Alopecia

Hair loss can be a physiological consequence of advancing age, but it can also depend, for example, on stress.

• What is that
• Causes
• Symptoms
• Diagnosis
• Treatment

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Hair loss can be a physiological consequence of advancing age, but it can also depend, for example, on stress.

What is that

The term alopecia describes a symptom and not a particular disease. By itself it indicates the loss and failure to regrow hair (or hair) in an area where it is normally present.

Hair has a life cycle consisting of three phases, regulated by the activity of the hair follicle (the structure contained in the thickness of the skin from which the cells that determine hair growth originate):

After the hair loss, at the end of the telogen phase , the follicle left empty is reactivated starting a new anagen phase to generate another.

In humans, unlike what happens in other mammals in which the renewal of a large part of the hair mantle periodically occurs, this cyclical evolution is not synchronous, so each hair grows independently from the others: as regards the hair, under normal conditions 80-90% of the total is in the anagen phase , about 1% in the catagen phase and 10-20% in the telogen phase .

Any factor that interferes with the sequence of these phases and above all with the proliferative activity of the follicles can alter the physiological balance between hair loss and regrowth.

Causes

Different factors can determine an imbalance between hair loss and growth: the physiological involution of the hair follicles in old age, the effect of male sex hormones, a genetic predisposition, conditions of physical or psychological stress, inflammatory changes in the skin of the scalp, some systemic diseases, the effect of some drugs, nutritional deficiencies, exposure to toxic substances, mechanical factors.

The most frequent clinical forms are:

• l ‘ androgenetic alopecia, which is characterized by shortening of the anagen phase in charge of most of the follicles of the affected areas, with production of hair that do not grow and move quickly in the telogen phase; it depends on an increased effect of male hormones at the follicular level mediated by a genetic predisposition
• the telogen effluvium,which is characterized by a rapid increase in the proportion of hair in the telogen phase, and then by a much higher than normal loss; it is linked to physical or mental stress or to pregnancy / childbirth (in acute form), to thyroid dysfunction, nutritional deficiencies (in chronic form)
• the anagen effluvium, which is characterized by a drastic reduction of the proliferative activity of the follicles, and therefore by a lack of regrowth; it can be caused by chemotherapy, radiation therapy, exposure to toxic substances
• l ‘ alopecia areata, which is characterized by dysfunction of dependent follicles from an inflammatory process localized, and is often of autoimmune origin.

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Symptoms

In androgenetic alopecia , also called common baldness, the clinical presentation is somewhat different in the two sexes.

In men, who are affected much more frequently, the initially affected areas are usually the fronto-temporal ones (with the formation of the classic “receding hairline”) and the vertex, but the thinning patterns can also vary from subject to subject. onset is almost always early (around the age of 30) and the fastest progression.

In women, who are affected to a lesser extent and often in conjunction with conditions of hormonal imbalance that lead to a decrease in the activity of estrogens in favor of that of androgens (pregnancy, menopause , polycystic ovary, taking oral contraceptives ), the thinning tends to be localized in the central areas of the head (vertex, forehead), starts more slowly and progresses more gradually.

Often, but not a rule, androgenetic alopecia is accompanied by an increase in sebaceous secretion (seborrhea) and a fine peeling of the skin (dandruff).

In the forms of effluvium , in which the most striking event is the increase in the number of hairs that fall out daily, the thinning can affect any area of ​​the head and is usually widespread, occurs gradually or suddenly and progresses in an acute or chronic way to depending on the cause (stressful event, systemic disease, drugs, toxic substances, etc.).

In the forms of anagen effluvium hair loss is generally much faster and, in the absence of regrowth, it can lead to complete loss of the hair.

L ‘ alopecia areata typically presents with sudden hair loss in small well-defined patches of rounded shape that can be distributed everywhere, but more often are located in the temporal and occipital regions, ie at the sides and at the nape.

This form can affect both sexes and all age groups, although it is rare after the age of 60. Progression involving most or all of the scalp is a sporadic occurrence, unfortunately more frequent when the disease begins before puberty.

The forms of alopecia are amenable to healing, with hair regrowth in the affected areas, depending on the cause and the triggering event.

Only in male androgenetic alopecia linked to constitutional factors is the process of involution of the hair follicles, which leads to the gradual reduction of the hair, irreversible, even if it can be partially counteracted with some drugs. In the other forms, however, the removal of the cause (stress, drugs, toxic exposures, etc.) or the control of the underlying disease allow the temporarily dysfunctional follicles to resume proliferative activity.

Diagnosis

The evaluation of a form of alopecia implies first of all a dermatological examination and the execution of specific trichological tests, which allow to evaluate the prevailing evolutionary stage in a hair sample and any structural alterations of the hair stems and bulbs.

Subsequently, depending on which is supposed to be the cause of alopecia, some targeted laboratory tests may be necessary (hormonal dosages, dosages of vitamins and minerals, haematological tests, protidogram, inflammatory indices, immunological tests, etc.).

Treatment

The treatment of alopecia obviously starts from the treatment or correction of the causes when these are identifiable in a disease, an inflammatory process, a hormonal imbalance, drug therapy, a lack of nutrients, etc.

In male androgenetic alopecia it is possible to intervene, provided it is in an initial or intermediate stage, by slowing down hair loss with some drugs: minoxidil, used locally, which has a stimulating effect on the hair follicle, or finasteride (and similar molecules) from take by mouth, which blocks the excessive production of testosterone metabolites in the follicle.

In female androgenetic alopecia, preparations based on progestogens or estrogens for topical use can also be recommended.

The treatment of alopecia areata involves the use of drugs that counteract the immune process that determines it, such as corticosteroids , locally or, if necessary, systemically.

A series of preparations based on plant extracts with various effects (stimulating on the microcirculation, astringent, sebum-regulating, antiseptic, anti-inflammatory) can be useful as adjuvants for local use.

Some other drugs and plant derivatives with an antiandrogenic effect already in use with other indications are being studied, such as azelaic acid (used in the treatment of acne) or Serenoa repens extract (used in the treatment of prostatic hypertrophy ), and also the association of zinc and vitamin B6 .