Hair loss

Hair loss is divided into two categories. Cicatricial alopecia, which is characterized by permanent damage to the hair follicles, is uncommon. In clinical practice, non-invasive forms are the most common cause of alopecia. Although men’s hair loss is usually hereditary and caused by androgenic mechanisms, less than half of all women who suffer from hair loss have a genetic predisposition. Other cases are caused by a variety of factors, some of which may indicate the disease.

Hair loss in women

FPHL, or scarless alopecia, is one of the most common reasons why women should consult a dermatologist.1,2 Hair loss can be irritating at any age and often leads to high levels of psychological distress and loss of self-confidence which can affect daily life. In a study of women in Australia, 40% said they had problems with hair loss in their marriage, and 64% said that hair loss was a contributing factor.3


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FPHL is a progressive, scarring disease. Inferiority complex Hair loss occurs. The hair follicles gradually change from a dense terminal to a short, thin, and colorless wheel..3

49% to 55% of women over the age of 70 experience this hair loss and growth retardation.1,3 It is more common for white women compared to Korean, Asian, or African-American tribes.1,3 The genetic component has been observed in 40% to 54% of patients, especially in the early stages.2

The pathophysiology of FPHL is not fully understood, although the hormonal component indicates early onset, usually in the second trimester after menopause. Some data suggest that follicles in FPHL have a short growth cycle and may disappear earlier than normal.1

A number of risk factors for FPHL have been identified, including aging, family history, smoking, high fasting glucose levels, and exposure to ultraviolet light for more than 16 hours / week.3

But physical consequences are also possible. Associations with insulin resistance and atherosclerosis have not been fully established, but FPHL is considered an indicator of increased risk for cardiovascular (metabolic) diseases.1,3 FPHL testing in women of childbearing age is associated with high blood pressure, and in women over the age of 50, this is a sign of coronary heart disease..3

Examination

The hair-growth cycle has 3 main stages: growth (anesthesia), transition (catagen) and rest (telogen).1 The growth rate in a healthy young person lasts an average of 2 to 8 years, most of the hair at any time in this part of the cycle.

Clinical symptoms of FPHL include increased hair loss on the top of the head, which is often combined with periods of severe bleeding associated with life-threatening stress. According to the American Academy of Dermatology, people lose 50 to 100 hairs a day from the scalp and other parts of the body.4 Shedding more than 100 hairs a day can be considered temporary. Telogen influenza, The causes are generally associated with stress-related physiological disorders, e.g.

  • Soon to be born
  • Discontinuation of hormonal contraceptives
  • Significant anxiety (caring for a sick person, divorce, unemployment)
  • Recent high fever
  • Surgery

Hair loss usually occurs 2 months after the onset of a traumatic event, usually 4 to 5 months. It is considered a normal reaction and usually resolves itself into normal hair growth in 6 to 9 months.

Rating FPHL

Sinkler scales are preferred for FPHL ratings, as a simple visual guide to assess the distribution of hair in the frontal lobe.1:

  • Grade 1: Small Thin
  • Grades 2 and 3 The middle class is paddling and expanding.
  • 4th and 5th grade hair diffuse and advanced hair loss to centro-parietal scalp

Shaving completely is rare in women, because the frontal lobe is often accompanied by hair loss to the central scalp.

Differential diagnosis

Diffuse alopecia areata (AA) is a benign hair loss that begins with thinning hair, which is the loss of facial and temporary scalp hair.

Many other types of hair loss that should be differentiated from FPHL occur in women.

Alopecia areata (AA) forward-temporal and parietal scalp becomes more common and indicates thyroid disease.

Telogen influenza (TE) It is a type of temporary, stress-related hair loss that often occurs during pregnancy, medication, surgery, and other health conditions. Hair in the shower may fall into the collection in the bathroom, although in severe cases it is seen in the same way as FPHL, the middle part is widening.

Facial fibrosis alopecia (FFA) It is a rare type of hair follicle that resembles FPHA or serves as a large hair follicle. Hair loss is permanent and can be a sign of a systemic reaction in other parts of the face and body. lichen planopilaris Infection.

Medications Antihypertensives, stimulants, antipsychotics, and antiviral drugs can cause hair loss.

Medical problems Symptoms of hair loss include cancer, iron deficiency, thyroid disorders, rheumatic diseases and Treponema palladium Infection. Hormonal disorders, especially polycystic ovary syndrome (PCOS), have been linked to FPHL as well as hirsuitism and other dermatological problems, possibly due to impaired androgen levels.

Related dermatological conditions They include vitiligo, atopic dermatitis and psoriasis.

Treatments

Hair loss treatment in women varies according to the underlying cause, but is very limited. The most common type of FPHL, minoxidil 2% solution is first line treatment. Locally applied, minoxidil is a potassium channel blocker that stimulates local blood flow to the hair follicles and prolongs hair growth cycles.1-3 Recently, oral minoxide in combination with oral spironolactone has shown promising results.3 Oral finasteride is commonly prescribed for men with baldness. no I do not It is recommended to treat alopecia in women.5

Corticosteroid injections, May be effective in cases of alopecia areata for the affected area. Needles need to be repeated every month or every two months, and growth is expected at 12 weeks.4

Microning tools, It has been shown in several studies to have new hair growth, especially when used in combination with minoxidil, which has hundreds of tiny needles that penetrate the skin.4

Low-grade laser treatment Inherited hair loss, localized alopecia, and hair loss are treated with chemotherapy. It is also used following hair transplants to stimulate new growth.4 Treatments are safe and painless, but they must be repeated every week for months to be effective.

References

1. Bertoli MJ, Sadoughifar R, Schwartz RA, LottiTM, Janniger CK. A comprehensive review of female hair loss. Dermatol Ther. 2020 November; 33 (6): e14055. doi: 10.1111 / dth.14055.

2. Ramos PM, Miot HA. Women’s Design Hair Loss: Clinical and Pathological Review. A Bras Dermatol. 2015 July-August; 90 (4): 529-43. doi: 10.1590 / abd1806-4841.20153370.

3. Chan L, Cook DK. Female hair loss. Aust J Gen Pract. 2018 Jul; 47 (7): 459-464. doi: 10.31128 / AJGP-02-18-4498.

4. American Academy of Dermatology – Hair Resource Center. https://www.aad.org/public/diseases/hair-loss

5. Manabe M, Tsuboi R, Itami S, et al. Men’s and Women’s Hair Loss Treatment Guidelines, 2017. Japanese Dermatology Journal 127 ፡ 2763–2777, 2017.