|
●
About Hair Growth
back
to top
Hair that is grown on the head can
grow longer and is more dense than most hair found elsewhere on the
body. The average human head has about 100,000 hair follicles. Long
lustrous hair is marker for a healthy individual with good nutrition,
waist length hair approximately 1 meter or 39 inches long would take
around 84 months, or about 7 years, to grow.
Each follicle can grow about 20
individual hairs in a person's lifetime. Average hair loss is about 100
strands a day. The average human scalp measures approximately 770 cm˛.
●
Types of hair
back to top
Humans have four
different types of hair:
Lanugo - fine hair that covers nearly the entire body of fetuses
Vellus hair short - fine fuzz body hair that grows in most places on the
human body.
Terminal hair - fully developed hair, generally longer, coarser,
thicker, and darker than vellus hair.
Fine Hair
About 15% of women have fine hair
that has a diameter of 50 microns. Fine hair reflects light the best.
When it is healthy, fine hair will often have a natural shine. Fine hair
is soft, shine, limp, flyaway, lifeless and flat.
Medium Hair
Most people have medium hair it is
not too thick, not too thin, and has a diameter between 60-90
microns. Medium hair has good body and usually holds either a shape of
hairstyle well.
Coarse Hair
has a diameter of 100 microns or
more, Coarse hair is rough, wiry, heavy, but strong, Coarse hair is
often dry and needs conditioning to keep it under control.
●
Hair
Conditions
back to top
Dry Hair
Dry hair is due to inactive
oil glands. It can also be caused by harsh shampoo and chemical
treatments such as colours and perms, and sun exposure. Another reason
for dry hair can be accumulated oil blocks the pores not allowing the
oil to flow to the surface.
Oily Hair
Often accompanied with oily skin.
This is due to the over secretion of oil. Therefore the scalp and hair
gets too oily. Oily hair looks greasy even after shampooing and attracts
more dirt.
Combination Hair
Is a combination of greasy and dry
hair, usually long the hair nearest the scalp is greasy and the ends are
dry.
Normal Hair
This is the most ideal hair type.
It is shining, well balanced and does not dry out. To maintain this
ideal condition a well balanced diet and proper care is essential.
Dandruff
Dandruff is flakes of dead skin it
can be seen on hair and clothing. Dandruff isn't contagious or
dangerous.
Hair Breakage
Hair can break when points in the
hair thicken or weaken. Sometimes this happens near the scalp so a
person's hair never grows very long. When hairs break at the ends,
they're called "split ends," and the splits can travel up the hair
shaft. A cause of hair breakage is use of chemical hair treatments.
Brushing or combing hair too frequently or in the wrong way can lead to
breakage. Sometimes hair breakage and dry, brittle hair are signs of a
medical problem, such as hypothyroidism or an eating disorder.
●
Alopecia Hair
Loss back
to top
It's normal to lose some
hair, we lose about 100 hairs a day, as old hairs fall out they are
replaced with new ones. When hair falls out and isn't replaced by new
hair, a person can become bald or have bald patches. Hair loss can be
temporary or permanent, depending on the cause.
●
Alopecia
in Men
back to top
Introduction
With all its colours, styles
and variations, the hair has an important role in the look and the
imagination of the people, no matter their age or if they are men or
women.
Hair loss is an important factor in the life of millions of men.
Besides, the probabilities that a man experiences some hair loss in his
life are from 3 to 7.
Statistics show that almost 40% of men will lose some hair when they are
about 35 years old, but these numbers increase until 65% in men who are
60 or more years old. Many men find this a very alarming problem. For
some men the loss can be permanent. However, many of the causes of the
hair loss are treatable. Certainly, the physical appearance depends very
much on the look of the hair and it is not unusual that we spend a lot
of money on hairdos and products made to give to the hair a healthy,
lustrous and young look. For many people, the hair is a sign of youth
and vitality.
Structure of the hair
The external portion of the
hair shaft is the part that we see and comb. Actually, it is a dead
tissue, manufactured by the hair follicles, small structures with the
form of sack, located in the depth of the scalp.
Each hair is found within a follicle. The head has an average of 100.000
hairs. In the base of the follicle the root is found with an oval form,
and is the responsible place for the hair growth. In the inferior
portion of it, the papilla is found, which contains the blood vessels
that provide blood flow to each hair. As the hair grows the cells are
moved toward the surface and are converted into a protein called
keratin, being replaced for new cells.
Keratin is the same protein that is found in the nails. 3 layers compose
the shaft: cuticle, bark (cortex) and marrow (medulla). The cuticle or
external layer consists of small cells known as scales. The cuticle
serves, as casing to the bark, the most bulk portion of the hair shaft
is compound by cells disposed in the form of tobacco leaves. The bark
harbours the pigment that gives to the hair its colour. The marrow is
composed by cells with the form of box and is located in the centre. The
spaces between the cells of the marrow influence the refraction of the
light and the tone of the hair.
Glands and muscles
The hair is lubricated by
the oily secretions that are originated in the sebaceous glands, located
at the sides of most of the follicles. Surrounding these glands and the
rest of the follicle, there are groups of muscles (erector pili),
permitting the hair to be bristled or stood on end when we frighten
ourselves or we are cold.
Growth and Cycles
The head has an average of
100.000 hairs. The hair grows and is renewed regularly. Normally,
everyday about 50 and 100 hairs fall. If there are no problems probably
this small loss is not noted. The hair grows about 1cm a month, though
this is slower as we age. Each hair stays on the head from two to six
years, and during most of this time continues growing. When the hair is
older enters in a rest stage in which stays on the head, but does not
grow. At the end of this stage the hair falls.
Normally, the follicle replaces it every six months. But many factors
can disorganize this cycle. The result can be that the hair falls sooner
or is not replaced. Usually, 90% of the hair is found in a continuous
growth phase (anagen) that lasts between 2 and 6 years. 10% of the hair
is in a rest phase that lasts around 2-3 months. At the end of the rest
phase it is normal that the hair falls (telogen phase). As the hair
falls, a new hair from the same hair follicle, located under the skin,
replaces it. In the life of a person new follicles are not formed. Blond
people tend to have more hair (140.000) than the Mediterranean (105.000)
or redheaded (90.000).
As we age, the rate of hair growth decreases, being produced a
progressive thinning of the hair. The hair is composed by proteins
(keratin), also found in the nails. It is essential that all the people
take or eat an abundant quantity of proteins to maintain the hair
production. Proteins are found in meat, chicken, fish, eggs, milk,
cheese, cereals, nuts and soybean.
Androgenetic Alopecia.
It is the most frequent cause of
hair fall. It is determined by 3 factors: aging, hormones and
inheritance. Most of the people experience some hair loss as they get
older. The result can be a partial or a total baldness. Men are much
more prone to baldness and hair loss than women. The masculine baldness
produces a hair loss in a very typical way that affects to the forehead
(receding hairline) and the "roof of the head". It's typically genetic.
Besides, there is a type of feminine baldness, also hereditary, which
can cause a modest or important hair loss in women. This hair loss is
apparent initially from 25 / 30 years old. In this case, the hair is
replaced by increasingly fine and short hair. They can be converted even
into transparent. Normally, the hair loss is less evident than in men.
Also, the way in which the hair falls is different.
The majority notes thinning and hair loss on the roof of the head, but
they do not have a receding hairline. It is inherited from both the
father and the mother. About 50% of women who experience hair fall have
"feminine baldness". In this case, exists plenty of dyhydrotestosterone,
a masculine hormone, within the hair follicle. An enzyme, 5-alpha
reductase on the scalp, regulates the conversion from testosterone to
DHT. Later, the action of DHT facilitates that the follicle is demoted
and shortens its growth phase (anagen). Though the follicle is
technically alive, it will grow increasingly small. Some follicles
simply die, but the majority simply become smaller and hairier. As the
anagen phase continues being very short, hairs fall more often. The hair
slims progressively until is so fine that cannot resist the daily
hairdo. Baldness transforms a long, bulk and pigmented hair into a fine
hair, clearer and hairy.
However, the sebaceous gland adhered to the follicle continues having
the same size and producing the same quantity of sebum. When with a
medical treatment (flutamide, ciproterone, spironolactone) a reduction
of the masculine hormones is achieved, the sebaceous glands are slimmed
and reduce their oil production. In this case, the quantity of hormone
in the sebum is also smaller, not being produced so much damage.
Besides, seems to exist an immunologic factor in baldness. Basically,
the immune system starts taking as target the hair follicles in the
alopecia areas. An increase in the masculine hormones (DHT) during the
puberty begins this process.
Iron deficiency anemia
The lack of iron produces hair loss
in men as well as in women. However, in women this problem is more
frequent, particularly in those who have long or abundant periods. This
lack of iron is detected with analysis and is amended easily with a
medical treatment.
Diet
A low protein diet can also cause
hair loss, as well as a poor intake of iron. Vegetarians, people who
make poor diets in proteins and patients with nervous anorexia can
present a protein deficiency. When this occurs, the body helps preserve
the proteins, diverting the growing hair toward the rest phase.
Therefore, people note a massive hair loss around 3 months later. After
pulling the hair, it leaves easily with root. This process is reversible
with an adequate intake of proteins.
Thyroid disease
A thyroid hyperactivity or little
active can cause hair loss. These diseases are diagnosed by the clinical
symptoms and analysis. They require a specific treatment.
Medicines
Some medicines used in the cancer
chemotherapy make the cells of the hair stop their division, so hairs
are slimmed and broken easily while emerging from the scalp. This
phenomenon occurs 1-3 weeks after the beginning of the anti-cancer
treatment. The patient can lose 90% of the hair. In most of the patients
the hair returns to grow when the treatment ends. It is advised that
these patients acquire a wig before beginning the treatment.
Many popular medications can cause hair loss too. Here we compile a list
of drugs that are known to cause hair loss in some patients:
- Cholesterol-lowering drug: clofibrate (Atromis-S) and gemfibrozil (Lopid).
- Parkinson Medications: levodopa (Dopar, Larodopa).
- Ulcer drugs: cimetidine (Tagamet), ranitidine (Zantac) and famotidine
(Pepcid).
- Anticoagulents: Coumarin and Heparin.
- Agents for gout: Allopurinol (Loporin, Zyloprim).
- Antiarthritics: penicillamine, auranofin (Ridaura), indomethacin (Inacid),
naproxen (Naprosyn),
sulindac (Clinoril), and
methotrexate (Folex).
- Drugs derived from vitamin-A: isotretinoin (Accutane) and etretinate (Tegison).
- Anticonvulsants for epilepsy: trimethadione (Tridione).
- Antidepressants: tricyclics, amphetamines.
- Beta-blocker drugs for high blood pressure: atenolol (Tenormin),
metoprolol (Lopressor),
nadolol (Corgard),
propranolol (Inderal) and timolol (Blocadren).
- Antithyroid agents: carbimazole, Iodine, thiocyanate, thiouracil.
- Others: Blood thinners, male hormones (anabolic steroids).
Alopecia Areata
It is a common disease that
produces hair loss at patches on the scalp, as well as on other body
areas. It occurs at any age, but affects more to young people. The
affected follicles reduce notably their hair production and are turned
very small, producing a hair that hardly can be seen. These follicles
are in a state of sleeping, and in any moment they can resume their
activity after receiving an appropriate sign. Some people develop only
some few patches of baldness that are recovered in a year. In some
people all hair is lost on the scalp (alopecia totalis). In other people
hair is lost on the whole body (alopecia universalis). Alopecia areata
is thought to be an autoinmune disease in which the organism
fallaciously produces antibodies against the hair follicle (autoallergy).
The nervous factors can trigger the disease or prevent its improvement.
The treatment consists of applying topical Minoxidil, ciclosporine,
steroids or dithranol creams or in injecting steroids within the
baldness areas. In some cases, it can be useful the UVA light, as well
as the application of dibenciprone on the patches to induce an allergic
reaction that stimulates the asleep follicle.
Tinea capitis
It is an infection by fungi
on the scalp. It can produce small scaling patches and some hair loss.
Inappropriate care of the hair
Some men employ chemical treatments on their hair, such as dyes,
bleachers, permanent waves, etc. These chemical treatments can damage
the hair if they are made in a wrong way. The hair is weakened and
broken when these substances are applied frequently, if they are let too
long, if two procedures are made the same day or if bleachers are
applied to a previously whitened hair. If hair has turned too porous and
without sheen by overexposure to chemical treatments, it is advisable to
discontinue treatments until the hair is recovered.
Shampoo, brushed and hairdo are all necessary for an adequate hair care.
But if they are not well applied or are in excess, these procedures can
damage the hair, causing its break by the shaft or splitting the tips.
A conditioner or a repairing serum can be used after the shampoo to
reduce the intensity required to comb the hair, and also to make it more
manageable. When broken tips are present and hair is difficult to comb,
it is advisable the use of repairers with silicone. The excess of water
must be dried and not rubbed vigorously with a towel. When the hair is
wet its structure is more fragile, so a hard hairdo or brushed must be
avoided. Forget the old recommendation to brush or comb in excess, since
this damages the hair. Use combs with widely separate teeth and fine sow
brushes, preferably natural (brushes made of boar sow). Hairdos that
require tension on the hair, such as locks and braids, should be
alternated with loose hairdos to avoid the constant "pull" that produces
hair loss, especially at the sides of the scalp.
Treatments: Local Use
1.Minoxidil. It is a vasodilator
agent that has been taken by mouth in the treatment for arterial
hypertension. Nowadays is being used widely in the treatment of various
alopecias. As a rule, it is applied 1 ml of the lotion twice a day
(every 12 hours) on dry hair, since the dampness increases the
breakthrough of the product several times. It works better in young men
than in women (20 years), especially in those with a light hair loss
(thinning) on the crown (vertex) or a small patch of 3-4 cm, though it
has also action on the income. The response to Minoxidil is very
individual. Treatments should be made from 2 to 5 years. The hair will
be recovered from the hairy hair that existed on the scalp. Minoxidil
makes the hair stronger and healthier. The response is better in people
with hair loss less than 2 years. The majority sees small white hairs in
the first months. It can be appreciated a greater hair fall after the
first applications. This is due to the fact that old hairs have to fall
before new hair grows. Positive results can be seen 4-8 months later,
though the maximum effects are reached after 12-14 months.
2. Pyrimidine Oxide. It is a generic type of Minoxidil like hair tonic (aminexil
2,4-Diaminopyrimidine -3-oxide). Results in more than 250 women and men
include an increase of 8% of growing hair after 6 treatment weeks, in
comparison with a decrease in the percentage of growing hair with
placebo.
3. Tretinoin. It has been used during years for the acne treatment. It
is also a hair tonic in adequate dosages, particularly in combination
with Minoxidil. If both are applied, first apply Minoxidil, wait to dry
(normally 15-30 minutes) and then apply tretinoin gel. Tretinoin will
have to be applied alone at nights. It's expected a light irritation on
the skin of the scalp, especially at the beginning of the treatment.
4. Natural Treatments. There are treatments with vitamins, sulfured
amino acids (cistine, metionine, cisteine, tiazolidin carboxylic acid),
minerals (zinc) and plant extracts (Indians chestnut, marigold). They
are useful to supply the diet and promote a healthier hair. Sulfur amino
acids favor the development of keratin, the protein that gives structure
to the hair. Plant extracts act stimulating the blood flow and
revitalizing the follicle. Zinc gluconate is astringent and reduces the
sebaceous secretion upon inhibiting the production of DHT when is
applied topically. Amniotic liquid and trichosaccharides hydrate and
stimulate the follicle.
5. Others. Recently some hair lotions containing superoxide dismutase
(copper ligant peptides) have been used to strengthen and activate the
hair growth. This is due to the fact that there are chemical messengers
in the organism that send a signal to the follicles to begin the anagen
and telogen. In this sense, free radicals turn the hair towards the
telogen phase (rest phase), while the nitric oxide turns hair into
anagen (growth phase). Obviously, treatments should stimulate the levels
of nitric oxidize and reduce free radical levels employing superoxide
dismutase and other antioxidants. Also, some years ago, Polisorbate 80,
was employed to induce hair growth.
Treatments: Oral Use
1. Dietetic supplements (Vitamins
and sulfured amino acids). Though androgenetic alopecia is not due to
the lack of vitamins, it has been seen that sulfured aminoacids
supplements (arginine, cisteine), vitamins and minerals (biotin, iron,
folic acid) favor the capillary nourishment, reduce oiliness and favor
the synthesis of proteins that gives structure to the hair, the keratin.
Many of these compounds have an antioxidant action.
2. Antiandrogens. They reduce the masculine hormone (DHT) that produces
baldness. DHT is an androgen (masculine hormone) that competes by the
place in the receptors of the hair follicle. If receptors of the
follicle are occupied by additionally agents, DHT does not enter and
therefore does not induce its aggressive action. The problem is that it
can also block the DHT in other body areas, appearing symptoms of
feminization in the male. On the other hand, this blockade is less
problematic in women.
A. Finasteride. It was employed initially in the treatment for prostatic
problems. It prevents testosterone to be converted into the responsible
masculine hormone for prostate enlarging (this is the same hormone
responsible for hair loss). It's taken orally.
- Which are the side effects of Finasteride?
Side effects are not important. In the first studies, a very low
percentage (2%) of the patients who were taking Finasteride experienced
sexual problems. In subsequent studies, an equal percentage was found in
patients who were taking a placebo. Somehow, the problems seem to be
transient and stop completely when the drug is interrupted. A decrease
in the amount of hair on thorax, back and shoulders may be also noted.
Very rarely may appear some sensibility and enlargement of the nipples.
If this occurs, the drug must be interrupted.
- What can I expect?
Finasteride acts by reducing the masculine hormone that begins and
maintains the hair loss. In most of the men the baldness process stops
or decreases notably. They note an increase of 10% after a year.
Finasteride does not stimulate the hair growth, but maintains the
removed hair from the influence of the masculine hormones. The hair
requires certain time to grow again, and only hairs recently lost will
grow. The greater impact of this medication is the detention, not the
cure of the baldness. Results are individual. Some men experience an
important quantity of hair growth and others just a little. In most of
them is prevented the hair fall. The more recent the hair loss is, the
easier the growth is.
B. Zinc. It affects the hormonal levels when is taken by mouth and
inhibits the production of DHT when is applied topically.
C. Spirolactone. It is often used as a diuretic. It is one of the most
potent antiandrogens. It reduces DHT, the hormone that produces hair
loss. It can be also applied topically and in this way it is not
absorbed and it does not produce internal effects. It is employed to
doses from 50 to 100 mg a day.
D. Ketoconazol. It´s an antifungal agent that possesses antiandrogen
properties. In men it may be very useful the treatment with Finasteride,
a drug often employed for the prostate.
Treatments: Cosmetic
This includes imaginative hairdos, wigs and hair transplants. To reduce
the visual effect of the hair that has turned thinner, a hair camouflage
may be done. An advice is to have the hair short. In this sense, the
hair seems less patched and it will be easier to take care of it. With a
longer hair, wick bunches are produced and they will be separated,
showing wide areas on the scalp. A good hairdresser can camouflage the
fine hair on certain areas. If the hair is fine in the front, the
frontal line is extended until the temples.
Ask your hairdresser to clip the part lead shorter and to let the hair
at the level of the longest temples.
If the hair is thinner on the crown, maintain it short on the nape. The
long hair on the nape is heavier and will remove the crown, exposing
more the patch area.
If there is still a reasonably bulk hair on the roof of the head, leave
it long and cover the baldness patches. If the hair is very fine there
will be some problems to cover the hair loss areas. You may try a soft
permanent to increase the volume.
If hair is dark, clarify the colour a little. This trick will reduce the
contrast between the remaining hair and the scalp, making the skin less
noticeable. A cosmetic trick that can work is to apply some eyeshadow
close to the colour of your hair on the fine hair areas. This is
harmless and can make the fine hair less noticeable. Finally do not use
products that favor the adherence of hair locks, permitting that free
spaces are seen on the scalp.
Adequate shampoos
Maintaining a clean hair
contributes to keep its health and beauty. The frequency of the wash and
a shampoo adapted for each person are important factors and they will be
recommended by your dermatologist.
In cases of oily and thinning hair, it is advised frequent washes, since
this reduces the sebum (oil) on the scalp. It is important to have a
clean hair, without oil, since the sebum contains high levels of
dyhydrotestosterone and testosterone (masculine hormones) that could be
reabsorbed within the skin, affecting the hair follicle. In cases of
dandruff and oiliness, the best you can do is to alternate a treatment
shampoo with a frequency shampoo. With both shampoos you must wash the
hair twice, and in the second one, let the foam 2-3 minutes without
rubbing. The comb must be made of broad and with separated teeth.
Metallic brushes should be avoided. Broken tips (tricoptilosis) can be
repaired with a repairing fluid containing silicone polymers that acts
patching the broken tips
Conclusions
Hereditary hair fall is not
curable, but controllable. The earlier the treatment starts the better
the results are. Though there is not an ideal treatment for androgenetic
alopecia, there are medicines that stop hair fall and extend the life of
the follicles. We should consider that present and future treatments for
the hair require live hair follicles. In baldness, follicles are
miniaturized and die after 5-10 years.
The more live follicles we maintain the better the response will be.
Many hair problems are transient and can be treated with dietetic
measures and others. In this case, some good habits in the diet, like
vitamin supplements, minerals, antioxidants, etc., will stop hair loss
and normalize the growth some months later. Consult your dermatologist
if you need more information about hair fall, since the skin diseases
include also hair and nails diseases. Do not be influenced by
commercials about "hair tonic", neither by specialists, hairdresser...
●
Alopecia in Women
back to top
With all its colours,
styles and variations, the hair plays an important role in the look and
in the imagination of the people, no matter their age or if they are men
or women.
You would not guess by the advertising of products that "strengthen the
hair", normally focused on men, that more than two-thirds of the women
have problems of hair loss. Many women find this a very alarming
problem, perhaps more than men do.
Besides, the feminine physiology is unique, and factors such as
menstrual cycles, pregnancies and menopause are particularly important.
For some women their hair loss can be genetic. However, many of the
causes are treatable. Certainly, the physical appearance depends very
much on the look of the hair and it's not unusual that we spend a lot of
money on hairdos and products made to give to the hair a healthy,
lustrous and young look. For many people the hair is a sign of youth and
vitality.
Structure of the hair
The external portion of the
hair shaft is the part that we see and comb. Actually, it's a dead
tissue, manufactured by the hair follicles, small structures with the
form of a sack, located in the depth of the scalp.
Each hair is found within a follicle. The head has an average of 100.000
hairs. In the base of the follicle the root is found with an oval form,
and is the responsible place for the hair growth. In the inferior
portion of it, the papilla is found, which contains the blood vessels
that provide blood flow to the hair. As the hair grows, the cells are
moved toward the surface and are converted into a protein called
keratin, being replaced for new cells.
Keratin is the same protein that is found in the nails. 3 layers compose
the shaft: cuticle, bark (cortex) and marrow (medulla). The cuticle or
external layer consists of small cells known as scales. The cuticle
serves, as casing to the bark, the most bulk portion of the hair shaft
is compound by cells disposed in the form of tobacco leaves. The bark
harbors the pigment that gives to the hair its colour. The marrow is
composed by cells with the form of box and is located in the centre. The
spaces between the cells of the marrow influence the refraction of the
light and the tone of the hair.
Glands and muscles
The hair is lubricated by
the oily secretions that are originated in the sebaceous glands, located
at the sides of most of the follicles. Surrounding these glands and to
the rest of the follicle, there are groups of muscles (erector pili),
permitting the hair to be bristled or stood on end when we frighten
ourselves or we are cold.
Growth and Cycles
The head has an average of
100.000 hairs. The hair grows and is renewed regularly. Normally,
everyday about 50 and 100 hairs fall. If there are no problems, probably
this small loss is not noted. The hair grows about 1 cm a month, though
this is slower as we age. Each hair stays on the head from two to six
years, and during most of this time continues growing. When the hair is
older enters in a rest stage in which stays on the head, but does not
grow. At the end of this stage the hair falls.
Normally, the follicle replaces it every six months. But many factors
can disorganize this cycle. The result can be that the hair falls sooner
or is not replaced. Usually, 90% of the hair is found in a continuous
growth phase (anagen) that lasts between 2 and 6 years. 10% of the hair
is in a rest phase that lasts around 2-3 months. At the end of the rest
phase it is normal that the hair falls (telogen phase). As the hair
falls, a new hair from the same hair follicle, located under the skin,
replaces it. In the life of a person new follicles are not formed. Blond
people tend to have more hair (140.000) than the Mediterranean (105.000)
or redheaded (90.000).
As we age, the rate of hair growth decreases, being produced a
progressive thinning of the hair. The hair is composed by proteins
(keratin), also found in the nails. It is essential that all the people
take or eat an abundant quantity of proteins to maintain the hair
production. Proteins are found in meat, chicken, fish, eggs, milk,
cheese, cereals, nuts and soybean.
Main Causes
Androgenetic Alopecia. It is the
most frequent cause of hair fall. It is determined by 3 factors: aging,
hormones and inheritance. Most of the people experience some hair loss
as they get older. The result can be a partial or total baldness. Men
are much more prone to baldness and hair loss than women. The masculine
baldness produces a hair loss in a very typical way that affects to the
forehead (receding hairline) and the "roof of the head". It's typically
genetic. Besides, there is a type of feminine baldness, also hereditary,
which can cause a modest or important hair loss in women. This hair loss
is apparent initially from 25 / 30 years old. In this case, the hair is
replaced by increasingly fine and short hair. They can be converted even
into transparent. Normally, the hair loss is less evident than in men.
Also, the way in which the hair falls is different. The majority notes
thinning and hair loss on the roof of the head, but they do not have a
receding hairline. It is inherited from both the father and the mother.
About 50% of women who experience hair fall have "feminine baldness". In
this case, exists plenty of dyhydrotestosterone, a masculine hormone,
within the hair follicle. An enzyme, 5-alpha reductase on the scalp,
regulates the conversion from testosterone to DHT. Later, the action of
DHT facilitates that the follicle is demoted and shortens its growth
phase (anagen). Though the follicle is technically alive, it will grow
increasingly small. Some follicles simply die, but the majority simply
become smaller and hairier. As the anagen phase continuous being very
short, hairs fall more often. The hair slims progressively until is so
fine that cannot resist the daily hairdo. Baldness transforms a long,
bulk and pigmented hair into a fine hair, clearer and hairy.
However, the sebaceous gland adhered to the follicle continues having
the same size and producing the same quantity of sebum. When with a
medical treatment (flutamide, ciproterone or spironolactone) a reduction
of the masculine hormones is achieved, sebaceous glands are slimmed and
reduce their oil production. In this case, the quantity of hormone in
the sebum is also smaller, not being produced so much damage. Besides,
seems to exist an immunologic factor in baldness. Basically, the immune
system starts taking as a target the hair follicles in the alopecia
areas. The increase in the masculine hormones (DHT) during the puberty
begins this process.
Secondary Causes
Many factors can cause hair loss,
frequently transient:
Birth control pills
They contain two ingredients, a
synthetic estrogen and a progestagen. Women whose hair falls while
taking contraceptives are prone by inheritance to a progressive thinning
of the hair. The effects of the masculine hormone that some progestagens
possess can accelerate it. If this occurs, it's advisable to change to
other birth control pills. Also when a woman stops taking some oral
contraceptives, she can note 2-3 months later how her hair falls. This
fall lasts about 6 months and commonly stops. This is similar to the
hair fall after the delivery.
Iron deficiency anemia
The lack of iron produces hair fall
in men as well as in women. However, in women this problem is more
frequent, particularly in those who have long or abundant periods. The
lack of iron is detected with analysis and is amended easily with a
medical treatment.
Diet
A low protein diet can cause hair
loss, as well as a poor intake of iron. Vegetarians, people who make
poor diets in proteins and patients with nervous anorexia can present a
protein deficiency. When this occurs, the body helps preserve the
proteins, diverting the growing hair toward the rest phase. Therefore,
people note a massive hair loss around 3 months later. After pulling the
hair, it leaves easily with root. This process is reversible with an
adequate intake of proteins.
Post-delivery
Some women lose a lot of hair 2-3
months after the delivery. When a woman gives birth, some hair enters in
the rest phase of the pillar cycle. 2-3 months later they can note that
many hairs are held in the comb or brush. This hair fall can last about
6 months. In most of the cases the problem is solved after an adequate
medical treatment. Not all the new mothers will suffer this experience
and neither all the women will have a hair fall with each pregnancy.
Stress and diseases
A person may start losing hair 1-3
months after a stressing situation, such as an important surgery. High
fever, severe infections or chronicle diseases can produce hair loss.
Thyroid disease
A thyroid hyperactivity or little
active can cause hair loss. These diseases are diagnosed by clinical
symptoms and analysis. It's required a specific treatment.
Medicines
Some medicines used in cancer
chemotherapy make the cells of the hair stop their division, so hairs
are slimmed and broken easily while emerging from the scalp. This
phenomenon occurs 1-3 weeks after the beginning of the anti-cancer
treatment. The patient can lose 90% of the hair. In most of the patients
the hair returns to grow when the treatment ends. It is advised that
these patients acquire a wig before beginning the treatment.
Many popular medications can cause hair loss too. Here we compile a list
of drugs that are known to cause hair loss in some patients:
- Cholesterol-lowering drug: clofibrate (Atromis-S) and gemfibrozil (Lopid).
- Parkinson Medications: levodopa (Dopar, Larodopa).
- Ulcer drugs: cimetidine (Tagamet), ranitidine (Zantac) and famotidine
(Pepcid).
- Anticoagulents: Coumarin and Heparin.
- Agents for gout: Allopurinol (Loporin, Zyloprim).
- Antiarthritics: penicillamine, auranofin (Ridaura), indomethacin (Inacid),
naproxen (Naprosyn),
sulindac (Clinoril), and
methotrexate (Folex).
- Drugs derived from vitamin-A: isotretinoin (Accutane) and etretinate (Tegison).
- Anticonvulsants for epilepsy: trimethadione (Tridione).
- Antidepressants: tricyclics, amphetamines.
- Beta-blocker drugs for high blood pressure: atenolol (Tenormin),
metoprolol (Lopressor),
nadolol (Corgard),
propranolol (Inderal) and timolol (Blocadren).
- Antithyroid agents: carbimazole, Iodine, thiocyanate, thiouracil.
- Others: Blood thinners, male hormones (anabolic steroids).
Alopecia Areata
It is a common disease that
produces hair loss at patches on the scalp, as well as on other body
areas. It occurs at any age, but affects more to young people. The
affected follicles reduce notably their hair production and are turned
very small, producing a hair that hardly can be seen. These follicles
are in a state of sleeping, and in any moment they can resume their
activity after receiving an appropriate sign. Some people develop only
some few patches of baldness that are recovered in a year. In some
people all hair is lost on the scalp (alopecia totalis). In other people
hair is lost on the whole body (alopecia universalis). Alopecia areata
is thought to be an autoinmune disease in which the organism
fallaciously produces antibodies against the hair follicle (autoallergy).
The nervous factors can trigger the disease or prevent its improvement.
The treatment consists of applying topical Minoxidil, ciclosporine,
steroids or dithranol creams or in injecting steroids within the
baldness areas.
In some cases, it can be useful the UVA light, as well as the
application of dibenciprone on the patches to induce an allergic
reaction that stimulates the asleep follicle.
Tinea capitis
It is an infection by fungi
on the scalp. It can produce small scaling patches and some hair loss.
Inappropriate care of the
hair
Some women employ chemical
treatments on their hair, such as dyes, bleachers, permanent waves, etc.
These chemical treatments can damage the hair if they are made in a
wrong way. The hair is weakened and broken when these substances are
applied frequently, if they are let too long, if two procedures are made
in the same day, or if bleachers are applied to a previously whitened
hair. If hair has turned too porous and without sheen by overexposure to
chemical treatments, it's advisable to discontinue these treatments
until the hair is recovered.
Shampoo, brushed and hairdo are all necessary for an adequate hair care.
But if they are not well applied or are in excess, these procedures can
damage the hair, causing its break by the shaft or splitting the tips.
A conditioner or a repairing serum can be used after the shampoo to
reduce the intensity required to comb the hair, and also to make it more
manageable. When broken tips are present and hair is difficult to comb,
it's advisable the use of repairers with silicone. The excess of water
must be dried and not rubbed vigorously with a towel. When the hair is
wet its structure is more fragile, so a hard hairdo or brushed must be
avoided. Forget the old recommendation to brush or comb in excess, since
this damages it. Use combs with widely separate teeth and fine sow
brushes, preferably natural (brushes made of boar sow). Hairdos that
require tension on the hair, such as locks and braids, should be
alternated with loose hairdos to avoid the constant "pull" that produces
hair loss, especially at the sides of the scalp.
Treatments: Local Use
1. Minoxidil. It's a vasodilator
agent that has been taken by mouth in the treatment for arterial
hypertension. Nowadays is being used widely in the treatment of various
alopecias. As a rule, it's applied 1 ml of the lotion twice a day (every
12 hours) on dry hair, since the dampness increases the breakthrough of
the product several times. It works better in young men than in women
(20 years), especially in those with a light hair loss (thinning) on the
crown (vertex) or a small patch of 3-4 cm, though it has also action on
the income. The response to Minoxidil is very individual. Treatments
should be made from 2 to 5 years. The hair will be recovered from the
hairy hair that existed on the scalp. Minoxidil makes the hair stronger
and healthier. The response is better in people with hair loss less than
two years. The majority sees small white hairs in the first months. It
can be appreciated in some people a greater hair fall after the first
applications. This is due to the fact that old hairs have to fall before
new hair grows. Positive results can be seen 4-8 months later, though
the maximum effects are reached after 12-14 months.
2. Pyrimidine Oxide. It is a generic type of Minoxidil like hair tonic (aminexil
2,4-Diaminopyrimidine-3-oxide). Results in more than 250 women and men
include an increase of 8% of growing hair after 6 treatment weeks, in
comparison with a decrease in the percentage of growing hair with
placebo.
3. Tretinoin. It has been used many years for the acne treatment. It is
also a hair tonic in adequate dosages, particularly in combination with
Minoxidil. If both are applied, first apply Minoxidil, wait to dry
(normally 15-30 minutes) and then apply tretinoin gel. Tretinoin will
have to be applied alone at nights. It's expected a light irritation on
the skin of the scalp, especially at the beginning of the treatment.
4. Topical Estrogens. Dienestrol or progesterone lotions applied daily
during 6-12 months may be used.
5. Natural Treatments. There are treatments with vitamins, sulfured
amino acids (cistine, metionine, cisteine, tiazolidin carboxylic acid),
minerals (zinc) and plant extracts (Indians chestnut, marigold). They
are useful to supply the diet and promote a healthier hair. Sulfur amino
acids favor the development of keratin, the protein that gives structure
to the hair. Plant extracts act stimulating the blood flow and
revitalizing the follicle. Zinc gluconate is astringent and reduces the
sebaceous secretion upon inhibiting the production of DHT when is
applied topically. Amniotic liquid and trichosaccharides hydrate and
stimulate the follicle.
6. Other: Recently some hair lotions containing superoxide dismutase
(copper ligant peptides) have been used to strengthen and activate the
hair growth. This is due to the fact that there are chemical messengers
in the organism that send a signal to the follicles to begin the anagen
and telogen. In this sense, free radicals turn the hair towards the
telogen phase (rest phase), while the nitric oxide turns hair into
anagen (growth phase).
Obviously, treatments should stimulate the levels of nitric oxidize and
reduce free radical levels employing superoxide dismutase and other
antioxidants. Also, some years ago, Polisorbate 80 was used to induce
hair growth
Treatments: Oral Use
1. Dietetic supplements. (Vitamins
and sulfured amino acids). Though androgenetic alopecia is not due to
the lack of vitamins, it has been seen that sulfured aminoacids
supplements (arginine, cisteine), vitamins and minerals (biotin, iron,
folic acid) favor the capillary nourishment, reduce oiliness and favor
the synthesis of proteins that gives structure to the hair, the keratin.
Many of these ingredients have an antioxidant action.
2. Antiandrogens. They reduce the masculine hormone (DHT) that produces
baldness. DHT is an androgen (masculine hormone) that competes by the
place in the receptors of the hair follicle. If receptors of the
follicle are occupied by additionally agents, DHT does not enter and
therefore does not induce its aggressive action. The problem is that it
can also block the DHT in other body areas, appearing symptoms of
feminization in the male. On the other hand, this blockade is less
problematic in women.
A. Zinc. It affects the hormonal levels when is taken by mouth and
inhibits the production of DHT when is applied topically.
B. Spirolactone. It is often used as a diuretic. It is one of the most
potent antiandrogens. It reduces DHT, the hormone that causes hair loss.
It can be also applied topically and in this way it is not absorbed and
neither produces internal effects. It is used from 50 to 100 mg. a day.
It can alter the menstrual cycle and increase bled in some patients, but
usually, is well tolerated.
C. CPA (ciproterone acetate). It's a derivative from progesterone with
antiandrogen effects. It is used for the control of androgenetic
alopecia exclusively in women. It cannot be used in men. It is used in
combination with etinil estradiol. The treatment must be followed at
least during 12 months and frequently 2 years are required to obtain
improvement. The response is more favorable if the treatment starts in
the first two years of the beginning of the alopecia. The treatment
stops hair fall and improves the quality of the hair. The length of
treatment is about 1-2 years.
D. Flutamide. It is other antiandrogen agent indicated for women. The
length of treatment is 1-2 years.
E. Other Antiandrogens.
- Ketoconazol. It's an antifungal
agent that possesses antiandrogen properties. The treatment with
Finasteride may be very useful for men. It's also a drug often used for
the prostate.
- Saw Palmetto. Saw Palmetto (Serenoa Repens) berries grow naturally.
Their extract has antiandrogenic properties. There have not been
extensive studies to show how antiandrogenic they are, but typical side
effects include breast growth in males, which seems to indicate that it
does not act on DHT alone. To be effective, you must get the extract of
the berries, not the berries themselves. It usually comes as a capsule.
Treatments: Cosmetic
This includes imaginative hairdos,
wigs and hair transplants. To reduce the visual effect of the hair that
has turned thinner, a hair camouflage may be done. An advice is to have
the hair short. In this sense, the hair seems less patched and it will
be easier to take care of it. With a longer hair, wick bunches are
produced and they will be separated, showing wide areas on the scalp. A
good hairdresser can camouflage the fine hair on certain areas. If the
hair is fine in the front, the frontal line is extended until the
temples. Ask your hairdresser to clip the part lead shorter and to let
the hair at the level of the longest temples. If the hair is thinner on
the crown, maintain it short on the nape. The long hair on the nape is
heavier and will remove the crown, exposing more the patch area. If
there is still a reasonably bulk hair on the roof of the head, leave it
long and cover the baldness patches. If the hair is very fine there will
be some problems to cover the hair loss areas. You may try a soft
permanent to increase the volume. If hair is dark, clarify the colour a
little. This trick will reduce the contrast between the remaining hair
and the scalp, making the skin less noticeable. A cosmetic trick for
women that can work is to apply a little bit of eyeshade close to the
colour of your hair on the fine hair areas. This is harmless and can
make the fine hair less noticeable. Finally do not use products that
favor the adherence of hair locks, permitting that free spaces are seen
on the scalp.
Adequate shampoos
Maintaining a clean hair
contributes to keep its health and beauty. The frequency of the wash and
a shampoo adapted for each person are important factors and they will be
recommended by your dermatologist. In cases of oily and thinning hair
it's advised frequent washes, since this reduces the sebum (oil) on the
scalp. It is important to have a clean hair, without oil, since the
sebum contains high levels of dyhydrotestosterone and testosterone
(masculine hormones) that could be reabsorbed within the skin, affecting
the hair follicle. In cases of dandruff and oiliness the best you can do
is to alternate a treatment shampoo with a frequency shampoo. With both
shampoos, you must wash the hair twice, and in the second one, let the
foam 2-3 minutes without rubbing. The comb must be made of broad and
with separated teeth. Metallic brushes should be avoided. Broken tips (tricoptilosis)
can be repaired with a repairing fluid containing silicone polymers that
acts patching the broken tips.
Conclusions
Hereditary hair fall is not
curable, but controllable. The earlier the treatment starts the better
the results are. Though there is not an ideal treatment for androgenetic
alopecia, there are medicines that stop hair fall and extend the life of
the follicles. We should consider that present and future treatments for
the hair require live hair follicles. In baldness, follicles are
miniaturized and die after 5-10 years.
The more live follicles we maintain the better the response will be.
Many hair problems are transient and can be treated with dietetic
measures and others. In this case, some good habits in the diet, like
vitamin supplements, minerals, antioxidants, etc., will stop hair loss
and normalize the growth some months later. Consult your dermatologist
if you need more information about hair fall, since the skin diseases
include also hair and nail diseases. Do not be influenced by commercials
about "hair tonic", neither by specialists, hairdresser...
|
medi-spa
treatment
available to go with this home care ask your local spa about
SeSDERMA