Hair loss (alopecia): types, causes and treatment

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Lush hair is a sym­bol of health, hap­pi­ness and suc­cess in our soci­ety. Hair loss is there­fore com­bat­ed by all means. Unfortunately, hair loss is a very com­plex prob­lem for which nei­ther a cause nor an effec­tive treat­ment can always be found imme­di­ate­ly.

Skin and hair are some­times referred to as “mir­rors of our body”. Hair loss can indeed be the result of a phys­i­cal or men­tal ill­ness, and con­verse­ly, prob­lems with hair or hair growth can lead to seri­ous men­tal health prob­lems and even depres­sion. It is there­fore not sur­pris­ing that this is one of the most pop­u­lar areas where all types of quack sabers are active and for which the most fan­tas­tic reme­dies are rec­om­mend­ed. At best, these mir­a­cle drugs have no effect at all, some­times doing more harm than good.

There are many pos­si­ble caus­es of hair loss (or alope­cia) and also var­i­ous types of hair loss. Determining the exact cause is a first step in treat­ment.

How do hair grow?

Hair is made from skin cells in the hair fol­li­cles or hair fol­li­cles. The num­ber of hair fol­li­cles on the scalp varies by 100,000. The num­ber of hair fol­li­cles is genet­i­cal­ly deter­mined. Blonde hair, for exam­ple, has more hair fol­li­cles than dark and red-haired hair.

With age, the num­ber of hair fol­li­cles decreas­es slight­ly, and thus auto­mat­i­cal­ly the num­ber of hairs.

Hair growth is a cycli­cal process with phas­es of growth (“ana­genic phase”), tran­si­tion (“cata­genic phase”) and degra­da­tion (“tel­o­gene phase”). The growth phase of the skull hair takes about 3 years. At the end of this peri­od, the cell divi­sion stops and the hair becomes thin­ner and thin­ner. During the tran­si­tion phase, the hair grad­u­al­ly loosens out of the hair fol­li­cle and falls out dur­ing the degra­da­tion phase. This con­struc­tion phase takes about 3 months. Unlike some ani­mals, where hair is mas­sive after win­ter, the hair cycle in humans is much more reg­u­lar. Although there is a cer­tain sea­son­al influ­ence with a peak of hair loss around August-September.

In humans, 60 to 90% of hair is always in the growth phase and 10 to 20% in the rest or degra­da­tion phase. Assuming that 10,000 hairs are on one head and that a hair stays for 100 days (3 months), then an aver­age of 100 hairs go out nat­u­ral­ly in one day.

The speed at which the hair grows varies from per­son to per­son, but on aver­age the hair swells per day by 0.5 mm longer. Women’s hair grows slight­ly faster than men’s, and the “peak age” is between 50 and 70 years.

Measure hair loss

If you have the impres­sion that you are los­ing too many hairs, fol­low-up exam­i­na­tions can be car­ried out:

- During 24 hours, 4 days after wash­ing (or if you wash the hair more often, 24 hours before the next wash) col­lect and count the hair loss;
— the pull test: Carefully pull on a hair bun­dle of about 100 hairs. If more than 20 hairs are dis­charged, fur­ther exam­i­na­tions are required;
— the tri­chogram or hair root sta­tus: In this method, about 50 hairs are cut off to 1 cm, which are then pulled with a quick jerk towards the hair growth. The hair roots are then exam­ined under the micro­scope, which pro­vides objec­tive infor­ma­tion about the growth phas­es and the abnor­mal forms of the hair roots.

Androgenetic alopecia

The most com­mon form of hair loss is andro­ge­net­ic alope­cia, which occurs under the influ­ence of andro­gens, the male hor­mones. This type of hair loss occurs in both men and women, albeit to a less­er extent.

It is the typ­i­cal hair loss that occurs from a cer­tain age. In men, it usu­al­ly begins with a shift of the hair­line at the tem­ples, lat­er also on the fore­head. At the same time, the crown can become bare. The final stage, in which only horse­shoe-shaped hair remains, is only reached by 10 to 15% of men. In women, hair loss is more dis­creet and nev­er devel­ops into a real bald­ness.

This form of hair loss is hered­i­tary. It is thought that there is a genet­ic pre­dis­po­si­tion that makes the hair root more sen­si­tive to the male hor­mone in some peo­ple, even at nor­mal con­cen­tra­tions, which caus­es the hair to end its hair cycle faster and there­fore more hair to fail than are formed.

This form of hair loss can­not be “cured”, but there are a num­ber of meth­ods to stop the devel­op­ment or even cause new hair growth:

- A hair lotion with 2% minox­i­dil, a drug orig­i­nal­ly used for high blood pres­sure, can make hair grow back. However, the prod­uct must be used for life, oth­er­wise the hair loss will start again.
— Recent stud­ies also show that a lotion with an antibac­te­r­i­al and an anti­fun­gal active ingre­di­ent can also inhib­it hair loss and the asso­ci­at­ed itch­ing.
— In women, in about 50% of cas­es it is pos­si­ble to inhib­it hair loss with hor­mone prepa­ra­tions that block the action of the male hor­mone testos­terone.
— Surgical meth­ods such as hair trans­plan­ta­tion and scalp reduc­tion can pro­vide very sat­is­fac­to­ry results.

Alopecia areata

Alopecia area­ta, the most com­mon form of hair loss after andro­ge­net­ic alope­cia, is char­ac­ter­ized by one or more round to oval, com­plete­ly bald spots, which are well defined and usu­al­ly lim­it­ed in size. However, these spots can merge and devel­op into a com­plete bald­ness.

The bald spots occur main­ly on the scalp, but they can also affect the beard area, the eye­brows, the eye­lash­es or the pubis. The dura­tion of this dis­ease varies between 4 and 10 months. The heal­ing process begins with the growth of small, white fluffy hairs, which grad­u­al­ly dis­col­or.

The cause of this has not yet been clar­i­fied, but here too there could be a hered­i­tary fac­tor. It is also sus­pect­ed that cer­tain autoim­mune dis­eases (i.e. dis­eases, caused by the pro­duc­tion of anti­bod­ies against parts of the own body, in this case against the hair roots), a hered­i­tary pre­dis­po­si­tion to the devel­op­ment of an aller­gy, thy­roid prob­lems, some infec­tions of the mouth, nose, throat and ears (e.g. sinus itin­er­ary, den­tal and oral cavi­tis, etc.) and psy­cho­log­i­cal fac­tors (such as stress) may play a role.

Since the cause and course of this type of hair loss is not known, there is also no causal treat­ment. Therapeutic options include gen­er­al or local use of cor­ti­cos­teroids or PUVA ther­a­py, which is a treat­ment with UVA rays of light that can tem­porar­i­ly cause hair growth. Due to the sus­pi­cion of a mal­func­tion of the immune sys­tem, a sub­stance has already been used, which trig­gers a con­tact aller­gy to the bald spots. The immune response direct­ed against this con­tact aller­gen then sup­press­es the reac­tion direct­ed against the hair root, so that the hair can regrow again.

Diffuse hair loss

This form of hair loss spreads through­out the scalp and rarely leads to com­plete bald­ness.

The most com­mon form is tel­o­gen­hair or tel­o­gen­ef­fvi­um, which ter­mi­nates the hair cycle pre­ma­ture­ly and reach­es the tel­o­gen or degra­da­tion phase faster. This form of hair loss can be a con­se­quence of phys­i­cal or psy­cho­log­i­cal stress, such as high fever, infec­tions, ane­mia, surgery, an acci­dent, emo­tion­al prob­lems, a strict diet, alco­hol abuse and so on. Some med­ica­tions (e.g. some blood thin­ning and anti­hy­per­ten­sive drugs) can also trig­ger such hair loss.

Normally, hair loss occurs about 3 months after the trig­ger­ing fac­tor.

Hair loss, which often occurs about three months after child­birth, is also a form of tel­o­gen efflu­vi­um. The pro­por­tion of anaeous hair (hair in the growth phase) is 95% dur­ing preg­nan­cy, so that the nor­mal tel­o­gen hair loss is great­ly reduced at this time. After child­birth, these hair fol­li­cles quick­ly pass into the tel­o­gen phase under the influ­ence of the decrease in estro­gen lev­els. The result is an increase in hair loss about 3 to 4 months lat­er.

With the tel­o­gene Effluvium, there is lit­tle more to do than to tack­le the cause and wait: in the next 6 to 12 months, the hair will spon­ta­neous­ly grow in. If nec­es­sary, sup­ple­ments of cys­tine and methio­n­ine, the build­ing blocks of our hair, can be giv­en for a few months.

The same applies to hair loss in can­cer patients treat­ed with chemother­a­py. Here, how­ev­er, the hair roots are so bad­ly dam­aged that the hair still fails in the growth phase and the hair loss can occur with­in the week after the start of ther­a­py. This form of hair loss also recov­ers by itself after dis­con­tin­u­a­tion of ther­a­py.

Scarring

This type of hair loss, scar alope­cia, is a con­se­quence of scar­ring of the skull skin, which caus­es the per­ma­nent loss of a num­ber of hair fol­li­cles. This can be present from birth or may occur lat­er in life due to burns, acci­dents or infec­tion. It can also be the final stage of a fun­gal infec­tion. To deter­mine this, a spe­cial­ist exam­i­na­tion is required to remove a small piece of skin.
Recovery is not pos­si­ble, but in the case of a fun­gal infec­tion, for exam­ple, anoth­er cat­a­stro­phe can be pre­vent­ed.

Traumatic alopecia

Traumatic alope­cia is caused by the stretch­ing of the hair. A typ­i­cal exam­ple is hair loss in women, who often make a pony­tail. This some­times leads to a dilu­tion of the hair at the lev­el of the fore­head.

Another typ­i­cal exam­ple is the so-called tri­chotill mania, the mania of con­stant­ly play­ing with hair bush­es. This can lead to exten­sive bald spots.

A full recov­ery is pos­si­ble if the hair is left alone.

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