Are you suffering from hair loss?

The term ‘Alopecia’ refers to hair loss regardless of the etiology. Alopecia or hair loss is a form of hair fall that is not exclusive to the scalp; it can be anywhere on the human body. Alopecia can affect both males and females. The pattern of hair loss may vary from the bald patches to more subtle, such as diffuse hair loss. Alopecia can be temporary or permanent.
Hair loss or Alopecia is not life-threatening, but it is distressing and significantly affects the individual’s quality of life.^1,2

The pathogenesis of alopecia is asynchronous. Androgenetic alopecia, as the name depicts has a clear genetic predisposition. Research confers that this type of hair loss pattern is a polygenic disorder with variables, and both mother and father genes are involved. There is a familial predisposition to androgenetic alopecia with sons at a five to six times higher relative risk if their fathers were balding. Both hormone metabolism and androgen receptors play a key role in the pattern of alopecia.⁸

The growth and loss of hair may seem like a simple process, but hair growth and regeneration is a cyclic process encompassing three distinct stages:

• Anagen,
• Catagen,
and
• Telogen. (Figure1). ^2,3

Types of Alopecia

Alopecia can be subcategorized into scarring and non-scarring alopecia.

A) Scarring alopecia includes

• The inflammatory variety of tinea capitis (favus) that may culminate with scarring alopecia.
• The second subcategory of scarring alopecia is Alopecia mucinosa which occurs when mucinous material accumulates in the hair follicles and the sebaceous glands. The mucinous material causes an inflammatory response that hinders the growth of hair.
• Thirdly, Alopecia neoplastica is the metastatic infiltration of the scalp hair with malignant cells.

B) The non-scarring alopecia can be subdivided into six major categories; wherein, the most common type of non-scarring alopecia is

• Androgenetic alopecia is a pattern of hair loss affected by genes and hormones.2-4 Other categories of non-scarring alopecia are as follows: -
• Alopecia areata5:
  • Etiology- Unknown
  • This is a pattern of hair loss that is not exclusive to the scalp but can affect every part of the body, including the face, trunk, and extremities.
  • It is further classified into 3 categories based on the affected location- Alopecia areata (Pattern of hair loss that affects only a portion of the body), Alopecia Totalis (Pattern of hair loss that affects an entire site), and Alopecia Universalis (Pattern of hair loss which involves the entire body).
• Telogen effluvium6
  • Etiology- It might cause due to improper diet (crash diet or poor feeding) and drugs; Stress; Thyroid/ Endocrine disorders.
  • This is a pattern of hair loss that results from the shifting of the hair cycle growth (anagen) phase towards the shedding (telogen) phase.
• Traumatic alopecia7:
  • Etiology- Unknown
  • Commonly seen in Children
  • This is like traction alopecia, which results from forceful traction of the hair
• Tinea capitis2,4:
  • The classical type of Tinea capitis causes non-scarring hair loss
• Anagen effluvium2:
  • Etiology- Chemotherapeutic agents
  • Commonly seen in patients undergoing chemotherapy
  • This is a pattern of hair loss that occurs during the anagen phase of the cell cycle.

Symptoms of Hair Loss

Hair loss is a common condition, it can affect every individual differently depending on the etiology. The general symptoms of hair loss include gradually thinning of hair, scaling of the skin of the scalp, bald spots in patches, sudden loosening of hairs, and or broken hair.^1,3,5-10.
Hair loss can appear in many different ways, depending on what's causing it. It can suddenly or gradually affect just your scalp or your whole body (Figure 2).

Signs and symptoms of hair loss may include:

• Gradual thinning on top of the head. This is the most common type of hair loss, affecting people as they age. In men, hair often begins to recede at the hairline on the forehead. Women typically have a broadening of the part in their hair. An increasingly common hair loss pattern in older women is a receding hairline. (Frontal Fibrosing Alopecia)
• Circular or patchy bald spots. Some people lose hair in circular or patchy bald spots on the scalp, beard, or eyebrows. Your skin may become itchy or painful before the hair falls out.
• Sudden loosening of hair. A physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing your hair or even after gentle tugging. This type of hair loss usually causes overall hair thinning but is temporary. (Traumatic Alopecia)
• Full-body hair loss. Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over your body. The hair usually grows back. (Anagen Effluvium)
• Patches of scaling that spread over the scalp. This is a sign of ringworm. It may be accompanied by broken hair, redness, swelling, and, at times, oozing. (Tinea Capitis)
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  Hair loss is typically related to one or more of the following factors: Hair loss has many causes. Regardless of whether it develops in a man or woman, it is vital to evaluate the actual etiological factor as it can help the clinician prescribe the right treatment. Following are a few commonly known etiological factors of hair loss⁹:-

  • Heredity/ Genetic
  • Age
  • Hormonal changes
  • Excessive stress or trauma
  • Physical changes like extreme weight loss/ weight gain
  • Improper hair management- certain hairstyles that pull the roots tightly
  • Diseases/ Disorders- thyroid, PCODs etc.
  • Diet- lack of nutrients like protein & iron in the diet
  • Side-effects of certain medicines/ Chemotherapeutic agents
• Family history (heredity). The most common cause of hair loss is a hereditary condition that happens with aging. This condition is called androgenic alopecia, male-pattern baldness and female-pattern baldness. It usually occurs gradually and in predictable patterns — a receding hairline and bald spots in men and thinning hair along with the crown of the scalp in women.
• Hormonal changes and medical conditions. A variety of conditions can cause permanent or temporary hair loss, including hormonal changes due to pregnancy, childbirth, menopause, and thyroid problems. Medical conditions include alopecia areata, immune system-related and causes patchy hair loss, scalp infections such as ringworm, and a hair-pulling disorder called trichotillomania.

Medications and supplements. Hair loss can be a side effect of certain drugs, such as those used for cancer, arthritis, depression, heart problems, gout, and high blood pressure.
Radiation therapy to the head. The hair may not grow back the same as it was before.
A very stressful event. Many people experience a general thinning of hair several months after a physical or emotional shock. This type of hair loss is temporary.
Hairstyles and treatments. Excessive hairstyling or hairstyles that pull your hair tight, such as pigtails or cornrows, can cause a type of hair loss called traction alopecia. Hot-oil hair treatments and permanents also can cause hair to fall out. If scarring occurs, hair loss could be permanent.

Risk factors^8-10

Several factors can increase your risk of hair loss, including:

• A family history of balding on your mother's or father's side
• Age
• Significant weight loss
• Certain medical conditions, such as diabetes and lupus
• Stress
• Poor nutrition

Prevention¹⁰

Most baldness is caused by genetics (male-pattern baldness and female-pattern baldness). This type of hair loss is not preventable.
These tips may help you avoid preventable types of hair loss:

• Be gentle with your hair. Use a detangler and avoid tugging when brushing and combing, especially when your hair is wet. A wide-toothed comb might help prevent pulling out hair. Avoid harsh treatments such as hot rollers, curling irons, hot-oil treatments, and permanents. Limit the tension on hair from styles that use rubber bands, barrettes, and braids.
• Ask your doctor about medications and supplements you take that might cause hair loss.
• Protect your hair from sunlight and other sources of ultraviolet light.
• Stop smoking. Some studies show an association between smoking and baldness in men.
• If you're being treated with chemotherapy, ask your doctor about a cooling cap. This cap can reduce your risk of losing hair during chemotherapy.

Laboratory Testing

Owing to the non-specific nature and clinical manifestations of Hair loss/ Alopecia, prompt diagnosis is very important to prevent undesirable outcomes. Dr. Dangs Lab recommends comprehensive tests for optimal hair health including (Table-1):-

• Thyroid-stimulating hormone and iron studies (including serum ferritin, serum iron, and total iron-binding capacity) can help assess men and women with pattern hair loss.
• A complete blood cell count and comprehensive metabolic panel are also routinely done. Because many people are on restricted diets, a nutrient screen is suggested that includes iron saturation, ferritin, zinc, and vitamin D levels.

Treatment of Hair Loss

There are multiple ways to treat and manage hair loss. Hair loss management solely depends on the underlying cause and the symptoms that an individual experiences. Regardless of gender, the first line of treatment by default is through medication that is prescribed by a dermatologist/ hair -specialist/ clinician. Moreover, the second line of treatment comes into effect only the first line of treatment, i.e. medications fail. Depending on the cause and severity the clinician may opt for medical or surgical procedures like hair transplant surgery.^3-9

Summary

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The term alopecia means hair loss regardless of the cause. It is not exclusive to the scalp; it can be anywhere on the body. Everyone is born with hundreds of thousands of hair on the head. Losing hair is not usually anything to be worried about, but it can be upsetting. Patients with alopecia are at increased risk of psychosocial complications of hair loss such as anxiety and depression. At the same time, these patients need to be assessed for other autoimmune conditions such as thyroid conditions, vitiligo, etc. Prompt Diagnostic testing enables health providers to swiftly identify the etiological factor and in facilitating appropriate treatment.
Publisher’s name- Dr. Dangs Lab

References :

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• Lee YB, Jun M, Lee WS. Alopecia areata and poliosis: A retrospective analysis of 258 cases. J Am Acad Dermatol. 2019 Jun;80(6):1776-1778.
• Liu LY, King BA. Response to tofacitinib therapy of eyebrows and eyelashes in alopecia areata. J Am Acad Dermatol. 2019 Jun;80(6):1778-1779.
• Chen P, Chen F, Zhou B. The risk of dermatological toxicities of combined BRAF and MEK inhibition versus BRAF inhibition alone in melanoma patients: a systematic review and meta-analysis. Cutan Ocul Toxicol. 2019 Jun;38(2):105-111.
• Ho CH, Sood T, Zito PM. Androgenetic Alopecia. [Updated 2021 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available at
  https://www.ncbi.nlm.nih.gov/books/NBK430924/ ,accessed on 25/5/2022.
• Hair loss: Who gets and causes. Available at
  https://www.aad.org/public/diseases/hair-loss/causes/18-causes, accessed on 25/5/2022.
• Hair loss. Available at
  https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926#:~:text=Hair%20loss%20(alopecia)%20can%20affect,it's%20more%20common%20i, accessed on 25/5/2022

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Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion.

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READ MORE (RELATED ARTICLES): -

• Wang TL, Zhou C, Shen YW, et al. Prevalence of androgenetic alopecia in China: a community-based study in six cities. Br J Dermatol. 2010;162(4):843–847.
• van Zuuren EJ, Fedorowicz Z, Schooners J. Interventions for female pattern hair loss. Cochrane Database Syst Rev. 2016(5): CD007628.
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