Alopecia

Hair is the crowning glory. 4 in 10 people are complaining of hair fall these days. Not all people have the same reason for alopecia. To reduce hair fall, the exact reason should be identified and corrected. The various causes of hair fall are:

 

  • Nutritional deficiencies – Vitamin deficiency like vitamin D, B12, ferritin. Less protein intake in diets for weight loss, renal issues, etc., can also result in hair fall.
  • Hormones- An imbalance in hormones like PCOS in women, hormone therapies, and rarely contraceptive devices. In Men, androgenic alopecia is due to high DHT levels, a metabolite of the male hormone testosterone in genetically prone individuals. 
  • Mental and bodily stress also can result in hair fall. 

Types of Alopecia

Telogen Effluvium 

Sudden severe hair loss is called telogen effluvium, usually after stressful events or nutritional deficiencies.

Hair usually grows in three phases:

  • Anlagen phase – the growing phase
  • Catagen phase – the transitional phase
  • Telogen phase – the falling phase

Pathology 

In this type of hair fall, pathology is usually 5-10 % of hair in the telogen phase. In telogen effluvium, up to 30% of hair goes into the telogen phase leading to increased shedding and thinning of volume. It is called chronic telogen effluvium if the hair shedding is more than 6 months. 

Causes

Nutritional deficiencies like vitamin D, B12, calcium, iron, and protein are common causes. Physical, work and emotional stress like loss of family members or health issues like severe fever, malaria, typhoid, CoVid, and major surgeries can cause severe hair fall.

Treatment

Identifying the stressful event and correcting the deficiencies is the mainstay of Telogen Effluvium treatment. We will give you an array of lab tests to identify the deficiencies. Vitamin and other nutritional supplements, good hair care routine will be the mainstay. Peptides like procapil, capixyl, etc., will help in early recovery.

Androgenic Alopecia 

Alopecia due to androgen excess. In men, it is called male pattern alopecia, commonly known as bald head. In women, female pattern alopecia or hair loss. In men, it can start as early as their twenties and lose hair from the frontal and crown area and become bald.

Pathology

Hair grows in three phases. Anagen or growing phase will be for 3-6 yrs where the hair grows, followed by the Catagen phase or transitional phase of 3-4 weeks. It is followed by the telogen phase or shedding phase, where the shrilled hair follicle falls off, and new hair grows in the next anagen phase. In Androgenic Alopecia, the Anlagen Phase reduces to few weeks. Hence, the follicle’s growth is short and fine, leading to gradual miniaturization and permanently shedding the follicle.

Causes

The cause for this type of hair loss is multifactorial. It can be genetic for people who have a family history. Androgens, i.e., male hormones, are responsible for hair thinning and shedding. Testosterone and its metabolite Dihydrotestosterone (DHT) are responsible.

Treatment

Medical Treatments

  • Correction of Vitamin Deficiency – We can correct vitamin deficiency through nutritional supplements.
  • Androgen Receptor Blockers – Androgen, or 5 alpha-reductase inhibitors like finasteride and dutasteride, will block testosterone conversion to active DHT.
  • Topicals
    • Minoxidil – Minoxidil lotion topical application will help convert the hair follicles to anaphase or growing stage, prolong the anaphase and help the hair grow.
    • Peptides – We will give a combination of peptides to stimulate hair growth.


Procedural Treatments

  • Platelet Rich Plasma (PRP) – PRP is a regenerative treatment to stimulate the regressing hair follicle. Platelets are rich in growth factors. PRP therapy stimulates different singling pathways and peptides. They lead to stem cell differentiation of dermal papilla, stimulating new hair follicles and hair thickness. There will be a 30-40% increase in hair density and number after 4-6 PRP sessions. PRP is usually done once a month. But, you may need a maintenance treatment thrice or four times yearly.
  • Mesotherapy – This is also called intradermal drug delivery. Using various growth factors, vitamins, and other nutritional supplements and medicines, also helps regrowth and healthy hair. 
  • Low-Level Laser Therapy – These lights will increase blood flow to the hair and improve hair growth. Used two to three times a week for few months. 
  • Hair Transplant – In severe grades of alopecia, where most hair follicles regress, leaving bald areas, Hair transplant is the treatment of choice.


Camouflage

  • Hair Fiber – This is used to cover bald areas and improve aesthetic appearance.
  • You can use wigs and hairpieces.


In female pattern hair loss, identifying the reason for androgen excess is important. Tests to rule out PCOS, other adrenal and pituitary, and thyroid hormones are necessary whenever required and corrected accordingly. Besides topical minoxidil, oral nutritional supplements, anti-androgens like spironolactone, cyproterone acetate, and finasteride are given to treat the androgen excess. PRP, Mesotherapy, and Low-Level Laser are the mainstays.

Alopecia Areata

Alopecia Areata is a common autoimmune disorder that leads to sudden and patchy hair loss. Most of the time, it would be one or few hairless patches. It may spread, causing extensive hair loss all over the scalp called alopecia totals. Sometimes there can be loss of body hair and eyebrows and eyelashes called alopecia universals, which is the most severe form of alopecia areata. Alopecia Areata usually runs in families with genetic predisposition and may be associated with other autoimmune disorders like thyroiditis.

 

Treatment

Hair growth will be spontaneous in most patients who have few patches and for the first time. Topical steroid lotions and minoxidil are used in severe cases. Topical anthralin and immunomodulators are also used.

Intralesional steroid injections help in the regrowth of hair in resistant areas.

 

We may require oral steroids, cyclosporin, methotrexate, and other immunomodulators in severe and progressing cases.

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