Hair loss is a common problem that affects up to 50% of men and women throughout their lives. There are an average of 150,000 hairs on our scalp. We lose an average of 50 to 125 hairs per day. An average growth of 1 to 1.5 cm occurs per month. Growth is faster in the summer and slower in the winter.
STAGES OF HAIR GROWTH
Anagen: This is the growth phase where protein synthesis and keratinization last for 5 years.
Catagen: This is a transitional phase where growth slows down. It lasts 21 days.
Telogen: This is the phase where the strands are released and fall out, of which 85% are shed in the anagen phase, 13% in the telogen phase and 2% in the anagen phase. the catagen phase. It lasts 3 months. Hair loss occurs when this routine is disrupted!
Causes of hair loss
- Genetic predisposition
- Hair growth disorders
- Systemic diseases and autoimmunity
- Scalp diseases
- Drugs
CAUSES OF DIFFUSE HAIR LOSS
1- DIFFUSE HAIR LOSS
A) ANDROGENETIC ALOPECIA
Androgens shorten the anagen phase from puberty and cause follicular miniaturization, which results in progressive thinning of the hair. Laboratory examination is required for women who have hirsutism, menstrual irregularities, acne, infertility. M-shaped hair loss is characteristic in men.
B) Telogen Effluvium
This occurs when the number of hairs entering the telogen phase increases. ~ 25% of hairs enter the telogen phase. Significant hair loss is observed ~3-4 months after the triggering event.
Acute: Less than 6 months, longer than 1 month chronic
Causes of telogen effluvium
Physiological
- Postpartum
- Mechanical or psychological trauma
- Prolonged fever (malaria..)
- Serious infections
- Serious systemic diseases
- Major surgery
- Hypothyroidism/other endocrinopathies
- Crash diet/malnutrition
DRUGS AND TOXINS
- Retinoids
- Anticoagulants (heparin, warfarin)
- Antithyroid drugs
- Anticonvulsants
- Hormones
2- LOCAL HAIR LOSS (alopecia areata)
This is an autoimmune disease characterized by focal hair loss. It is often accompanied by other autoimmune diseases. It may present a genetic transition. Spontaneous regression is common in 6 to 12 months. The prognosis is poor in those that last more than a year and begin in childhood.
TRICHOTILLOMANIA: It is a psychiatric disorder. It begins at the age of 8-10 years. Some patients eat the hair they pull. But, they usually do not admit it. Erythema and pustules may be observed on the scalp. The diagnosis is made after shaving the bald area. It is a psychiatric disease.
TRACTION ALOPECIA occurs in those who wear their hair pulled back. It can lead to permanent hair loss.
TINEA CAPITIS: It occurs mainly in prepubertal individuals. It is more common in those who are in close contact with infected cats, dogs or children. An oral antifungal is necessary (terbinafine).
3- SCAR ALOPECIA
It can lead to permanent hair loss. It can be seen in diseases such as discoid lupus erythematosus, lichen planopilaris, folliculitis decalvans. In patients with hair loss, iron deficiency, goiter, menstrual irregularities, syphilis, diabetes, hormonal profile, Dvit level, Ca level should be examined.
TREATMENT
MEDICAL TREATMENT
ANDROGENETIC ALOPECIA (AGA)
- Minoxidil 5%: Spray on dry scalp 5 times 2 times daily
- Finasteride: – 5-α-reductase inhibitor: DHT ↓ – 1 mg/day orally
- Ketoconazole shampoo
- Zinc pyrithione shampoo
ALOPECIA AREATA
- Topical steroid Apply 2 times to scalp
- Minoxidil 5%: Spray on dry scalp 5 times 2 times daily
- Topical immunotherapy with DNCB or SADBE
- Oral steroids
- Intralesional steroids
- Anthralin cream