Where did my hair go? Understanding Hair loss

One day, Kumar was looking through the family ‘album and as he was about to see the reflection of himself in the mirror,. He was aghast and lost for words. both his hands went to his balding head and twiddled with it. “The hair, where is the hair?” he thought to himself, falling alongside other men who are experiencing androgenic alopecia.

What is Androgenic Alopecia?

Patterned hair loss, also known as androgenic alopecia, is estimated to affect 30% of men in the third decade and 70% in the seventh decade of life. This is a condition where the hairline at the forehead begins to be pulled backwards and there is thinning of hair at the top of the head. Hair is usually spared in a  narrow margin at the back of the scalp. The same condition in women is widely referred to as female pattern hair loss

Understanding Hair Biology

Let’s describe the key principles of hair biology. Hair exists in bundles, or follicular units, of terminal and vellus hair, the former being the large, course hair and the latter the fine, downy hair. In male pattern baldness, terminal hair increases to become vellus hair, hence giving the impression of a receding hairline. Present remedies are based on this process and the aim is to stop this process and transition vellus hairs back to terminal hairs.

Causes of Hair Shrinking

It is triggered by genetic and environmental factors such as infections, changes in working schedules and provoking agents including stress. This condition may be passed from one generation to the next through either parent or both parents. One of the major protagonists in this process is dihydrotestosterone, or DHT, which is produced from testosterone in the vicinity of the hair follicle. Remedies like minoxidil reduce the influence of DHT. While  minoxidil boosters increases the effectiveness of the given treatment,.

Diagnosing Androgenic Alopecia

A dermatologist assesses male pattern baldness chiefly clinically, based on the patient’s history. The diagnosis can be helped by such tools as dermatoscopy. The symptoms include hair loss at the front or top of the head, a hairline that is gradually moving back and thinning hair in the family. In general, the skin of the scalp is not involved.

Treatment Options

Despite the fact there is no one cure for androgenic alopecia, treatmentfor the condition in both medical and surgical settings is always possible. If left untreated, the hair loss gradually gets worse over several years to decades, and the earlier one is affected, the quicker the hair loss will progress.

Medical Treatments

Minoxidil: A topical solution called 5% minoxidil liquid or foam applied to the scalp will help decrease further hair loss and might even regrow some hair. And it should be gently placed to the affected scalp area using dropper or pump spray and lightly massaged. Common adverse effects include dryness of the skin, local skin redness, scaling and itchiness. Benefits may take up to half a year to appear, though the first two to eight weeks may be characterized by hair loss as healthier hair begins to grow.

Finasteride and Dutasteride

 

These medications taken for 3-6 months, reduce DHT levels and hence the hair loss is slowed down and regrowth is encouraged. Potential risks are reduced sexual desire and difficulties in achieving an erection.

Surgical Treatments

Hair Restoration Surgery: The hair follicles are relocated from the regions of the head at the back and sides of the scalp to the areas of baldness.

Scalp Reduction: This involves cutting out a strip of the bald scalp, moving a strip of hair bearing scalp and then fixing it to cover the bald area. Such associated devices, such as tissue expanders, may be useful for stretching the skin.

Non-Medical Options

Wigs and Hairpieces: Surgery or false hair such as wigs, toupees or hair extensions can make one hide the fact that they are bald.

Skin Camouflage: Cosmetic products in the form of a spray with pigmented fibres can cover the bald spots, but this is removed when washing with water.

Light Therapy: There is mild evidence on the use of laser and light treatment.

Future Directions

New therapies, like growth factors and PRP therapy, can also be used to treat MPB.

Treatment Duration

The therapy for androgenic alopecia is effective at the time when the treatment methods are being developed.

Female Pattern Hair Loss

Causes of FPHL

FPHL arises from genetic and hormonal causes, stated to affect the hair at the vertex and mid and part scalp leading to thinning or shedding of hair gradually. It could be linked with diseases such as polycystic ovarian syndrome (PCOS), which leads to formation of cysts in ovaries, production of excess male hormones, formation of acne, hair on face and irregular menstrual cycles.

 
Heredity and Manifestation

FPHL can be inherited from either or both parents of the patient. The condition presents itself as generalised baldness; this is the type that affects the covering on the top of the head, spreading from the back towards the front of the scalp, especially at the crown area and unlike androgenization, it initially presents as enlargement of the partition lines. Unlike men, women are likely to lose hair only on the vertex but keep the frontal hairline intact. Although FPHL may occur at any age, it can present as soon as in the fourth decade, and patients with PCOS are at a relatively younger age.

Diagnosing FPHL

A dermatologist diagnoses FPHL through taking a patient’s history, conducting a physical examination and utilizing dermatoscopy. In diagnosis, one looks for slow decrease or excessive hair loss on the scalp, particularly on the crown, and past history of similar balding in the family. majority of FPHL patients do not have hormonal imbalances but investigations such as FSH and luteinizing hormone are done to exclude causes such as PCOS and congenital adrenal hyperplasia. Female Pattern Hair Loss (FPHL) cannot be cured, but it can be treated and therefore managed in a proper way. However, the condition has a very slow disease progression, on a scale of several years to decades, in most patients.

Treatment Options for FPHL
Medical Treatments

• 
  Topical Minoxidil: Thus, with the help of a 2 % or 5 % minoxidil solution for the scalp, hair loss can be stopped, and, to a certain extent, the hair loss in women can be restored. It should be used only on the scalp, and where there is transfer of the solution on the forehead or cheeks, extra care should be taken to wash off the area to avoid growth of hair on these places. The improvements related to Minoxidil are visible only when it is used consistently for a minimum of six months.
  • Oral Treatments: Several over-the-counter drugs can be taken orally to reduce the effects of DHT on the head, which in turns can help in the improvement of hair loss. These include:
  o Spironolactone
  o Cyproterone Acetate
  o Flutamide
  o Cimetidine
  Pregnant and breastfeeding woman should not use Spironolactone or Cyproterone Acetate, as it can harm the baby. Flutamide also has side effects, specifically for the liver.

Surgical Treatments

• 
  Hair Transplantation: The hair follicles are harvested from the permanent donor region that is at the back and side of the scalp, and then implanted in the bald region.
  Non-Medical Options
  • Wigs, Toupees, and Hair Extensions: These are very useful in concealing baldness and they are non-surgical in nature.
  Consequences of female-pattern hair loss
  Thus, FPHL is not only a vanity problem, as it inevitably leads to severe psychological disorders. FPHL negatively affects the quality of life; most women diagnosed with FPHL suffer from low self-esteem, depression and unattractiveness. Hence, a specific approach according to the patient’s requirements is crucial to prevent the abovementioned effects and enhance living quality.
  
  Diffuse Hair loss

Understanding Diffuse Hair Loss
Telogen effluvium, while diffuse hair loss is defined as thinning hair loss seen on the scalp that is more than 25% perceived by a person,. This condition is most evidently seen on the central and front regions of the scalp and is scientifically referred to as telogen effluvium. While androgenetic alopecia has characteristics of balding hair pattern, telogen effluvium has hair loss characteristics of thinning hair distribution.

Normal Hair Growth and Hair Shedding

This usually grows at the rate of 1 cm per month. The hair cycle consists of three phases:

• Anagen (growth phase): Is 2–6 years long and targets approximately 90% of the hair follicles in the scalp.
  • Catagen (transitional phase): It is a brief phase in which the growth of hair is not as fast as it was before.
  • Telogen (resting phase): It is noteworthy that hair condition are quite different before they finally shed out or rather are shed out.

One can shed between 50 and 100 hairs in normal circumstances; however, the extent may differ.

Telogen effluvium is a condition in which a large number of hairs pass into the resting phase at any one time. This condition can be triggered by various factors, including: This condition can be triggered by various factors, including:
• Nutritional deficiencies: Iron, protein and zinc.
• Autoimmune diseases: Diabetes, thyroid disease and many more.
• Stress: It is both the emotional stress like after childbirth, operation, or burial of a close friend/family member, and the physical stress.
• Severe illnesses: Typhoid fever, malaria and dengue fever are examples of infections that can be transferred from person to person.
• Medications: Some causative agents cause diffuse hair loss Some drugs contribute to hair loss.
Procedures Used In Hair Cosmetics And Styling
Certain hair care practices and products can exacerbate hair loss.

• Alkaline shampoos: This can bring along with it some harm to the hair, such as increased hair damage.
  • Hair prostheses: Wigs, curlers, tight braids and weaving should be avoided since they pose a danger to the hair.
  • Hair cosmetics: Hair dye, bleach or colours, perms, and hair straightening also cause hair loss.
  
  

A concern that relates to hair loss, environmental factors, are documented as follows

• 
  These cause psychological stress, air pollution, and smoking are all major factors that cause increased hair loss.
  • A study in the effects of sun exposure has pointed towards hair shedding in women.
  • The hardness of water during hair washing has no influence with hair loss, according to scientific evidence.
  
  

Diagnosing Hair Loss

A dermatologist will typically assess hair loss through:

• Clinical examination: Dermatologic examination, trichoscopy, and hair sampling: hair pull test.
  • Laboratory tests: hemoglobin, TSH level, 25(OH) vitamin D level, serum iron level and Vitamin B12 level. In women, due to clinical suspicion, hormonal tests may be required from time to time.

Treating Hair Loss

• 
  Hair loss can largely be regulated by modification of lifestyle and dieting on a healthier regime.
  • Treating underlying disorders: As thyroid complications, vitamin D deficiency and anemia, among others.
  • There are foods, drinks and creams that help encourage hair growth and most are accompanied by a time factor of 3-6 months.
  Now there’s going to be hair thinning after hair loss and they want to do something about it.
  In the event that regrowth is not sufficient, one can opt to use hair prostheses such as wig or hairpieces. But if misused, these can further harm the hair and scalpmore. It is advisable to approach a dermatologist for the correct procedure to be followed.

Post-Hair Loss Instructions

1. 
   Consult a dermatologist: Thus, they can assist in diagnosing and treating hair loss in the best way possible.
   2. Follow treatment plans: Patients should keep using the prescribed drugs and maintain the new and improved lifestyles they opted to embrace.
   3. Consider prosthetics cautiously: As for hair styling products, wigs or hair pieces should be taken, especially if these are well-fitted, in order not to cause harm to the hair further.
   
   Hair Transplant
2. 
   What is Hair Transplantation?
   Hair transplantation is a technique where hair is moved from the back of head (donor area) to the areas that are bald or mini-balding (recipient area). Moreover, the transplanted hair does not change the colour or characteristics of the hair found in the donor area.
3. 
   Indications for Hair Transplantation
   Hair transplantation is indicated:
   • Male pattern baldness
   • Female pattern hair loss, also referred to as female alopecia.
   • Skin loss for scarring that occurs in surgery, trauma, or burn cases
   • Eyebrow, eyelash, moustache, beard During
4. 
   Techniques of Hair Transplantation

Hair transplantation can be performed using two techniques:

• Strip Method: It makes it 1-1. Stitches are made to remove 2 cm-wide strip of scalp skin. The FUT method leaves small, narrow strip scar. Follicular units or hair grafts, are dissected by magnifying loupes and implanted to the recipient site that is affected by baldness.
  • Follicular Unit Extraction (FUE): The kind of punch that is applied is a small, round one that removes the follicular unit by directly punching it from the donor area. This technique minimizes the formation of a linear scar but the implantation is identical to the strip method.

4. 
   Post-Transplantation Sequelae

When beginning, the transplanted hair will gradually shed, starting from the second or third week after the transplantation. They will begin regrowing in the recipient area in 2-3 months, and their effectiveness should reach a satisfactory level in 6–9 months.

5. 
   Is the Procedure Painful?

The first time the anaesthetic is given, it can be slightly painful, but otherwise, it doesn’t hurt and does not cause any discomfort. Depending on the type of surgery, you will be awake and able to communicate throughout the procedure.

6. 
   Number of Sessions Required

The number of sessions required is also determined by the area to be conducted.
7. Time Taken to Carry Out the Procedure and Any Time Lost
The whole process is periodontal surgery and it is considered a daycare treatment that takes 8 to 10 hours only. Working is possible immediately after the procedure but it is recommended to have it easy for three days.

8. 
   Expected Side Effects

• 
  Pain: It can be taken care of and controlled by the intake of some particular medicine.
  • Infection: Little risk is posed mainly because all the procedures are conducted under aseptic conditions.
  • Swelling: Some patients may develop some swelling over the forehead and periorbital region in 1-3 days. Do not bend and also try to sleep in a laying-down position. Ice massage can help and usually the swelling resolves within the first week.
  • Rare Side Effects: In this report, some of the patients may be diagnosed with curable ailments such as boils. There are no long-lasting side effects.

9. 
   Follow-Up Schedule

• 
  Day 3: Head washing
  • Day 15: Take daily prescribed drugs
  • Every 6 weeks: If you have undergone-Platelet Rich Plasma (PRP) therapy

10. 
    Resuming Work

This surgery normally does not require a long time to be healed completely; you can go back to work if you are happy with your new look from the third day after the procedure.

11. Post-Transplantation Treatments

This decision is, However, necessary to keep on using the medical treatments taken to avoid more hair loss from the balding zone. All the transplanted hairs do not need treatment.

12. 
    Post-Surgery Instructions

Actually, the first 3-5 days are critical for patients after surgery. Follow these simple instructions:
• Splash normal saline every 2 hours in the first 48 hours.
• See a doctor for some medication to relieve pain and undertake an antibiotic course.
• Readmission back to the hospital for a head wash on the third day.
• All topical treatments may be started two weeks postoperatively.