HAIR LOSS

WHAT IS HAIR LOSS

Hair grows on human skin except palms and soles.

Hair follicles New hair cells Keratin protein Hair.

Old Hair cells Pushed out through skin Hair loss.

Average Hair loss 100-150 hair strands per day.

Alarming Hair loss >150 hair strands per day.

HAIR FOLLICLE CYCLE

ANAGEN-- active hair growth that lasts between

two to six years

CATAGEN -- transitional hair growth that lasts

two to three weeks

TELOGEN -- resting phase that lasts about

two to three months. At the end of the resting phase the hair is shed

and a new hair replaces it

TYPES OF HAIR LOSS (ALOPECIA)

Involution alopecia is a natural condition in which the hair gradually thins with age.

Alopecia areata often starts suddenly and causes patchy hair loss in children and young adults. This condition may result in complete baldness (alopecia totalis). But in about 90% of people with the condition, the hair returns within a few years.

Alopecia universalis causes all body hair to fall out, including the eyebrows, eyelashes, and pubic hair.

Trichotillomania, seen most frequently in children, is a psychological disorder in which a person pulls out one's own hair.

Telogen effluvium is temporary hair thinning over the scalp that occurs because of changes in the growth cycle of hair. A large number of hairs enter the resting phase at the same time, causing hair shedding and subsequent thinning.

ANDROGENIC ALOPECIA (GENETIC CONDITION)

MALE PATTERN BALDNESS

FEMALE PATTERN BALDNESS

suffers hair loss as early as their teens or early 20s.

It's characterized by a receding hairline and gradual disappearance of hair from the crown and frontal scalp.

noticeable thinning until their 40s or later.

It's characterized by general thinning over the entire scalp, with the most extensive hair loss at the crown.

What Causes Hair Loss?

Hormones

Genes

Stress, illness,

and childbirth

Drugs

Burns, injuries, and X-rays

Autoimmune disease

Cosmetic procedure

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•abnormal levels of androgens•hormonal changes like those in pregnancy, puberty, and menopause

Hormones

•Both male and female parents, influence a person's predisposition to male or female pattern baldness

Genes

• thyroid disease and iron deficiency anaemia,

• . Ringworm caused by a fungal infection

Stress, illness,

and childbirth

Drugs• chemotherapy drugs used in cancer treatment, blood thinners, beta-adrenergic blockers and birth control pills

• can cause temporary hair loss. In such cases, normal hair growth usually returns once the injury heals

Burns, injuries,

and X-rays

• cause alopecia areata• In most people with alopecia

areata, the hair grows back

Autoimmune disease

• shampooing too often, perms, bleaching, and dyeing hair contribute to overall hair thinning

• severe damage to the hair causes permanent bald patches.  

Cosmetic procedure

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HAIR LOSS MANAGEMENT

Management For Androgenic Alopecia

Conventional Medication 5 alpha reductase inhibitors Other topical treatments Anti-androgens Hair transplantation Stem cell therapy

Conventional Medication

5 alpha reductase inhibitors

Other topical treatments

Anti-androgens

Finasteride

Dutasteride

Alfatradiol

Minoxidil

Ketoconazole

Spironolactone

Flutamide

5 alpha reductase inhibitors

Finasteride Finasteride (brand names Proscar and Propecia by Merck, among other generic names) is a synthetic drug approved by the FDA for the treatment of benign prostatic hyperplasia (BPH) and male pattern baldness (MPB). It is a type II 5α-reductase inhibitor. 5α-reductase is an

enzyme that converts testosterone to dihydrotestosterone (DHT).

 In clinical studies, finasteride, like minoxidil, was shown to work on both the crown area and the hairline, but is most successful in the crown area.

Gynecomastia, erectile dysfunction and depression, are some possible side-effects

Dutasteride

Dutasteride (trademark name Avodart, manufactured by GlaxoSmithKline) is approved for the treatment of benign prostatic hyperplasia and used off label for androgenic alopecia.

It is a dual 5-a reductase inhibitor that inhibits conversion of testosterone to dihydrotestosterone (DHT). The drug inhibits all three isoforms of 5-alpha reductase, whereas finasteride only inhibits type II and III.

Alfatradiol

Alfatradiol is a topical 5α-reductase inhibitor that has been shown to slow progression of hair loss in women. It is marketed as Avixis, ELL Cranell Alpha and Pantostin.

Other topical treatments

Minoxidil Minoxidil is an antihypertensive vasodilator medication.

It also slows or stops hair loss and promotes hair regrowth. Now off-patent, it is available over-the-counter

for the treatment of androgenic alopecia. Minoxidil is also a vasodilator. Hypothetically, by widening

blood vessels and opening potassium channels, it allows more oxygen, blood, and nutrients to the follicle. This may cause follicles in the telogen phase to shed, which are then replaced by thicker hairs in a new anagen phase.

Minoxidil needs to be applied once or the recommended twice daily, and may be used indefinitely for continued support of existing hair follicles and hair regrowth. To achieve maximum effect, the solution should be in contact with the scalp for at least 4 hours before allowing hair to get wet.

. Minoxidil stimulates hair follicles and growth, but does not reduce DHT or the enzyme responsible for its accumulation around the hair follicle, 5-alpha reductase, which is the primary mediator of male pattern baldness. Treatments usually include a 5% concentration solution that is designed for men, and a 2% concentration solution for women. Common side effects of minoxidil include burning or irritation of the eye, itching, redness or irritation at the treated area, as well as unwanted hair growth elsewhere on the body

It is marketed under many trade names, including Avacor Physician's Formulation, Loniten (oral), Mintop, Amexidil, Rogaine, Spectral.DNC, and Vanarex

Anti-androgens

Ketoconazole Ketoconazole is a topical anti-fungal agent. As an

imidazole, Ketoconazole is effective for the treatment of dermatitis and dandruff. It is also an anti-androgen, and may improve hair growth .

Spironolactone Spironolactone is a possible selective androgen

receptor modulator, and both reduces adrenal androgen production and exerts competitive blockade on androgen receptors in target tissues. It can be administered topically or systemically. Due to its feminizing side effects and risk of infertility in men; it is used more often in female androgenic alopecia.

Flutamide

Flutamide has more anti-androgenic activity than spironolactone, and is also referred to as chemical castration. It can cause marked reduction in libido and estrogenic side effects including gynecomastia, lipid profile changes, and emotional lability, although when used in women it can be associated with increased positive affect. There is a significant incidence of hepatic dysfunction with the medication in women . Like spironolactone, it is more often used clinically in female androgenic alopecia

Hair transplantation

Hair transplantation is a surgical technique that moves individual hair follicles from a part of the body called the donor site' to bald or balding part of the body known as the 'recipient site'.

It is primarily used to treat male pattern baldness.

In this condition, grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. More recently, bioengineered hair follicles have been successfully transplanted to create histologically normal hair follicles.

Management for Alopecia Totalis

Chemotherapy induced hair loss occurs by a non- androgenic mechanism, and can manifests as alopecia totalis.

It is usually associated with systemic treatment due to the high mitotic rate of hair follicles, and more reversible than androgenic hair loss, although permanent cases can occur.

It is usually reversible, with prophylactic measures including scalp cooling, and temporary interval cosmeses such as wigs and head garments.

Management For Alopecia Areata

It can be self-contained and resolve without therapy, although there are relapsing and remitting forms of the illness.

In distinction to androgenic hair loss, pulsed corticosteroid therapy has been found effective over the long term in its treatment.

Topical calcipotriol, a vitamin D derivative, has been used successfully in treatment of areata.

Management For Telogen Effluvium

Telogen effluvium is hair thinning or shedding from early entry of the follicle into telogen.

Most cases are self-limited and resolve on their own, although zinc has shown some effectiveness in treatment.