Fact About Baldness – Baldness in a medical term named alopecia. Androgenic alopecia is a common form of hair loss in both men and women. This baldness condition in men also known as male-pattern baldness, and in women named female pattern hair loss (FPHL). Androgenic alopecia (AGA) is considered to be the most common type of baldness characterized by progressive hair loss. It is estimated that prevalence rates in Caucasian populations is around 30% for men in their 30s, 40% for men in their 40s and 50% for men in their 50s.1
In the Indian context, a population based study of 1005 subjects showed a 58% prevalence of AGA in males aged 30-50 years. In oriental races, a lower prevalence has been shown.2 In a Chinese study by Wang et al.,1 the overall prevalence was 21.3%, while in a Korean study, the overall prevalence was 14.1%.3 All studies demonstrate a gradual increase in incidence with age.4
In women androgenic alopecia, a study by Norwood,4showed a total prevalence of around 19% in a population of 1006 Caucasian patients. In a Chinese population study, the prevalence was only 6.0% and a Korean study had a relatively similar lower prevalence of 5.6%, suggesting that like in men, the prevalence is considered to be lower in oriental races compared to Caucasians.1,3 The incidence of AGA in women also tends to increase with age.4,5
Do you know if our hair has a cycle of life?
Fact about Baldness – A normal hair cycle has 3 stages: Active growth phase or Anagen, Regression phase or Catagen, Resting phase or Telogen.
Anagen is the active growth phase of hair follicles during which the root of the hair is dividing rapidly, adding to the hair shaft. During this phase the hair grows about 1cm every 28 days. Scalp hair stays in this active phase of growth for 2-7 years. At the end of the anagen phase an unknown signal causes the follicle to go into the catagen phase.6
Catagen is a short transition stage that occurs at the end of the anagen phase. It signals the end of the active growth of a hair. This phase lasts for about 2-3 weeks while the hair converts to a club hair. A club hair is formed during the catagen phase when the part of the hair follicle in contact with the lower portion of the hair becomes attached to the hair shaft. This process cuts the hair off from its blood supply and from the cells that produce new hair. When a club hair is completely formed, about a 2-week process, the hair follicle enters the telogen phase.6
Telogen is the resting phase of the hair follicle. When the body is subjected to extreme stress, as much as 70% of hair can prematurely enter the telogen phase and begin to fall, causing a noticeable loss of hair. This condition is called telogen effluvium. The club hair is the final product of a hair follicle in the telogen stage, and is a dead, fully keratinized hair. 50 to 100 club hairs are shed daily from a normal scalp.7
Does the baldness in all populations are the SAME?
Fact about Baldness – Baldness or in medical terms named alopecia, has many types due to the etiology that caused baldness. Alopecia divided into 2 main groups, Non cicatricial alopecia and cicatricial alopecia(Scarring hair loss, also known as cicatricial alopecia, is the loss of hair which is accompanied with scarring. It can be caused by a diverse group of rare disorders that destroy the hair follicle, replace it with scar tissue, and cause permanent hair loss). The non cicatricial alopecia type: Androgenic Alopecia, Alopecia areata, Telogen Effluvium. Anagen Effluvium, Loose Anagen Syndrome, Trichotillomania, and Traction Alopecia. Cicatricial Alopecias type : Chronic Cutaneous Lupus Erythematosus, Lichen Planopilaris, Central Centrifugal Cicatricial Alopecia.9
I. Non Cicatricial Alopecias
- Androgenetic Alopecia(AGA)9
Androgenetic alopecia (AGA) is a multifactorial disorder caused by interactions between several genes and environmental factors.4 Also known as patterned hair loss, is the most common type of alopecia in both men and women. Although AGA is a physiological condition, the psychological impact of hair loss can be profound. Half of men are affected by age 50, whereas 40% of women are affected by age 70 (Norwood 1975, 2001).
Male pattern: Thinning of the frontal hairline, bitemporal recession, hair loss at the crown, Female pattern: Hair loss at the crown with preservation of the frontal hairline. Caused by the effect of dihydrotestosterone on hair follicles leading to miniaturization.9 The duration of anagen phase in AGA gradually decreases and that of telogen phase increases. As the duration of anagen phase determines the hair length, the maximum length of the new anagen hair becomes shorter than that of its predecessor, leading to miniaturization and eventually a bald appearance.7,9
- Alopecia Areata9
Equally affects both sexes, with usual onset before age 30. Most common areas of hair loss are scalp and beard regions. Caused by autoimmune destruction of hair follicles involving cell-based and humoral immunity.
- Telogen Effluvium9
Acute telogen efﬂuvium is characterized by diffuse scalp hair loss lasting < 6months, whereas the duration is >6month for chronic telogen efﬂuvium. Women between ages 30 to 60 are most commonly affected. A stressor event may or may not be present, usually occurring 2–4 months before onset of hair shedding 20%–50% of scalp hairs transition prematurely to telogen phase and are shed with normal hair shafts.
- Anagen Effluvium9
Diffuse hair loss characterized by hair breakage during anagen phase. Classic causative agents are radiation therapy and cancer chemotherapy. Affects 80%–90% of scalp hairs with onset within 1–4 week of exposure. Narrowing, fractured hair shafts constitute a characteristic sign.
- Loose Anagen Syndrome9
Typical patient is a blond female aged 2–5 who presents with diffuse hair loss and short, dull hair 6:1. Female to male ratio among the patient population, which includes adults and dark-haired individuals as well Greater susceptibility to hair breakage caused by premature keratinization of the inner root sheath, causing impaired adhesion with the hair shaft cuticle. Shorter anagen phase leads to reduced hair length.
Patients experience an irresistible urge to pull out their own hair despite negative impacts to their occupational and social function. Childhood trichotillomania affects more boys than girls and resolves spontaneously. Adult trichotillomania affects women much more frequently than men. Often comorbid with mood or anxiety disorders. Short, fractured hairs distributed sparsely and irregularly in affected areas.
- Traction Alopecia9
Results from tension applied to hair for a prolonged period of time, from hairstyles such as tight ponytails and braids, as well as hair-styling devices. Areas under greatest pressure are most affected, usually scalp margins. Especially common among African-American females because of their association with certain hairstyles. Typically hair loss is transient; scarring or inﬂammation may be observed.
II. Cicatricial Alopecias9
- Chronic Cutaneous Lupus Erythematosus
Scaly, erythematous plaques(a big patch redness in the scalp) with well-demarcated borders that eventually atrophy(decrease in size of a body part, cell, organ, or other tissue), found on sun-exposed areas including scalp. Most common form is discoid lupus erythematosus, accounting for 50%–85% of all cases. Affects more women than men, usually between ages 20–45 Associated with carpet tack sign, describing follicular spikes on the undersurface. Cases among African-Americans are often more severe.
- Lichen Planopilaris9
Considered to be a variant form of lichen planus . Classic lesions are smooth white areas with absent follicle ostia and central scarring; edges are characterized by erythema and scaling around hair follicles. Mostly affects adult women at the crown and parietal areas of the scalp. Due to autoimmune attack on hair follicles mediated by T lymphocytes.
- Central Centrifugal Cicatrical Alopecia
Scarring hair loss that usually begins at the crown and expands outward to affect the entire scalp. Middle-aged African-American females are most commonly affected; individuals of other races rarely present with this condition. May be associated with chemicals and pressure applied to hair Lymphocyte-rich inﬁltrates observed at edges of balding lesions with signs of inﬂammation.
Treatment You Need
There are many types of alopecia. Each of it has different etiology and different kind of treatment. From topical medication, oral medication, mesotherapy, microneedling treatment, light treatments, hair transplant, and also cognitive behavioral therapy/CBT (for Trichotillomania).
This is a piperidino pyrimidine derivative and potent vasodilator that is effective orally for severe hypertension. Minoxidil was first approved in 1979 by the FDA for the treatment of hypertension. It’s 2% and 5% were approved for the treatment of male AGA in 1988 and 1991, respectively. In Female Pattern Hair Loss, 2% minoxidil was approved by the FDA in 1991 and a 5% minoxidil foam with once daily application was approved in 2014.10
2. Hair Supplement (Viviscal)
A double-blind, placebo-controlled study evaluating the efficacy of oral hair supplement in women showed women aged 21 to 75 years of age who were in generally good health, but complained of self-perceived thinning hair. Subjects were randomized in double-blind fashion to receive hair oral supplement (Viviscal Maximum Strength) or placebo. Viviscal contains AminoMar C™ marine complex, a proprietary blend of shark and mollusk powder, an organic form of silica derived from Equisetum sp. (horsetail), vitamin C derived from Malpighia emarginata (acerola cherry), microcrystalline cellulose (E460), natural orange flavor, magnesium stearate, hypromellose, and glycerol. Subjects were instructed to take one tablet of their assigned treatment each morning and one tablet each evening with water following a meal.11
When women with thinning hair were treated with the study medication, the mean number of terminal hairs in the target scalp area increased from 271.0 at baseline to 571 after three months of treatment and increased further to 609.6 after six months. Both were significantly greater than the mean number of terminal hairs among placebo-treated subjects at baseline (256.0), which remained unchanged throughout the study. These results support the hypothesis that Viviscal increases hair growth in women with thinning hair.11
Mesotherapy or intradermal therapy(injected into the scalp) is a technique defined as multiple intradermal injections or pharmaceutically active substances in low dose, at numerous points, near/over the affected sites, at longer time intervals than conventional routes. Once the drug is administered, it achieves a longer lasting effect and a great local bioavailability . The injectable blend for mesotherapy may contain several drugs. In one case report a 47-year old healthy male with a complaint of hair loss and the patient had diffuse thinning on his scalp hair and recession of the frontal and temporal hairline(Hamilton-Norwood Scale IV) without evidence of inflammation or scarring. He also had a positive family history of hair loss.
The patient received 10 sessions of sterile injectable blend containing 1ml minoxidil 0,5%, 1ml finasteride 0,05%, 2ml biotin 5mg/ml, and 2ml D-panthenol 50mg/ml, with total volume of injection is 6ml per session. At the 10th session, we noted a significant improvement in hair density, less hair fall, and an increase in hair thickness. We decided to maintain the injections for more than 10 sessions due to a good clinical response. The patient reported remarkable hair regrowth, and the photographic assessment showed excellent improvement after the 20th session (Figure 1). The treatment was well‐tolerated, with no evidence of adverse events.12
4. Platelet Rich Plasma (PRP)
Platelet-rich plasma (PRP) is an autologous source of growth factors derived from platelet sequestration and concentration via gradient density centrifugation. And its gained popularity in the treatment of androgenic alopecia.13
Microneedling is a minimally invasive dermatologic procedure in which fine needles are rolled over the skin to puncture the stratum corneum. Through the physical trauma from needle penetration, microneedling induces a wound healing cascade with minimal damage to the epidermis that induces collagen formation, neovascularization, and growth factor production of the treated areas. Microneedling has shown promising results as an adjuvant therapy for enhanced drug delivery in the treatment of atrophic scars , AGA, alopecia areata, and pigmentation disorders such as melasma. 14
That’s all article fact about baldness that we can share to you. Wish that discussion will help you to know fact about baldness well. See you on the next articles!