Hair loss is one of the most frequent reasons for which patients visit their dermatologist.
The truth is that it I completely normal to lose some amount of hair every day. It is considered normal for the scalp to part ways with between 50 and 200 hairs per day. Patients often ask us how much hair that is, and we often answer them with the following image:
As a rule, if you are losing more than 400 hairs per day, it is good to consult your dermatologist. They also ask us why this is normal. To understand that we must understand the cycle of growth of the hair follicles. Each one of them goes through three phases:
A fourth, less popular phase, also exists, called exogen. It is often defined as a phase of losing the hair, in which the old hairs are released from the follicle, making space for the new ones. The reason for us having long and beautiful hair is that unlike the growth of the hair elsewhere on the body, the hair on the scalp has a long anagen phase.
The main task of your dermatologist is to get to the correct diagnosis, to work with you, so that you can find the causes of the hair loss or any connected diseases and conditions which you may suffer from.
The first step is to see whether the process affects the entire scalp, i.e. diffuse hair loss, or if there is any other model of hair loss such as widening hair path, hair loss on the crown of the head, frontal hair thinning, defined zones of hair loss.
Afterwards, it must be determined whether you suffer from cicatricial alopecia or non-cicatricial alopecia. Non-cicatricial alopecia is defined by the secondary potential for full recovery of the hair, while cicatricial alopecia is defined by a loss of follicular openings and a permanent or long-lasting hair loss in the affected zones. It is important to know that the different types of hair loss have a different and specific for each of them treatment and the result from the therapies depends on whether the right diagnosis was made.
Androgenic alopecia is the most common form of non-cicatricial alopecia, and its characteristics include thinning of the hair in specific zones of the scalp. They are different for men and women, and dermatology defines a male and female model of androgenic alopecia.
We are often asked “What is the reason behind my hair loss?”. When we have made the diagnosis of androgenic alopecia, one hormone – dihydrotestosterone, is the main cause of the condition. This is a hormone which shortens the growth phase of the hair. As we mentioned, in normal conditions it lasts between 2 and 6 years, but when DHT is too high, it is shortened to a few months or weeks. Consequently, hairs become thinner and shorter, sometimes not even managing to break the epidermis.
The condition is very common, but its successful treatment remains challenging.
Telogen is the phase of rest of the hair follicles, while effluvium means an increase in hair loss. In normal conditions, around 10-15% of our hairs are in the rest phase, which lasts for about 3 months. Different conditions such as a pregnancy, malnutrition, usage of certain medications, disease, surgery and other stress factors can affect the biological clock of the hair follicles, leading to an abnormal amount of them being in the telogen phase at the same time. When this happens, the type of hair loss is called telogen effluvium. The hair loss usually begins about 3 months after the stressor occurs. The good news is that we expect a full recovery of hair growth in about 6-12 months after we remove the cause of the condition.
Alopecia areata is an autoimmune disease, in which the so-called immune privilege of the hair follicle is lost, i.e. the immune system stops recognizing the hair follicles as its own and instead sees them as foreign invaders in the body, therefore attacking them. This attack causes sudden hair loss in circular zones, usually on the scalp, but sometimes on other parts of the body such as the beard, eyebrows or eyelashes.
The main characteristics of this disease are:
There are four main spheres of treatment which we can use for androgenic alopecia – approved medications, laser treatment, injectables or hair transplants.
The medications approved for the treatment of androgenic alopecia are two – local application of minoxidil or finasteride. The first is the gold standard for treating the disease. The history of minoxifil starts in the 1960s, where patients, who use the medication for treatment of hypertension, notice unusual or abnormal increase of hair growth on their body, i.e. the medication causes hypertrichosis as a side effect. In some cases, however, this side effect becomes wanted.
Minoxidil, used topically, is used for more than 30 years as a treatment for different types of hair loss. It affects the growth phases of the hair, shortening the rest phase – telogen, and stimulating and lengthening the active growth phase. In addition, the medication widens the blood vessels, improving oxygen saturation and growth factor delivery to the hair follicles. In the beginning of the treatment, hair loss may increase, but this is completely normal and expected and shouldn’t worry you. Due to the shortening of the rest phase, some of the hairs, which were going to fall anyway, fall a bit earlier, making space for new hairs to grow. Stopping treatment with minoxidil or finasteride may cause a fast progression of hair loss in between 12-24 weeks.
Treatments with different injectables which increase hair growth are also a good option for androgenic alopecia. The most innovative one is treatment with autologous exosomes. More and more evidence of their effectiveness in stimulating hair growth, having thicker hairs and hair is being collected. Another advantage of this procedure is that it must be done only once every 6 months. It is classified as a regenerative procedure, as it uses the own blood of the patient to achieve the desired results. Another procedure like this is PRP or plasmotherapy with plasma rich in thrombocytes. With this option, more sessions are required – 3-6 sessions once per month. The procedure is also an excellent choice to prepare the scalp before a hair transplant or to maintain and improve the effects after a hair transplant.
Other therapies, which we often combine with exosomes or PRP are mesotherapy or microneedling – a minimally invasive procedure, which stimulates the release of growth factors and stem cells, helps synthesize collagen and elasting and improves the absorption of the locally administered medicines.
For optimal results, we combine microneedling with PRP, exosomes and minoxidil using individual protocols, which your dermatologist makes for you. It is proven that those combinations and the inclusion of procedures on top of the medication therapy gets better results than monotherapy.
In recent years, laser therapies for the treatment of hair loss have gained immense popularity. For this purpose, lasers are used that emit low-intensity light that stimulates cellular activity in the tissues. Wavelengths ranging from red to infrared laser light are used to promote tissue repair and regeneration. Low intensity laser therapies stimulate hair growth in men and women with androgenetic alopecia and are approved by the US FDA. They are supposed to stimulate re-entry into the anagen phase in telogen hair follicles, prolong the duration of the anagen phase and increase the proliferation rate in active anagen hair follicles. In addition, low-intensity laser therapies promote the reparative regeneration that occurs during wound healing and the physiological regeneration that occurs during the hair cycle, which relies heavily on cell proliferation. These laser actions can normalize the physiological regeneration of the scalp affected by various hair loss disorders, such as male and female androgenetic alopecia, alopecia areata, and chemotherapy-induced hair loss.
Of course, other types of hair loss also exist. They can be caused by trauma (such as hair styling tools, tight ponytails or braids), fungal infections, even psychological diseases (trichotillomania), which require specific treatment. If you suffer from hair loss, the dermatologists in Skin Line can help you identify the reasons behind it, diagnose the type of hair loss and prepare an individual treatment plan for you.
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