Androgenic hair loss

Androgenic hair loss is also called male or female hair loss as the hair loss is due to genetic programming, or hormonal influence. Hair loss is affected by androgenic hormones (testosterone).

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Telogenic hair loss

Telogenic hair (hair in the resting phase) has a hair follicle at the end of the hair. If all the hair follicles enter the synchronized resting phase, you may experience sudden hair loss. It occurs 2-6 months after an event that stops active hair growth. Reasons can be:

• Pregnancy (usually occurs 3 months after birth, during the breastfeeding period, but is not related to whether you breastfeed or not).
• Fever
• Weight loss
• Bleeding
• Surgery, illness or psychological stress
• Medications, such as birth control pills, blood thinners, or epilepsy medications.

Sometimes there is no definite cause and hair loss can persist for years.

Androgenic hair loss

Androgenic hair loss is also called male or female hair loss as the hair loss is due to genetic programming, or hormonal influence. Hair loss is affected by androgenic hormones (testosterone).

• Androgenic hair loss is visible in about 50% of all adults by the age of 50.
• Male pattern is manifested by the hair first becoming thin in the temple and forehead region. Later, the thinning spreads to the ice, and the hairline moves from the forehead further and further back.
• After menopause, the level of female sex hormones decreases, and male sex hormones become more dominant. With age, therefore, many women will experience thinner hair growth on top of their heads. In women, hair loss is more diffuse, and it is not as pronounced as in men. Women with polycystic ovary syndrome (PCOS) may also experience this type of hair loss.

Hair shaft

There are conditions where the hair shaft itself has reduced strength so that the hair breaks or splits up. The cause may be genetic defects that lead to weaknesses in the proteins that make up the hair. There are several variants of this condition, some of which are part of genetically determined syndromes (for example, Netherton syndrome). Some may be acquired due to illness or injury (for example, excessive hair brushing, hair extension (trichotillomania), hair dryer heat, chemicals, bleaching.

Skin disease

Skin conditions that can cause reversible blemished hair loss, poor hair quality or thinning of hair are:

• Localized alopecia areata.
• Localized hair infection, such as scalp fungus – tinea capitis.
• Localized skin disease such as psoriasis, seborrheic dermatitis, atopic eczema, pityriasis rubra pilaris, cutaneous lupus, cutaneous T-cell lymphoma.
• Generalized skin disease (erythroderma).

Systemic disease

Hair growth can also be affected by underlying disease.

• Severe deficiency conditions such as general calorie deficiency and protein deficiency, lead to thin hair and hair loss.
• Specific vitamin deficiency, especially B vitamins, zinc or iron can affect hair growth, but rarely is this a cause in Norway.
• Metabolic disorders, such as low or high metabolism, can be the cause of thin hair and hair loss. Hair loss can be the first symptom of the disease. It may therefore be relevant to examine the metabolism in hair loss.

Scarring skin diseases

Inflammation of the dermis or subcutaneous tissue can damage the hair follicles and cause hairless areas without signs of hair follicles. This is called scarring or cicatricial alopecia. Traumatic scarring can be caused by:

• Damage
• Surgery
• Radiation therapy
• Traction (tight braids)
• Central centrifugal cicatricial alopecia.

Infections that can cause scarring alopecia:

• Bacterial infections that cause deep hair follicles and abscesses (yellow staphylococci)
• Tinea capitis: Kerion which means a deep fungal infection of the scalp.
• Virus infection: Shingles

Inflammatory skin disease that can cause scarring alopecia:

• Foliculitis decalvans
• Dissecting cellulite
• Lichen planopilaris
• Frontal fibrosing alopecia
• Alopecia mucinosa
• Discoid lupus erythematosus
• Localized scleroderma

Pseudopelade of Broque is an end stage of scarring hair loss where the hair follicles have disappeared without signs of inflammation.

Complications

Whatever the cause, there can be extreme psychological strain that can affect quality of life and lead to psychosocial problems. Without normal scalp hair, there is also an increased risk of sunburn and the development of sun damage.

See a doctor?

If you experience abnormal, for you, large hair loss, you can see a doctor. If you have signs of scalp disease, it is a good idea to consult a dermatologist to get the correct diagnosis and treatment.

Diagnosis

The doctor will take a careful medical history and examine the skin. The doctor can perform:

• Traction test; the doctor pulls on the hair to assess the amount of hair that “loosens”
• Wood lamp – examines with a special lamp to look for signs of fungal infection.
• Bacteria or virus test
• Skin scraping for examination mtp fungal infection
• Blood tests to check vitamin status, metabolism, hemoglobin and iron levels.

Treatment

Depends on the diagnosis.

• Infections should be treated
• Deficiency conditions such as iron deficiency must be treated
• Medications that cause hair loss are stopped
• Treat underlying skin disease or condition
• Regulate metabolic disease with medication

Treatment may be appropriate for different conditions. For androgenic alopecia, you can use Minoxidil which stimulates hair growth and which can be effective to a certain extent as long as you use the product, but it is expensive. Finasteride is another drug that was originally used to treat benign prostate enlargement, but which also affects the inhibition and to some extent reversal of hair loss. The treatment can delay the process, but when the treatment is stopped, the hair loss will eventually pick up again. This medicine is on prescription and on so-called registration exemption.

How to prevent hair loss?

Unfortunately, most causes of hair loss can not be actively prevented. However, it can be helpful to be gentle on the hair strands with, among other things, the use of mild shampoo.

• Dry your hair naturally or with a hair dryer with cold air
• Minimize chemical treatments (hair bleaching)
• Use loose hairstyles to avoid traction damage to the hair roots.

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