Is treating baldness realistic?
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Hair loss (alopecia) can affect any part of the body. When it occurs on the scalp, it is called “baldness”. Alopecia often worries people for cosmetic reasons, but it can also be a sign of a systemic disorder.
Hair grows in cycles. Each cycle consists of the following phases:
- A growth phase (anagen phase) of 2 to 6 years
- A very short transition phase (Cartagena phase) of 3 weeks
- A short resting phase (telogen phase) of 2 to 3 months At the end of the resting phase, the hair falls out (exogenous phase) and the cycle begins again, while a new hair begins to grow in the follicle
- Anagen effluvium: disruption of the growth phase leading to hair loss in the anagen phase
- Telogen effluvium: Many more than 100 hairs/day go into the resting phase and then fall out.
- (androgenetic alopecia)
Others commons aetiologies of alopecia are:
- Alopecia areata
- Certain systemic disorders, such as cutaneous lupus erythematosus and hormonal disorders
- Medications, especially chemotherapy
- Fungal infections, such as ringworm of the scalp (tinea capitis)
- Physical stress such as high fever, surgery, serious illness, sudden weight loss, or pregnancy (all of which can lead to telogen effluvium)
- Psychological stress
- Injury (trauma)
- Trichotillomania (mental disorder characterized by habitual pulling out of healthy hair)
- Traction alopecia (hair loss caused by constant pulling, for example, from wearing braids, curlers, or a ponytail)
- Burns and radiation
- Pressure alopecia (for example, after a procedure in which prolonged pressure is applied to the scalp and causes damage to the hair follicles)
Androgenetic alopecia: This form of alopecia increases with age and affects more than 70% of men (male androgenetic alopecia) and 57% of women (female androgenetic alopecia) over the age of 80.
The hormone called “dihydrotestosterone” plays an essential role, as does heredity. Hair loss can start at any age, during or after puberty, including adolescence (see the figure Hair Loss).
In men, alopecia generally occurs at the temples or at the top of the head, towards the back. Some people lose little hair and simply have lightening of the temples or tonsure at the back of the head. Other men, especially those with early-onset alopecia, become completely bald on the top of their heads, but retain some hair on the sides and back of their heads. This pattern is called “male androgenetic alopecia.”
In women, alopecia affects the top of the head and usually manifests itself as a thinning rather than a complete disappearance of hair. Furthermore, the edge of the hair usually remains intact. This pattern is called “female androgenetic alopecia.”
Alopecia areata In alopecia areata, usually round, irregular patches of hair fall out suddenly. More hair loss may also occur. This disorder is believed to be caused by a malfunction of the body's immune system, causing the body to attack its own tissues (autoimmune reaction).
Centrifugal central scarring alopecia Central centrifugal scarring alopecia is the leading cause of scarring alopecia in women of black ethnicity. The combination of scalp damage, potentially caused by a hot comb, chemical straightener or weaves, with a genetic predisposition to follicular damage due to abnormal hair follicles, can lead to progressive hair loss and the appearance of scar tissue on the top and back of the scalp.
Cutaneous lupus erythematosus In cutaneous lupus erythematosus, patches of hair may fall out. Alopecia can be permanent if the hair follicle is completely destroyed.
Cutaneous lupus erythematosus can affect people with or without systemic lupus erythematosus (SLE or simply lupus). In this disorder, the body produces antibodies or cells that attack its own tissues (autoimmune disease).
Systemic lupus erythematosus affects different organs throughout the body and can cause acute cutaneous lupus with generalized alopecia without scar tissue formation. In chronic cutaneous lupus erythematosus, hair tends to fall out in patches, and permanent loss or loss with scar tissue formation may occur.
Hormonal imbalance If women have excessive levels of male hormones (excess androgens) or are more sensitive to the effects of these hormones (for example, due to a genetic predisposition), they may develop alopecia of the scalp, acne and hirsutism, that is to say excessive hair growth localized in a typically male pattern, on the face or torso, for example.
The most common cause of androgen excess in women is polycystic ovary syndrome (PCOS). Women with PCOS typically have excessive facial and body hair, and some lose their hair, resulting in enlargement of the central part (female pattern baldness).
Virilization occurs when androgen levels are high enough to cause not only hair loss, but also the appearance of other signs and symptoms, such as a deeper voice, decreased breast size, an increase in muscle mass, irregular periods, an enlargement of the clitoris (the small organ which, in women, corresponds to the penis) and an increase in libido. In rare cases, a tumour in the ovaries or adrenal glands can secrete male hormones and cause virilization. Virilization may also develop in a woman who takes anabolic steroids to improve athletic performance or in women with a genetic disease that affects the adrenal glands (congenital adrenal hyperplasia).
Working pattern: It should be said that oily hair and the heat caused by the sun are one of the primary causes of the onset of baldness in young adults (18 to 33 years old). For people wearing safety helmets in the kitchen or during construction work, there are many cases of early baldness. These cases are more easily treated, especially for those under 65.
Food troubles: Eating disorders are a less common cause of alopecia. Symptoms vary depending on the eating disorder:- Excess vitamin A: rash, chapped lips, painful swelling of the limbs, listlessness, loss of appetite and weight loss
- Iron deficiency: anaemia, with increased exhaustion and reduced ability to exercise
- Zinc deficiency: skin rash, diarrhoea, frequent infections, loss of appetite or difficulty healing
Drug use: Male or female pattern baldness can occur after taking anabolic steroids. Drugs used for chemotherapy usually cause disruption of the growth phase, leading to hair loss in the anagen phase (anagen effluvium).
Other prescription medications (for example, blood thinners and medications used to treat high blood pressure, acne, thyroid disorders, or seizures) commonly cause alopecia by causing telogen effluvium.
Ringworm of the scalp (tinea capitis) Ringworm of the scalp is a fungal infection that commonly causes alopecia areata in children. The infection begins as a dry patch with scaling, which gradually spreads.
The hair can then break off at the roots, leaving very short hair on the surface of the scalp, like small blackheads. Sometimes hair breaks above the surface of the scalp, leaving short hair. Alopecia can be permanent, especially if the infection is left untreated.
Traction alopecia: This disease is characterized by hair loss caused by tight braids, curlers or a ponytail that constantly pulls on the hair. Hair loss often occurs at the hairline (forehead and temples).
The following information can help people decide whether a physical examination is necessary and how one is performed.
Warning signs Here are the particularly worrying signs:
- Signs of a systemic condition (which affects the whole body)
- In women, development of masculine characteristics (virilization), such as a deeper voice, hair located in areas typical of male hair (hirsutism), irregular periods, acne, breast atrophy, increased muscle mass, clitoral enlargement and increased libido
When to see a doctor: People who experience alopecia and signs of a systemic disorder should seek medical attention promptly. Women who have developed masculine characteristics should seek medical attention as soon as signs appear. Other people should consult as soon as possible, but not urgently, unless symptoms progress.
What does the doctor do The doctor first asks questions about the person's symptoms and medical history and then performs a clinical examination. Information from the medical history and physical examination often suggests a cause for the hair loss and what tests may need to be performed.
Doctors can ask these questions about alopecia:
- Did it start gradually or suddenly?
- How long ago?
- Is it increasing?
- Is the hair falling all over your head or in a specific area?
Doctors look at current and recent medication use, and family history of alopecia.
During the clinical examination, doctors examine the scalp, determine the pattern of hair loss, the presence and characteristics of any skin abnormalities, and the presence of scarring.
They measure the width of the central area of the scalp in several locations (see the Hair Loss figure) and examine the hair using a microscope to look for abnormalities in the hair shafts.
Doctors evaluate alopecia throughout the body (eyebrows, eyelashes, arms and legs). They look for possible rashes that may be associated with certain types of alopecia and signs of virilization in women, such as a deep voice, hirsutism, clitoral enlargement and acne. They also examine the thyroid.
What are the Treatments ?
Treatment of specific causes Sometimes replacement methods Specific etiologies of alopecia are treated wherever possible: Medications causing alopecia are changed or stopped.
Medication or surgery can be use to treat hormonal disorders,depending on the cause.
Taking Iron or zinc supplements: Doctor's may prescribe eating supplements , if people are deficient in some minerals or vitamins.
Reduce the vitamin A. Doctore can also prescribe to reduced the consuption of A vitamin, in people with alopecia caused by excess vitamin A.
Alopecia areata can usually be treated with corticosteroids that are injected into the skin, applied to the scalp (topical), or given by mouth. Other topical and oral medications may be administered. Cutaneous lupus erythematosus, lichen planus pilaris, and frontal fibrosing alopecia can usually be treated with corticosteroids that are injected into the skin or applied topically, or with other topical or oral medications.
Eliminating the physical traction or stress experienced by the scalp.This is the way to treat Alopecia due to traction or stress to the scalp.
Anti-fungal medications administered orally. Ringworm of the scalp is treated with anti-fungal medications administered orally.
Trichotillomania is difficult to treat, but behavior modification, clomipramine, or a selective serotonin reuptake inhibitor (such as fluoxetine, fluvoxamine, paroxetine, sertraline, escitalopram, or citalopram) may be helpful.
Alopecia due to physical stress, such as recent weight loss, surgery, serious illness with high fever, or childbirth (telogen effluvium) is usually not treated and tends to resolve on its own. Applying minoxidil to the scalp may be helpful for some people. If hair does not grow back on its own, replacement methods may be considered, including Medications to prevent further hair loss or promote hair growth
Treatments Both male and female androgenetic alopecia can be effectively treated with medication. Minoxidil can prevent further hair loss and increase hair growth. When applied directly to the scalp twice daily, topical minoxidil is effective for male and female androgenetic alopecia. Hair regrowth can take 8 to 12 months. The most common side effects are skin irritations, such as itching and rash. Facial hair growth may also occur. Minoxidil, used off-label, can also be taken orally.
Finasteride blocks the action of male hormones on hair follicles and must be taken orally every day. Finasteride is sometimes used in postmenopausal women. Because finasteride causes birth defects in animals, its use is not considered safe in women able to become pregnant. In men, its effectiveness in stopping hair loss and stimulating hair growth generally appears 6 to 8 months after treatment, and increases over time, but can vary from one person to another. Finasteride may reduce libido, increase breast size, and contribute to erectile dysfunction, and, in rare cases, symptoms of depression or suicidal thoughts. Finasteride may also lower prostate-specific antigen (PSA) levels. Men should discuss the impact of finasteride on prostate cancer screening results with their doctor before starting treatment. The most important effect of minoxidil or finasteride may be to prevent hair loss from getting worse. The effectiveness of these medications is suspended when they are stopped. Hormone modulators such as spironolactone may be helpful in some women.
Hair transplant: Transplantation is a more permanent solution. In this procedure, hair follicles are taken from an area of the scalp and grafted into the alopecic area. This technique involves the transplantation of only 1 to 2 hairs per session.
Another surgical option involves taking alopecic areas of skin from the scalp and stretching the areas with hair over a larger area.
Hair transplant Wigs: Wigs are the best treatment for temporary hair loss (for example, due to chemotherapy). People undergoing chemotherapy should consult a wigmaker before treatment begins so that the wig will be ready when they need it. When hair grows back, it may have a different color and texture than the original hair.
Other options Laser phototherapy is an alternative or complementary treatment for male and female alopecia (androgenetic alopecia), whose effectiveness in hair growth has been demonstrated.
Over-the-counter devices are available, or doctors can perform laser treatment in the office.
A new treatment that may help hair follicles grow involves using the person's own plasma (liquid part of the blood) and platelets (small blood cells that help blood clot). Platelets are thought to contain substances that trigger hair growth. This treatment, called platelet-rich plasma or PRP, involves taking blood from a person and processing it to remove the platelet-rich plasma. The platelet-rich plasma is then injected into bald patches and could stimulate new hair growth.
Some people conceal thinning hair using camouflage powders, hair loss masking products (products containing fibres that bond to existing hair), and a form of tattooing called scalp micropigmentation.
Conclusions:
- Male/female androgenetic alopecia is the most common type of hair loss.
- Doctors look for an underlying disorder in women showing signs of virilization.
- A microscopic examination of the hair or a scalp biopsy may be necessary to determine the reason for the alopecia.
- Doctors treat the specific cause of alopecia when possible; Otherwise, treatments for male and female alopecia include medications, hair implants, laser phototherapy, and platelet-rich plasma injections.
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The treatment success rate is around 72% for men, 86% for women and 98% for people under 25 years old.