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Baldness or alopecia is partial or complete loss of hair. The start of hair loss is usually between 20th and 30th year. The most common baldness type is male baldness type (androgenic alopecia) and it can occur in men and women.
Hair growth cycle is divided into three phases:
- Anagen phase – phase of active hair growth – lasts for 3-6 years.
- Catagen phase – involution phase – lasts for about three weeks.
- Telogen phase – phase of hair growth stillness – lasts for about three months.
In the hair there are normally 80-90% of anagen hairs, 10-20% of telogen and 1-2% of catagen hair. Physiologically every day 70-100 hairs fall off the scalp.
Causes
Tendency for alopecia (hair loss) is inherited with one part (so-called polygenic inheritance), but the influence of other factors is also important.
Other factors that affect hair quality and growth:
- Stress
- Concentration of thyroid and sexual hormones (androgenic hormones)
- Deficiency of minerals iron, zinc, copper or silicon.
- Vitamin A and C deficiency.
- Deficiency of amino acids cystine and methionine.
- Inadequate nutrition.
- Severe infections.
- Immune disorders.
- Scars.
- Tumors.
- Types of baldness
Androgenic alopecia (male baldness)
This is the most common cause of hair loss in men and women. Dependent on the production of androgenic hormones.
Alopecia usually starts in youth with individual speed of progression. Very often it is followed by seborrhea and seborrhea dermatitis.
Hair at first starts to fall off at the edges, the head crown and the back of the head. The main cause of androgenic alopecia is dihydrotestosterone (DHT), active metabolite of male sex hormone (testosterone) which is linked to the cells of the hair follicle cells and inhibits their growth.
Baldness in women
Androgenic alopecia is the most common type of baldness in women as well.
Hair loss usually occurs as the result of sex hormones disbalance within the syndrome of polycystic ovaries – PCOS (increased level of androgenic hormones in blood, hair loss, acne, irregular menstrual cycles, obesity).
Clinical picture is usually lighter than in men so it is composed of diffuse hair sparseness.
Because of high frequency of the polycystic ovary syndrome PCOS (the most common endocrinological female disese) it is important to consult a gynecologist besides dermatologist and make a complete gynecological processing, transvaginal ultrasound and determining the concentration of sex hormones.
Alopecia areata
Alopecia areata is focal hair loss on the scalp or somewhere else on the body. It can be limited only to one area (unilocularis) or more (multilocularis). For this type of baldness it is thought that it is caused by immune mechanisms. It is often related to stress, thyroid diseases and vitiligo.
Scar alopecia
Scar alopecia can cause infections, bacterial and fungal ailments, skin diseases like scleroderma, sarcoidosis and scalp tumors. For this type of baldness there is no possibility for regrown the hair because the affected area has no more follicles but only scar tissue. Because of the mentioned, it is recommended skin biopsy so scar and non-scar alopecia could be differentiated.
Effluvium capillorum
This term means diffuse hair loss that is the consequence for a harmful influence on the body. Of common causes these are mentioned:
- Metabolic disorders: sudden weight loss, anemia, bleeding.
- Hormone disorders: thyroid diseases, polycystic ovary syndrome, hormonal imbalance, birth, cease of taking contraceptive pills.
- Medication.
- Poisoning.
- Mental stress
It is characteristic for the patients to complain about sudden and severe hair loss. Therapy is treating the original disease.
Diagnosis
It is important to determine biochemical findings and make the analysis of the scalp itself.
With lab tests thyroid diseases, anemia and sex hormones imbalance are excluded as the most common causes of alopecia (90% of all cases of alopecia in both genders are caused by increased concentration of androgen hormones).
Biochemical findings:
- CBW (complete blood work).
- determining the iron concentration in blood.
- determining the zinc concentration in the serum
- thyroid hormones (T3, T4, TSH).
Scalp analysis
Trichogram is a microscopic exam that is done by a dermatologist with which the ratio of presence of certain phases of hair growth is determined. It is required to take hairs from the whole scalp or, specifically, only from the part infected by some disease, in total 70-100 of them. After the morphology of the root is determined microscopically, the phase is determined and the percentage of hair in the certain growth phase is calculated. Normal trichogram contains 80-90% of anagen hair, 1-2% of catagen and 10-20% of telogen.
Trichoscopy is a method of epiluminescence microscopy with which also the total hair growth and presence of growth phases is analized. This is a newer method and actually a modified form of a classic trichogram.
Digital trichoscopy is a method that besides standard epiliminescence microscopy includes automatic and digital analysis of the pictures.
The search is done by shaving a part of the affected area and after three days the shaved area is died and digitally filmed with the enlargement of 20-30 times. From the obtained measures, the device with a special program calculates the ratio of anagen and telogen growth phase. Also images of the recorded area stay saved and allow a detailed inspection of the condition before and after therapy.
Advantages of trichoscopy to classic trichogram:
- The method is painless (with trichogram epilation is done – twitching 70-100 hairs).
- The method is simple and fast.
- The method allows permanent image storaging and comparing over the long period of time, which is important for controlling the therapy output.
- Possibility of getting photo documentation and digital documentation.
- Control of the therapy output
Methods of trichogram and trichoscopy are used besides for quantification of hair loss, also for monitoring and controlling the effects of therapy and improvement of the clinical picture.