'Alopecia' is the scientific name for "hair loss", it is a condition not a disease. Any form of hair loss can be referred as alopecia. Androgenetic alopecia (male or female pattern baldness) is the most common alopecia which is a genetic disease (inherited from parents). Apart from the genetic; there are number of other causes which can result in various forms of alopecia conditions or diseases. And depending upon the conditions, there are different treatments options available for hair loss restoration. For any hair-loss restoration to be successful, it is essential for a hair restoration doctor or a dermatologist to make correct diagnosis of underlying cause of Alopecia.
If you are suffering from hair-loss, a dermatologist may look from one of the following conditions:
Telogen effluvium (TE) is probably the second most common form of hair loss that a dermatologist sees. To understand the condition have a look at the biology of the hair follicle , the condition results when the number of hair in the growth phase drops significantly and there is a corresponding increase in telogen stage hair follicles. TE characterized by thinning of the hair that does not follow any particular pattern, but there is more thinning on top of the scalp than at the sides and back of the scalp. There is no hair line recession, except for few rare cases of chronic telogen effluvium which results from shortening of the growth phase.The hairs that are shed are typically telogen hairs which can be recognized by a small bulb of keratin on the root end. Telogen affluvium can also result if the telogen phase is prolonged; in this case the hair follicle do not fall but remain in resting stage for longer time. Due to prolongation of telogen stage, anagen phase is not resumed at those places and a gradual thinning of hair is seen.
Causes : Vaccinations, short term crash dieting, physical trauma like a car crash, death of a loved or a surgery can sometimes give a shock to the system and result in TE. Nutritional deficiencies (zinc, amino acid L-lysine, or vitamins B6 and B12, iron), hormonal shock at the time of child birth or stopping and starting of sex hormone therapy, thyroid dysfunction and contact dermatitis from hair dyes are also some other reasons for chronic TA in women. Seasonal variations are also known to cause TE.
Hair loss restoration treatment : Removal of the cause leads to normal hair growth in most of cases. The medications that have a high chance of causing TE should be substituted with benign alternatives, when possible. Hormone therapies should be stabilized. However, if a specific causal factor is not identified, or it is not possible to remove the underlying cause, most dermatologists resort to prescribing minoxidil. Minoxidil is a direct hair growth stimulator; it helps to resume the anagen growth phase from telogen resting hair follicles.
In contrast to telgen affluvium, anagen Affluvium involves the shedding of the anagen hair which can be recognized by the tapered or feathered root end. This condition results in rapid hair loss, sometimes to extent of loosing all the scalp hair. The cytoxic drugs such as those given for the cancer therapy and other toxins which stop the proliferation of cells are responsible for the disease. The hair follicles in the growth phase do not proceed to the resting phase but somehow get freezed in time.
Hair loss restoration Treatment : Stopping of drug therapy is the only hair loss restoration option available. Sometimes there is permanent change in the texture and nature of hair after the recovery.
This is the disease which affects men, women and children. Alopecia areata (AA) is perhaps the second or third most common form of hair loss that is seen in a dermatology clinic after androgenetic alopecia and telogen effluvium. The life time risk for experiencing AA is nearly 2%. That is, 2 in every 100 people will have AA at some point in their lives. This is autoimmune disease where body’s immune system starts attacking hair follicle thinking as if they are threat to the body. AA can affect men, women, and children and is manifested by presence of smooth circular patches of hair loss on the scalp. About 70% of people experience just one or two patches of AA, but for some the hair loss can become quite extensive. Unfortunately, children who develop AA before puberty are the ones most likely to develop more extensive and persistent hair loss. When the hair loss spreads to cover the entire scalp it is called “alopecia totalis” and when the AA spreads over the entire body, affecting, scalp, eyebrows, lashes, beard, pubic hair, and everything else, then the condition is called “alopecia universalis”.
The hair loss is very sudden; it develops in a matter of a few days anywhere on the scalp. Unlike other diseases the hair follicle is not destroyed and is able to grow after the inflammation at the root is subsidized. However, in about 30% of individuals AA becomes more extensive and goes through many cycles of hair loss and re-growth.
Hair loss restoration Treatment : In alopecia areata only growing hair follicles come under attack. Resting follicles allegedly escape destruction by immune cells. So by truncating the growth phase, total destruction of hair follicles can be avoided. And this forms the basis of treatment for the AA.
Though there are no FDA-approved treatments for AA. The topical corticosteroids or a combination therapy using minoxidil and anthralin are the available options. The management of the Alopecia Areta also takes into consideration many factors such as the age and the extent of the disease.
For more patients with more than 50% hair loss or rapidly advancing disease, cosmetic aids, scalp prostheses and other camouflage techniques can also be tried.
Scarring alopecia (Cicatricial alopecia)
Scarring alopecia refers to a collection of hair loss disorders, each of which is fairly rare. Specialist hair clinics may diagnose up to 3% of patients with some kind of scarring alopecia.
Most forms of scarring alopecia first occur as small patches of hair loss that may grow with time. In some cases the hair loss is gradual, without symptoms, and may go unnoticed for a long time. In other instances it is rapidly progressive and is associated with severe itching, burning and pain. The alopecia patches usually look a little different from alopecia areata in that the edges of the bald patches look more “ragged”. Since the destruction of the hair follicle occurs below the skin surface, the affected areas of the scalp are mostly smooth and clean, but in few cases there can be redness, scaling, increased or decreased pigmentation or pustules at the affected area.
These visual indicators may help with diagnosis, but it is difficult to diagnose a scarring alopecia. Often when scarring alopecia is suspected, one or more skin biopsies are done to confirm the diagnosis and to find out the particular form of scarring alopecia that is involved. A pathologist or dermatologist will look for destruction of the hair follicles, scar tissue deep in the skin, and the presence and location of inflammation around hair follicles. However, sometimes a biopsy from a scarring alopecia affected individual can show very little inflammation when the disease is in the “burn out” stage. The bald patches stop expanding and any itching, burning or pain goes away. Sometimes hair follicles, at least those at the periphery of a bald patch, are not completely destroyed and they can re-grow.
Hair loss restoration Treatment : Scarring alopecia can involve a lot of damage and permanent hair loss. For this reason treatment of scarring alopecia should be quite aggressive. The nature of treatment varies depending on the particular diagnosis. Scarring alopecias caused by the inflammation of lymphocyte are generally treated with corticosteroids topical creams or their injection into the affected skin. In addition, antimalarial and isotretinoin drugs may be used. The scarring alopecias caused inflammation of neutrophils or a mixture of cells is typically treated with antibiotics and isotretinoin.
Drugs like methotrexate, tacrolimus, cyclosporin and even thalidomide have been used experimentally to treat some forms of scarring alopecia. Once a scarring alopecia has reached the burnt out stage and there has been no more hair loss for a few years, the small bald areas can be surgically removed. Hair transplant surgery is another hair loss treatment option available for bigger patches of bald scalp.
Hair loss caused by Infectious agents
Ringworm: The disease is caused by th e fungus getting into the hair and making them brittle to break off easily leaving a bald patch of skin. The affected areas are in form of scaly patches that are often itchy, red and inflamed, that may blister and ooze. The patches are usually redder around the outside with a more normal skin tone in the center.
Hair loss restoration Treatment :
The Griseofulvin blocks the fungus from infecting the keratin. More recently some fungi that cause tinea capitis have been showing some resistance to the drug Griseofulvin. As an alternative to Griseofulvin, newer anti-fungal drugs like Terbinafine, Itraconazole, and Fluconazole can also be prescribed as Hair loss restoration Treatment medicines.
Folliculitis : Folliculitis is a term for focal inflammation of hair follicles. It looks like acne with little rings of inflammation surrounding the opening of a hair follicle. In the early stages of a folliculitis the hair fiber may still be present in the middle of the folliculitis, but as the folliculitis progresses the hair often falls out. It is also possible to have viral, fungal, or yeast induced folliculitis.
Hair loss restorationTreatment :Non-prescription topical antibiotics like bacitracin, mycitracin, or neomycin are used as Hair loss restoration Treatment options for minor folliculitis. For more serious infections, oral antibiotics such as erythromycin can be used. Hair loss restoration treatment with griseofulvin is also possible if the infection is fungal in nature.
Piedra : Piedra (Trichomycosis Nodularis) is a condition where the hair fibers are infected by a fungus. The visible indicator of a piedra infection is development of hard nodules on hair fibers.
Hair loss restoration Treatment generally involves shaving off affected areas or a topical application of salycylic acid, formaldehyde. White piedra is resistant to azole based antifungals, but this category of Hair loss restoration Treatment is used for black piedra. Oral hair loss restoration treatment with either ketoconazole or terbinafine is also available.
Seborrheic dermatitis is not an infectious disease, but it can involve infection. Seborrheic dermatitis is a skin disease, but it can also involve temporary hair loss if the dermatitis is located on the scalp or other terminal-haired skin areas. The condition worsens when the excess, rich sebum production in seborrheic dermatitis triggers the proliferation of skin flora.This excessive yeast proliferation causes more irritation and inflammation and can affect hair follicle in the vicinity to cause diffuse hair loss.
Hair loss restoration Treatment : The disease can be treated with medicated shampoos. A corticosteroid cream or lotion is also used as Hair loss restoration Treatment for controlling immune response. As it is a persisting disease preventative treatment is useful even when the symptoms are gone.
Mechanical Hair Loss
Traction alopecia and trichotillomania. In terms of the mechanical action that causes hair loss, traction alopecia and trichotillomania are exactly the same. The hair is plucked out of the skin leaving clear bald patches or diffuse, thin hair. With traction alopecia the cause may involve things like tight hat bands, pulling the hair into a tight pony tail, cornrow hair styles, and anything else that pulls on the roots of the hair. Sometimes the follicles are damaged to the extent that they stop growing resulting in permanent hair loss.
One of the most common hair shaft defects a dermatologist encounters is trichorrhexis nodosa (also called trichonodosis). The focal defect in the hair fiber, which can be only be observed under the microscope along the length of a fiber. The disease is caused by the absence of cuticle at some places resulting into swelling and/or fraying at those places.
Acquired trichorrhexis nodosa is much more common and develops as a result of excessive hair manipulation and over-processing. Too much brushing, hairstyles that put constant stress on the hair, excessive washing, dying, and perming may disrupt the cuticle in focal areas along a hair shaft. Trichorrhexis nodosa is particularly seen in people who overuse hot combs or permanent waves to style their hair. Once the cuticle is removed from hair fiber then the hair cortex swiftly breaks down.
Hair loss restoration Treatment : Hair loss restoration Treatment depends on the considered cause of the focal defects. If the hair production is believed to be abnormal then treatment will focus on the hair follicle and improving the strength of hair fiber. People are encouraged to stop using brushes, avoid hair styling that involves chemicals and use only very mild shampoos.
The above discussed conditions fall in the category of diseases which are triggered by the factors other than genetic. But genetics plays a major role in most of the cases of hair loss, the most common of which are the male pattern baldness, and female pattern baldness the treatment for which has been discussed separately in their respective section