What is hair loss?

The American Academy of Dermatology (AAD) estimates that 80 million men and women in the United States have hereditary hair loss (alopecia). It can affect hair on the scalp or the entire body. Although alopecia is more common in the elderly, it is also more common in children.

The loss of 50 to 100 hairs per day is common. With around 100,000 hairs on the head, that little damage is not noticeable. New hair usually replaces lost hair, but this does not always happen. Hair loss develops gradually over the years or occurs suddenly. Hair loss can be permanent or temporary.

It is impossible to calculate the amount of hair loss on a given day. If you notice a large amount of hair in the drain after washing your hair or hair follicles with your brush, you may lose more hair than usual. You may also notice sparse patches of hair or baldness.

If you notice that you are losing more hair than usual, you should discuss the problem with your doctor. They can identify the cause of hair loss and suggest appropriate treatment plans.

Symptoms

Hair loss can be seen in many ways. It appears suddenly or gradually and affects your scalp or your entire body.

Signs and symptoms of hair loss can include:

• Gradual overhead thinning: Hair loss is one of the most common types of hair loss and affects people of all ages. In men, hair often falls on the forehead. Women often spread part of their hair. Increase in normal hair loss in older women Hair loss (fibrosing frontal alopecia).

• Circular or mossy bald spots: Some people lose their hair in circular or mossy bald spots on the skin, chin, or eyebrows. Your skin may feel itchy or sore before hair loss.

• Sudden sagging of hair: Physical or emotional shock can cause hair to fall out. Some hair may come out when you comb your hair or even after washing or pulling it lightly. This type of hair loss usually causes thinning of the entire hair, but is temporary.

• Peeling spots that spread over the scalp: This is a sign of a ringworm. It can cause broken hair, redness, swelling, and sometimes dripping.

• Hair all over the body falls out: Certain medical conditions and treatments such as chemotherapy for cancer can cause hair to fall out all over the body. Hair usually grows back.

Causes

Both men and women develop this type of hair loss, which is the most common cause of hair loss worldwide. In men, this is called male hair loss. Women get female pattern hair loss. Regardless of whether it develops in men or women, the medical term is androgenic alopecia.

Whichever term you use it means that you have inherited genes that shrink your hair follicles (every hair grows) and eventually stop hair growth. The shrinkage begins in adolescence, but it usually begins later in life. In women, the first noticeable sign of hereditary hair loss is usually all of the thinning or enlarged part.When a man has hereditary hair loss, the first sign is often a loss of hair or baldness on the top of the head.

Risk factors

Since there are many types of hair loss, finding the cause can be difficult. This review covers the most common causes of hair loss on normal pale skin. The medical term for hair loss is alopecia.

Most of the hair loss is not associated with systemic or internal diseases, nor is a low diet a frequent factor. Hair becomes thinner as a result of predetermined genetic factors and the entire aging process. Most men and women in their 30s and 40s notice a slight physiological thinning of their hair.

Lifestyle changes, including illness, emotional trauma, protein deficiencies (during a strict diet), and hormonal changes such as pregnancy, puberty, and menopause can cause hair loss.

Many health conditions can cause hair loss, including thyroid disease, iron deficiency anemia, and secondary syphilis. Although thyroid blood tests and other laboratory tests, including a complete blood count (CBC), are common in people with normal hair loss, it is important to rule out treatable causes for hair loss.

Treatment

Hair loss due to telogen effluvium or side effects usually requires no treatment other than stopping the medication that is causing the problem. Limiting injuries or exposure to chemicals (such as blow dryers, hair straighteners, colorants, or perms) can limit or stop hair loss.

Hair loss due to a proper diet or a medical condition is usually stopped by a healthy diet and treatment of the underlying medical condition. Scalp fungal infection requires 6 to 12 weeks of oral treatment, with or without shampoos containing terbinafine (Lamisil) or itraconazole (Sporanox), selenium sulfide (Selsun Blue, Head & Shoulders, others) or ketoconazole (Nijoral).

Alopecia areata can be treated with corticosteroids, which can be injected or applied to the skin. Other treatments for this condition include anthralin cream (Drithocreme, Drithoscalp, Psoriatec), Minoxidil (Loniten, Rogaine), or a combination of these treatments.

Most men and women with hereditary baldness go untreated for hair loss. For those seeking medical treatment, the initial treatment is usually topical minoxidil (rogaine).Men can also be treated with oral finasteride (Propecia, Proscar) or dutasteride (Avodart), or they can opt for a hair transplant or skin reduction surgery. Menopausal women can be treated with estrogen or spironolactone, while menopausal women can be prescribed finasteride.

Diagnosis

Since they are not generally associated with an increased rate of damage, male and female pattern hair loss generally does not require testing. If hair loss occurs in a young person who has no family history, it may be due to drug use.

• The traction test is used to assess hair loss from the scalp. There is a slight pull on the hair group (around 40-60) on three different areas of the scalp. The number of hairs collected is calculated under a microscope. In general, less than three hairs should come out per area with each pull. If ten more than ten hairs are obtained, the traction test is considered positive.

• The plumage test is performed by pulling the hair “through the roots”. The root of the harvested hair is examined under a microscope to determine the stage of growth and is used to diagnose the defect of telogen, anagen or systemic disease. Telogen hairs have small bulbs without a sheath at their roots. The telogen effluvium test shows an increase in the percentage of hair.Anagen hairs have sheaths at their roots. Anagen effluvium shows a decrease in hair in the telogen phase and in the number of broken hairs.

• The daily hair count is usually done when the pull test is negative. This is done by counting the number of hairs lost. Hair should be counted from the first comb in the morning or during washing. Hair is collected in a clear plastic bag for 14 days. The strands are taped. If the hairs count is> 100 per day, it is considered abnormal except after shampooing, where the hairs count is up to 250 and is normal.

• Trichoscopy is an unintended method of examining the hair and scalp. The test can be done with a handheld dermatoscope or a video dermoscope. This allows the differential diagnosis of hair loss in most cases.

• Scalp biopsy is used if the diagnosis is unknown; The biopsy can distinguish scars from non-frightening forms. Hair samples are taken from the inflamed areas, usually around the edge of the bald area.

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