated by a psychiatrist. Hair might grow back once the individual stops pulling out their hair or it may need to be restored surgically. However, such treatment should follow after the individual has been treated by a psychiatrist first as the individual may pull out the newly restored hair also.

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