Alopecia: Types, Causes and Treatments

What is alopecia?

The medicine defines alopecia as the unusual loss of hair and body hair. Generally, an individual loses between 20 and 100 hairs daily, which can fluctuate depending on the season and age. However, it is called alopecia when hair loss exceeds this usual range and occurs repeatedly without significant regrowth. About 50% of men are affected after age 50 and 30% after age 30. Although women are less affected, approximately 20% suffer from it after age 40. It is, therefore, a widespread and well-known phenomenon. Chronic hair loss in men is generally more socially accepted than in women, as hair is often considered a criterion of female beauty in many cultures.

Understanding the structure of hair to understand the hair cycle:

The study of the hair structure and the hair cycle provides a better understanding of the origins of alopecia. Every person has between 100,000 and 150,000 hairs. The individual’s genetic makeup influences this density.

A hair consists of two distinct parts. The first, a living, invisible root, lies beneath the epidermis and originates from the hair bulb. The second part is the hair shaft, which is the visible portion of the hair. Not all hairs grow simultaneously because each follicle functions independently of the others. However, all individuals’ hair growth process is similar, regardless of their genetic makeup. This process takes place in repeating cycles, each with three distinct phases.

The phases of the hair cycle:

Depending on the individual, hair growth begins in the anagen stage, lasting 2 to 6 years. During this period, approximately 85% of the hair is in an active growth phase, thanks to the continuous production of keratin, the protein that makes up the hair shafts. At the same time, the hair root fills the hair follicle to its base. With age, the duration of the anagen stage is reduced, resulting in thinner and less dense hair. Hair growth pauses during the catagen stage, a phase that affects about 3% of hair, during which the hair remains attached to its base. This resting period is referred to as transient apoptotic.

The telogen stage lasts about 6-7 months, affecting approximately 12% of the hair. During this phase, the hair is at rest while the hair follicles continue their activities. Each hair shaft gradually detaches from its follicle, which retracts, allowing new hair to begin growing under the skin of the scalp. At the end of this stage, the old hair naturally falls out, replaced by the new hair, entering the anagen growth stage.

Throughout an individual’s life, this hair growth cycle can recur up to 25 times, resulting in the loss of 50 to 100 hairs per day for a dense head of hair. If the hair does not renew, this may be due to abnormalities in the growth cycle or the possibility that the hair bulb has reached its maximum number of possible growth cycles.

More on the hair growth cycle 

The different types of alopecia:

There are several types of chronic hair loss, of which the following are the most observed.

Androgenetic alopecia

Androgenetic alopecia or pattern hair loss affects both men and women. For men, the hair on the forehead and vertex gradually thins and eventually disappears. On the female side, the hair on the top and crown of the head becomes thinner. At the most advanced stage, this is called baldness.

Scarring alopecia

Scarring alopecia can occur following a significant injury to the scalp. In such cases, The healing process cannot generate new hair bulbs. As a result, the hair follicles are irreparably destroyed, and no new hair growth is possible.

Alopecia areata

Alopecia areata is characterised by a sudden loss of oval or round hairy patches.

Diffuse alopecia

Diffuse alopecia is a temporary disruption of the hair cycle following a physical or emotional shock such as illness, abortion or trauma.

Patchy Hair Loss

In the case of patchy hair loss, hair loss affects a well-defined and distinct part of the skull or scalp. Certain areas of the head are bald.

Causes of alopecia

Various factors can cause chronic hair loss. Hormones, genetics and even stress, are among the most common causes, but some are also the result of a disease.

Hormonal causes

Alopecia caused by hormonal dysfunction is called androgenetic or androgenic. Men are statistically more affected than women.

There are three forms of androgenetic hair loss.

Androgenetic alopecia in men

Androgenetic alopecia in men is often linked to heredity. So, if your relatives from your mother’s side (such as your grandfather) have suffered from baldness, there is a high probability that you will also suffer from it. Androgenetic alopecia is triggered by dihydrotestosterone (DHT), a transformation of testosterone due to the action of the enzyme 5 alpha-reductase. This hormone usually begins to act between 25 and 30 and can reach the hair follicles.

DHT accelerates hair cycles, resulting in faster hair growth, which leads to premature depletion of the hair’s ability to renew itself. In addition, DHT stimulates excessive sebum production, which accumulates near the hair follicle. This leads to a thickening of the scalp, which can impede the adequate blood supply to the hair roots, which is essential for hair follicle renewal and, thus hair growth.

Androgenetic alopecia in women

Several reasons exist for female pattern hair loss, such as childbirth, contraceptive treatment, or thyroid dysfunction. As a result of these events, there is a sudden drop in the production of female hormones and an increase in the so-called androgenic or male hormones (DHT). The result is chronic androgenic hair loss, which affects hair growth and causes progressive hair loss similar to that in men.

Postmenopausal alopecia

Menopause is the period when a woman’s reproductive time comes to an end. It is accompanied by notable disorders, including hair loss on the head (called postmenopausal alopecia or menopause hair loss). 30-50% of menopausal women are reported to notice thinning, weakening and breakage of their hair after this period. This is because the hormonal profile of women begins to develop male characteristics. The level of oestrogens (female hormones) decreases while the level of androgens (male hormones) remains stable. This affects the life span of the hair to the point where it gradually loses its strength. As a result, significant or moderate hair loss occurs, starting in the pre-menopause and ending in the post-menopause phase. It can lead to substantial hair loss.

Psychological causes

It is scientifically proven that psychology can influence certain hormones. For example, women have their periods at unexpected times following an emotional shock or intense stress. This is also the case for hair loss in women and men.

Telogen effluvium

Various factors can influence the occurrence of telogen effluvium. This is the case with a severe pathology or an intense fever. A Covid-19 infection with severe symptoms has already caused telogen effluvium. This hair disorder has also been diagnosed after childbirth, psychological shock or an operation under general anaesthesia. Similarly, people on antidepressants, antiepileptics, estroprogestative, anticoagulants and others undergoing allopathic treatment have already experienced chronic hair loss, which has subsided after treatment. A distinction is made between chronic telogen effluvium, which lasts long and shortens the hair cycle, and acute effluvium, which leads to 80% of sudden hair loss within three months. The hair loss caused by the chronic disorder occurs gradually over the years.

Peladic skin disease

The alopecia areata is an autoimmune disease recognised by sudden hair loss on specific parts of the scalp. It occurs in people who have not suffered from any systemic disease or skin disorder. It is difficult to classify it as one of the families of causes of chronic hair loss, but it has more psychological characteristics.

Trichotillomania or hair-pulling disorder

Otherwise known as hair-pulling disorder trichomania, trichotillomania is a behavioural disorder that has been recognised as an obsessive-compulsive disorder (OCD) since the year 2000. It causes the person to pull out hair and body hair compulsively. It can go to the extreme of pulling out pubic hair, armpit hair, beard and moustache regularly. While the less severe patients fiddle with this hair to alleviate their anxieties, the more worrying ones eat it. This non-gentle plucking traumatises the hair bulb and leads to the regrowth of white or frizzy hair instead of normal hair.

Toxic causes

Due to drug treatments, toxins in the body can affect hair health. This is particularly the case with chemotherapy, which can cause considerable hair loss in both sexes. However, alopecia here is not systematic and occurs depending on the type of treatment received and the duration. It also depends on the patient’s hair and hormonal profile. Once the treatment is completed, the hair grows back. However, they are thinner and may eventually fall out permanently.

Nutritional causes

Nutritional deficiencies not only affect the body, but they also cause damage to the hair. The lack of nutrients such as carbohydrates, fats, proteins, trace elements, vitamins and minerals weakens the hair. This can slow down the growth process. To boost hair health, eat iron-rich foods to stimulate the production of red blood cells. Through their consistent supply of oxygen, these strengthen the tissues that build hair. Also, ensure you take advantage of calcium, magnesium, zinc and vitamins B and D, which also act on the scalp. Foods such as pulses, beetroot, and red meat… included in a balanced diet, are among the first factors that will increase the life of your hair follicles. But before you go on, can you identify chronic hair loss?

Symptoms and stages of alopecia

Knowing the warning signs makes it easy to distinguish chronic hair loss from ordinary hair loss. However, in addition to these manifestations, this condition follows a particular course.

How to recognise the onset of alopecia?

This phenomenon starts with hair loss on the part of the head or the whole head. In some patients, it attacks intensely from the beginning, while in others, it is progressive. Here are some signs that may alarm you:

• Hair thinning
• Dulling of the hair
• Itchy scalp
• A large amount of hair is on the pillow when you wake up.
• A large amount of hair is left on the hairbrush.
• Pain in the roots
• A change in the appearance of the hair is seen in photographs.

Similarly, when the hair density decreases and the skull shows bald patches, this may be a sign of alopecia.

The evolution of androgenetic alopecia

This type of chronic hair loss progresses differently depending on the gender of the patient.

The Norwood-Hamilton scale: the 7 stages of alopecia in men

Also known as the Norwood-Hamilton classification, the Norwood-Hamilton Scale defines the progression of hair loss in men. It describes the different stages of male pattern baldness in 7 stages.

• Step 1: No hair loss to report or a slightly receding hairline.

• Step 2: A slight hairline recession, forming an apparent slight M.

• Stage 3: More visible hair loss at the temples, forming a more distinct M shape.

• Stage 4 vertex: Pronounced hair loss at the temples and the top of the head (vertex).

• Stage 5: Increased hair loss at the vertex, with a band separating the retracted frontal area from the hair on the crown.

• Stage 6: A larger area of thinning hair at the vertex, with the band of hair between the forehead and the top of the head becoming thinner.

• Stage 7: A narrow band of hair separates the receding frontal area from the bald spot at the top of the head. In this stage, the hair loss is more extensive, and only a thin area of hair remains between the neck and the ears.

The Ludwig scale: the four stages of alopecia in women

The progression of pattern hair loss in women is measured with Ludwig’s scale, which is divided into four stages.

• Stage 1: Mild hair loss at the crown of the head, usually characterised by a widening of the central parting.

• Stage 2: Increased hair loss on the crown of the head, forming a more visible thinning area.

• Stage 3: Extensive hair loss on the crown of the head, with a larger thinning area and less hair present.

• Stage 4: Severe hair loss on the crown of the head, with extensive thinning and a significant decrease in hair density.

In 90% of cases, chronic hair loss is not a pleasant experience for those affected. The study of its various causes has enabled researchers to provide effective solutions.

Possible treatments for alopecia:

There are various solutions for hair renewal after chronic hair loss. Improving dietary hygiene and eliminating psychological causes can slow down the process but not stop it. Treatment with medication and aesthetic medicine offers conclusive and definitive results.

Drug treatments:

Two drugs are used in the medical treatment of alopecia, but are they effective?

Minoxidil

Minoxidil is a baldness treatment that promotes hair growth and slows hair loss. It is available in pharmacies without a prescription under different trade names such as Alopexy, Alostil and Unipexil. Minoxidil should only be applied to the scalp and should not be used if there is a skin infection. It can cause unwanted side effects such as skin irritation, redness, itching and dryness. If you experience severe side effects, stopping treatment and consulting a healthcare professional is crucial.

Finasteride

Still called Propecia, Finasteride is prescribed as a cream with a concentration of 1 mg to treat alopecia. Thousands use it, but its side effects are disastrous and intense. The most common are severe insomnia, inability to work, sexual dysfunction, depression, and suicidal thoughts. An article in the newspaper Le Monde published in 2019 reported that a patient took his own life to end what he believed was pain caused by Finasteride. Despite this lousy campaign, this drug continues to be consumed. However, it can only increase the amount of hair by 10% on one part of the head: the top.

Aesthetic medicine

Aesthetic medicine offers four ways to get rid of alopecia.

Hair transplantation

Progress in hair transplantation has been impressive for more than twenty years. The FUE technique and its derivatives (DHI, or FUE by incision with sapphire blade) give natural and long-lasting results, unlike the old one called FUT. Having a hair transplant in Turkey with Dr Cinik allows you to save on your treatment while benefiting from unparalleled expertise and experience.

Hair treatment with low-level laser

The LLLT low-intensity laser hair treatment gives convincing results in slowing down androgenetic alopecia and is indicated for patients who have reached a weak stage. Its action is directed towards the areas most sensitive to the condition, such as the crown, the top of the forehead and the temples. It reactivates the hair follicles. It is also indicated after a hair transplant to stimulate the regrowth of the grafts.

PRP treatment

Platelet Rich Plasma (PRP) hair mesotherapy consists of infiltrating blood platelets into the scalp using a quantity of blood taken from the patient. The blood collected is first centrifuged and stripped of the desired blood platelets. In addition to a transplant, it stimulates the renewal of hair cells to build up a thick head of hair. It is particularly indicated following a hair transplant to avoid infections and to promote regrowth.

Regenera Activa hair transplantation

This technologically advanced aesthetic operation allows the regeneration of diseased hair cells. It encourages regrowth and stops hair loss. The Regenera Activa hair mesograft is recommended for men and women affected by androgenetic alopecia. It consists of cultivating stem cells previously removed from the scalp and reintroducing them after activating the altered follicular units.