HAIR FALL: REASON & SOLUTION

Dr Alok Tripathi

aloksecondopinion@gmail.com

https://iiopinion.blogspot.in

Hair loss, also known as alopecia or baldness

■ Alopecia is the general medical term for hair loss.

■ There are many types of hair loss with different symptoms and causes.

Kind of Hair Loss

genetics and male hormones

male-pattern baldness

not clear

female-pattern baldness

autoimmune

alopecia areata

complications of another condition

scarring alopecia

cancer chemotherapy

anagen effluvium

(thinning of hair) physically or psychologically stress

telogen effluvium

Androgenetic Alopecia (AGA:

Male- and female-pattern baldness (most common)

When it affects women, it leads to diffuse alopecia over the mid-frontal scalp (female pattern hair loss) [1].

Miniaturization of hair follicle is responsible for it, which represents a progressive reduction in diameter, pigmentation and length of the hair shaft [2,3].

Also androgens induced it in genetically susceptible persons, which is manifested by increased 5α-reductase activity and dihydrotestosterone (DHT) levels in hair follicles.

In such genetically susceptible cases, the DHT binds to the androgen receptor and the hormone-receptor complex, activating the genes responsible for the transformation of the normal hair follicle in miniaturized follicles [4, 5].

The reduction in the number of terminal fibers per follicular unit will produce a diffuse alopecia [3]. The impact of androgenetic alopecia is predominantly psychological [6].

Alopecia Areata (AA) (~2%)

a nonscarring autoimmune, inflammatory scalp, and/or body hair loss condition

characterized by patchy hair loss.

Histopathology shows an increased number of the catagen and telogen follicles

and the presence of an inflammatory lymphocytic infiltrate in the peribulbar

region [6].

Scarring alopecia (cicatricial alopecia)

It can be caused by a diverse group of rare

disorders that destroy the hair follicle, replace it with

scar tissue, and cause permanent hair loss.

Scarring alopecia (cicatricial alopecia) types

• a condition affecting the body's connective (supporting) tissues, resulting in hard, puffy and itchy skinScleroderma

•an itchy rash affecting many areas of the bodyLichen Planus

• a mild form of lupus affecting the skin, causing scaly marks and hair lossdiscoid lupus

• a rare form of alopecia that most commonly affects men, causing baldness and scarring of the affected areasFolliculitis Decalvans

•a type of alopecia that affects post-menopausal women where the hair follicles are damaged, and the hair falls out and is unable to grow back

Frontal Fibrosing Alopecia

Anagen effluvium

It is the pathologic loss of anagen or growth-phase hairs. Classically, it is caused by radiation therapy to the head and systemic chemotherapy, especially

with alkylating agents.

Less common causes of hair loss without inflammation or scarring include

pulling out of hair,

•including chemotherapy, HIV/AIDS, hypothyroidism,

certain medications

•including iron deficiency. Causes of hair loss that occurs with scarring or inflammation include fungal infection,malnutrition

lupus erythematosus,

radiation therapy,

•Diagnosis of hair loss is partly based on the areas affected.[2]

sarcoidosis

Age-dependent changes & hair conditioners in damage processes of hair cuticle

the dominant damage pattern shifts from type L to E with aging.

Cuticle becomes gradually less resistant to daily grooming stress.

dominance of type E damage accelerates cuticle loss.

Reduction of 18-MEA on weathered hair is accelerated with aging on elder hair [w].

age-dependent changes in age of 40s and 50s

Alt

era

tion

in

hair

sh

aft

, su

ch a

s

diameter,

density,

cuticle becomes more fragile

hair surface properties deteriorate [x]

Hair color changes

by daily care damages on

ultra-structure

which may be occur due to damaged of

endocuticle layer in form of hole n cavity

formation [y].

Nanoscale characterization of

human hair and hair conditioners [z]

Diagnosis

1- Pluck Testpulling hair out "by the roots".

examined under a microscope to determine the

phase of growth, and is used to

diagnose a defect of telogen, anagen, or

systemic disease

Telogen

hairs have tiny bulbs without

sheaths at their roots.

Telogen effluvium

an increased % of hairs upon

examination.

Anagen hairs have

sheaths attached to their roots.

Anagen effluvium

a fall in telogen-phase hairs &

raise in number of broken hairs.

Diagnosis (contd)

2-Pull Test evaluate diffuse scalp hair loss

Gentle traction is exerted on a group of hairs (~40–60)

on 3 different areas of the scalp

If more than ten hairs are obtained, the pull test is

considered positive

3-Scalp biopsy

to diffrenciates scarring and

nonscarring forms.

Hair samples are taken from areas of inflammation, usually around the

border of the bald patch.

4-Daily hair counts

done if the pull test is -ve. It

by counting the number of hairs lost. either after combing or after

bath

<100 is normal while after shampoo <250 is normal

Prevention

If some substantial loss of hairs (i.e.>100 hairs after combing or bathing and >250 hairs after shampoo) occur without family history, attention on points should be

Eat a nutritionally balanced diet.

Avoid tight hairstyles, such as braids, buns or ponytails.

Avoid compulsively twisting, rubbing or pulling your hair.

Treat your hair gently when washing and brushing. A wide-toothed comb may help prevent pulling out hair.

Avoid combing in wet condition.

Avoid harsh treatments such as hot rollers, curling irons, hot oil treatments and permanents.

Head massage with any natural oil and proper cleaning thereafter shall be helpful

types of problems as per your concern

Type I

Hormonal changes

Type II

alopecia areata

autoimmune

scarring alopecia

•scleroderma

•lichen planus

•folliculitis decalvans

•frontal fibrosingalopecia

telogen effluvium

•Stress

•Hair styling tools:

•Frequent use of chemicals

•Junk food:

•Harsh weather conditions:

•Sleep deprivation

anagen effluvium

Medications &

treatments:

Type III

Gender

genetic causes

growing age

Treatment Androgenetic Alopecia

Topical Minoxidil (2% solution recommended

by FDA for female)

Side effects include a transient shedding

during the first 4 months of use and contact

dermatitis

Finasteride is a synthetic type-2 5α-reductase

inhibitor: 2.5 in female ^ 1 mg/day in male

efficacy is questionable It is contraindicated in

pregnancy, due to known teratogenicity.

Anti-Hormonal Therapy

Spironolactone (aldosterone antagonist)

is employed as a potassium-sparing

diuretic

should not be used in pregnancy due to its

teratogenic effects

Cyproterone acetate is an androgen receptor blocker with strong

progestational activity

decrease hair shedding, but does not seem to promote regrowth

Treatment

Alo

pe

cia

Are

ata

Treatment not mandatory;

Some therapeutic agents includes systemic, intralesional & topical steroids under occlusion and topical

immunotherapy with squaric acid dibutylester or diphencyprone

Treatment

Chemotherapy Induced Alopecia

Scalp cooling is as a method of preventing hair loss during chemotherapy

. Trichotillomania

Behavior therapy and pharmacotherapy are the most efficacious treatments for adult

other medications such as opioid blockers, atypical neuroleptics, and glutamate modulators hold promise as treatment for trichotillomania

Treatment

Telogen Effluvium

Iron Supplementation

(+)

Biotin Supplement

@5mg/day (±)+B5

Cysteine Supplement @500

mg daily)±

Authors Recommendations: types of problems as per your concern

Ty

pes

Type I: you need not to seek much attention it will usually

go by its ownHormonal changes

Type II: where your attention is valuable

alopecia areata

scarring alopecia

telogen effluvium

Type III: where even your attention will not able to make significant change & that too

up to limited extent.

genetic causes

Age

Nutritional Requirements for Hair

Proteins

ILU, LEU, LYS, MET, CYS, PHE, TYR, THR, TRP, VAL,

HIS

Fat

hydrocarbon, Squalene, wax esters,

triglycerides, Fatty Acids, Cholesterols, Cholesterols Sulfate, Ceramides, 18-MEA,

Minerals

Ca Fe, Cu, Mg, Si, Pb Zn

& Se,

Vitamins

B6, B12, C, D

Nutritional Recommendations & Constituents

Egg

Oyster

Blueberries

Sprouted Lentils

Fish

Walnuts

Green Leafy Vegetables

Yogurt CURD

Protein: Amino Acids

++++

+++

-

++++

++++

--

++

+++

Fat

Saturated, Cholesterol

Saturated, Cholesterol

-

-

+++++

ω-3, EPA

ω-3,Mono, Polyun

--

Saturated, Cholesterol

Minerals:Zn, Se, S, Fe

Zn, Se,S, Fe, K, Mg,

Zn (x500)

Fe, K, Mg,

Ca, Mg, K,

Fe, Cu

Fe, Ca

Cu, Fe

Mg, K, Fe, Ca

Mg, Fe, Ca, K

Ca, Mg, K

Vitamins

A, B6/12 C, D,

A, B6/12 C, D,

A, B6/12 C, D,

A, C

Vit E D

B6, C,

B12, 6, C, A,

B12, A

Antioxidants

-

+

++++

++

+++

+

Carotene

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