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Baldness

Baldness

Baldness implies no or thinning head hair. In humans, baldness generally means androgenic alopecia or "male pattern baldness" or its variant "female pattern baldness". This syndrome occurs in adult male and some female humans and other species.

 

The degree and pattern of baldness can vary greatly; it includes male and female pattern alopecia (androgenic alopecia). This syndrome is also called androgenetic alopecia or alopecia androgenetica. An alternative term is alopecia seborrheica, used primarily in Europe.

 

Pattern balding should not be confused with alopecia areata, which commonly involves patchy hair loss. Extreme forms of alopecia areata are Alopecia totalis, which involves the loss of all head hair, and the most extreme form, alopecia universalis, which involves the loss of all hair from the head and the body.

 

Pattern baldness (androgenetic alopecia), the most common type of alopecia, affects roughly one-third of men and women. It's typically permanent. Other types of alopecia are temporary, including alopecia areata. It can involve hair loss on your scalp or other parts of your body.

 

Permanent hair loss

Male-pattern baldness (androgenetic alopecia). For men, pattern baldness can begin early, even in the teens or early 20s. It's typically characterized by a receding hairline at the temples and balding at the top of the head. The end result may be partial or complete baldness.

 

Female-pattern baldness (androgenetic alopecia). Women with permanent hair loss usually have hair loss limited to thinning at the front, sides or crown. Women usually maintain their front hairline and rarely experience complete baldness.

 

Cicatricial (scarring) alopecia. This rare condition occurs when inflammation damages and scars hair follicles, causing permanent hair loss. Sometimes the patchy hair loss is associated with itching or pain.

 

Temporary hair loss

Alopecia areata. Hair loss usually occurs in small, round, smooth patches about the size of a quarter. Usually the disease doesn't extend beyond a few bare patches on the scalp, but it can cause patchy hair loss on any area that has hair, including eyebrows, eyelashes and beard. In rare cases, it can progress to cause hair loss over the entire body.

 

If the hair loss includes your entire scalp, the condition is called alopecia totalis. If it involves your whole body, it's called alopecia universalis. Soreness and itching may precede the hair loss, but symptoms are often minimal.

 

Telogen effluvium

This type of temporary hair loss occurs suddenly, most often after a significant illness or major life stress. Handfuls of hair may come out when combing or washing your hair or may fall out after gentle tugging. This type of hair loss usually causes overall hair thinning and not bald patches.

 

Traction alopecia

Bald patches can occur if you regularly wear certain hairstyles, such as pigtails, braids or cornrows, or if you use tight rollers. Hair loss typically occurs between the rows or at the part where hair is pulled tightly.

 

Anagen effluvium

In this type of hair loss, actively growing hairs in the anagen state are affected most often by chemotherapeutic drugs given to fight cancer or lymphoma. Hair loss starts soon after beginning therapy and is more extensive than in the telogen effluvium state. In the weeks after the therapy has been completed, the hair cycles re-establish themselves, although the hair may not return as thickly as before chemotherapy.

Symptoms

The typical pattern of male baldness begins at the hairline. The hairline gradually recedes to form an "M" shape. The existing hair may become finer and shorter.

 

The hair at the crown also begins to thin. Eventually the top of the hairline meets the thinned crown, leaving a horseshoe pattern of hair around the sides of the head.

 

Hair loss in patches, diffuse shedding of hair, breaking of hair shafts, or hair loss associated with redness, scaling, pain, or rapid progression could be caused by other conditions.

Causes

There are many causes of scalp hair loss, and they do differ in men and women. This article will cover the common ones. Studies show that losing up to 100-150 hairs per day is normal. Human hair naturally grows in three phases: anagen, catagen, and telogen. Anagen is the active or growing phase. Catagen is a fairly short phase of the natural hair cycle during which hairs begin to break down.

 

Telogen is the resting phase. The hairs that are shed daily are often in the resting or late phase in the hair cycle. Normally, about 10% of the scalp hairs are in the resting or telogen phase at any time. These hairs are not growing and are getting prepared for cyclic shedding.

 

In general, most hair loss is not associated with systemic or internal disease, nor is poor diet a frequent factor. Frequently, hair may simply thin as a result of predetermined genetic factors, family history, and the overall aging process. Many men and women may notice a mild and often normal physiologic thinning of hair starting in their thirties and forties.

 

Other times, normal life variations including temporary severe stress, nutritional changes, and hormonal changes like those in pregnancy, puberty, and menopause may cause a reversible hair loss.

 

Notably, several health conditions, including thyroid disease and iron deficiency anemia, can cause hair loss. While thyroid blood tests and other lab tests, including a complete blood count (CBC), on people who have ordinary hair loss are usually normal, it is important to exclude underlying causes in sudden or severe hair loss.

 

If you are concerned about some other underlying health issues, you may start by seeing your family physician, internist, or gynecologist for basic health screening. Dermatologists are doctors who specialize in problems of skin, hair, and nails and may provide more advanced diagnosis and treatment of hair thinning and loss. Sometimes a scalp biopsy may be taken to help in diagnosis of severe or unexplained hair loss.

 

Although many medications list "hair loss" among their potential side effects, drugs are also not overall common causes of thinning or lost hair. On the other hand, with cancer treatments and immune suppression medications including chemotherapy, hair loss is a very common side effect. Complete hair loss often occurs after a course of major chemotherapy for cancer. Usually, hair regrows after six to 12 months.

Treatment

There are very few scientifically proven and FDA-approved treatments for hair loss. There are thousands of unproven claims and products to help with hair regrowth. Many conditioners, shampoos, vitamins, and other products claim to help hair grow in some unspecified way. Nioxin has been a popular brand of shampoo for hair loss, but there is no definite evidence showing it is any more effective than regular shampoos.

 

These products are usually harmless but generally not scientifically proven and therefore potentially useless. To slow down hair loss, there are at least four potentially effective, basic options. These include medications like Minoxidil, Propecia, and Avodart which are maintenance-type medications and are for long-term use. Stopping these drugs does not seem to worsen or exacerbate the prior hair loss. In other words, stopping the medication will not leave you worse than you started out prior to the medication.

 

Minoxidil (Rogaine):

This topical medication is available over the counter and no prescription is required. It can be used in men and women. It works best on the crown, less on the frontal region. Minoxidil is available as a 2% solution, 4% solution, an extra-strength 5% solution, and a new foam or mousse preparation. Rogaine may grow a little hair, but it's better at holding onto what's still there.

 

There are few side effects with Rogaine. The main problem with this treatment is the need to keep applying it once or twice a day, and most men get tired of it after a while. In addition, minoxidil tends to work less well on the front of the head, which is where baldness bothers most men. Inadvertent application to the face or neck skin can cause unwanted hair growth in those areas.

 

Finasteride (Propecia):

This medication is FDA approved for use in only men with androgenic hair loss. Although not FDA approved in women, it has been used "off label" in women with androgenic hair loss who are not pregnant or planning to become pregnant while on the medication. Finasteride is in a class of medications called 5-alpha reductase inhibitors. It is thought to help reduce hair loss by blocking the action of natural hormones in scalp hair follicles.

 

Propecia is a lower-dose version of a commercially available drug called Proscar that helps shrink enlarged prostates in middle-aged and older men. Women, especially those who are or may become pregnant, should not handle finasteride capsules. Touching the contents of the capsules may potentially harm a male fetus and females who accidentally touch leaking capsules should wash the area to avoid side effects. Propecia 1 mg tablets are available by prescription and taken once daily.

 

Propecia may grow and thicken hair to some extent for some people, but its main use is to keep (maintain) hair that's still there. Studies have shown that this medication works well in some types of hair loss and must be used for about six to 12 months before full effects are determined. This medication does not "work" in days to weeks, and its onset of visible improvement tends to be gradual. It may be best for men who still have enough hair to retain but also can help some regrow hair.

 

Possible but very unlikely side effects include impotence or a decreased sex drive (libido). Studies have shown that these side effects were possibly slightly more common than seen in the general population and are reversible when the drug is stopped.

 

Taking Propecia once a day seems to be easier than applying minoxidil, but the prospect of taking a pill daily for years doesn't sit well with some. There's also the cost, about $70-$100/month, which is generally not reimbursed by most health insurers.

 

Dutasteride (Avodart)

Has recently been used as "off label" to treat hair loss in men. It is FDA approved and primarily used to treat an enlarged prostate (benign prostatic hyperplasia, or BPH) only in men. Dutasteride is similar to finasteride (Propecia, Proscar) and is in a class of medications called 5-alpha reductase inhibitors.

 

Dutasteride may help in hair loss by blocking the production or binding of a natural substance in the scalp hair follicles. Although not FDA approved in women, it has been used "off-label" in women with androgenic hair loss who are not pregnant or planning to become pregnant while taking the medication. Women, especially those who are or may become pregnant, should not handle dutasteride capsules.

 

Touching the contents of the capsules may potentially harm a male fetus and females who accidentally touch leaking capsules should wash the area with soap and water immediately. There is a six-month clearance time required after taking this medication before being permitted to donate blood.

 

A group of topical medications called prostaglandin analogs have recently began undergoing testing for potential hair regrowth. They may be used in men and women. These drugs are not currently FDA approved for scalp hair loss. Currently these are primarily used for eyelash enhancement. One of the new medications is called bimatoprost. Further testing and studies are required to assess the efficacy of these products in scalp hair loss.

 

Bimatoprost solution (Latisse)

Has just been started to be used off-label for help in selected cases of hair loss. It is currently FDA approved for cosmetic eyelash enhancement. Studies have shown it can treat hypotrichosis (short or sparse) of the eyelashes by increasing their growth, including length, thickness, and darkness.

 

This medication is also commercially available as Lumigan, which is used to treatglaucoma. It is not known exactly how this medication works in hair regrowth, but it is thought to lengthen the anagen phase (active phase) of hair growth. 

Interestingly, during routine medical use of Lumigan eye drops for glaucoma patients, it was serendipitously found that eyelashes got longer and thicker in many users. This led to clinical trials and the approval of cosmetic use of Latisse for eyelashes.

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