hair loss Archives -

Alopecia areata

This is a type of non-scarring inflammatory hair loss that can afflict anyone of any age. It is characterised by patchy hair loss that usually starts on the head. It can progress to involve the entire scalp, when it is termed Alopecia Totalis, and Alopecia Universalis, when the entire body is involved. It typically occurs during periods of stress.

The cause of Alopecia areata is unknown. What is clear, however, is that it is an auto-immune disorder, i.e. the body for some reason attacks the hair follicle. It rapidly causes the hair to go from anagen to telogen, causing the hairs to fall out over night. Most persons state that they wake up with coin shaped patches of hair loss where the scalp is usually non-tender, non-itchy, non-scaly and smooth or bare. Some report waking up with grey hairs overnight, as the condition preferentially attacks pigmented hairs.

Rapid Regrowth can occur, however, the hair follicles can stay in a permanent state of telogen and this can be quite frustrating.

Treatment of Alopecia areata

Topical Therapy

Persons who have Alopecia areata are usually given anti-inflammatory corticosteroids injected directly into the scalp, eyebrows, or any other area that is affected as well as topical corticosteroid creams to use at home. For persons with limited (small areas affected), this can be suitable. However, for persons with more extensive hair loss, they may require more options.

Another treatment modality that can be considered is Topical Immunotherapy with contact sensitizers. This involves the use of a highly allergenic agent such as Diphencyclopropenone (DCP) or squaric acid dibutylester (SADBE), most commonly used in Canada and Europe. These solutions are used to deliberately create an allergic reaction in the skin. In essence the compound causes the inflammatory cells acting on the hair follicle to be distracted and attack the solutions instead. The hair follicle is then left relatively free and the hair usually starts to regrow within 8-12 weeks. Most persons may need continued application of these agents indefinitely in order to keep their hair.

A newer, more novel therapy is currently undergoing trials in both mouse models and humans. The novel agent is called a JAK inhibitor. JAK enzymes are one part of the complex environment. When activated, they seem to keep the hairs in a dormant state. The inhibitors when taken orally was found to regrow hair in a person who had Alopecia Universalis. Currently, they are testing topical forms of these agents which are showing some promise.

Oral Therapy

Oral medications are used for those who have have not responded to topical therapy or are in need of their hair to grow back for an event. Oral medications that tend to be used include corticosteroids like Prednisone and immunosuppresive agents such as Methotrexate, and Mycophenolate Mofetil. The problem with oral medications is that once they are stopped, the hair tends to fall out again, which is quite frustrating. Patients have the tendency to want to continue them, but the side effect profile of these medications are not worth trying it especially for a condition that can spontaneously resolve on it its own. Prednisone can stunt growth in children or affect development of secondary sexual characteristics such as beards for teenagers. Prolonged use can also cause thinning of the bones and persons on long term Prednisone can develop diabetes or hypertension as well as a host of other issues . Methotrexate can make persons be prone to more infections.

Non medical treatment

Persons are now trying dermal needling and/or Platelet rich plasma for Alopecia areata to see if they would make a difference. Again, these are novel treatment therapies and have not been rigorously examined to see if they truly work.

For those who have failed all of the above, wigs and other hair prostheses are used as camouflage. There are numerous types of wigs available that can be used in different lifestyles.

Here’s an article by the American Academy of Dermatology on Alopecia areata

https://www.aad.org/public/diseases/hair-and-scalp-problems/alopecia-areata

Telogen Effluvium

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What is Telogen Effluvium?

Telogen Effluvium is a type of non-scarring hair loss. It is also called “Resting Phase Hair Loss”. Normally, most persons have 90% of the hairs on their head in the Anagen or “growing” phase. That stands to mean that ~10% are in Telogen, the “resting” phase. This is the phase that the hair goes into before it is shed. The new hair that will replace it grows upwards, pushing the hair out allowing for easy extraction when combing, brushing or washing your hair. The shed hair would of course have the white tip at the root.

How does Telogen Effluvium present?

Telogen Effluvium usually starts 3-4 months after the incident that triggers it. It can be Acute or Chronic. Acute cases usually last 6 months. Anything longer than that indicates some chronicity and usually hints at a persistent problem triggering the hair loss.

In general, most persons lose 50-100 hairs per day, but in Telogen Effluvium, the numbers can rise significantly. This excessive shedding is what alarms persons, as they feel that they cannot control the amount of hair that is lost. Persons usually complain of a significant amount of hair being lost when they wash their hair. Some notice their hair showing up in random places like the floor, car seat, clothes, pillow etc. Or others may notice that when they do comb their hair, an insane amount seems to come out.

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Though it causes diffuse thinning all over the scalp, persons may notice that certain areas seem thinner. Women may notice that their hair seems thinned out especially the temples, top or crown of their scalp. Their pony tail seems thinner or their “buns” are smaller than usual. Men often notice thinning in the temples.

What causes Telogen Effluvium?

There are several causes of Telogen Effluvium:

Significant stressful life events: death, divorce, bankruptcy/debt.
Rapid weight loss
Medication- both vitamins (high amounts of Vitamin A), drugs e.g. certain anti-hypertensives, anaesthetics etc.
Major surgery
Anaemia- mainly Iron deficiency
Poor diet- anorexia nervosa, fad diets, malnutrition
Significant illness – e.g. chronic diarrhoea
Post pregnancy

So how do you treat Telogen Effluvium?

Most persons experiencing Telogen Effluvium will notice that it will spontaneously resolve. However, those who have Chronic Telogen Effluvium, will need to be investigated to find out the exact cause, and have that cause corrected. Additionally, certain products like Minoxidil (Rogaine) will help the hairs to stay in the anagen stage longer, thus prolonging the hair on the head and decrease shedding over time. Once the Telogen Effluvium is resolved, the individual will not need to continue using the Minoxidil.

Treatment of Female Pattern Hair Loss

It’s been a little while since I’ve done a blog post. The last blog post was on Female Pattern Hair Loss, a very common and distressing entity. Though the the true cause of FPHL has not been completely determined, it certainly has more medical (non-surgical) treatment options than Male Pattern Hair Loss.

Medical Management of Female Pattern Hair Loss

The medical management of FPHL can be categorised into two types: Topical and Oral.

Topical Treatment of Female Pattern Hair Loss

Topical Minoxidil (Rogaine)

Like Male Pattern Hair Loss, FPHL is treated with the agent Minoxidil. The dose recommended for women is the 2% solution used twice daily or the 5% foam (available only in the brand Rogaine) once daily. To be honest, most hair loss experts like to use the 5% solution or foam twice a day as it just seems to work better. The real problem lies in one of the side effects which is excessive hair growth (hypertrichosis). It is more likely to occur in women and with the 5% concentration used twice daily. To combat this, it is best to decrease the dosing to once a day or once alternate day. Again, like with Male Pattern Hair Loss, it takes 4-6 months with continuous use, to see the benefits.

Oral Treatment of Female Pattern Hair Loss

This medical management of Female Pattern Hair Loss is has many more options for women. Men only have Finasteride (Propecia) available for use, while women typically have four major agents available. Most of these agents are anti-androgen or anti-male hormone, HOWEVER, most women with Female Pattern Hair Loss have been found to not have excessive male hormones. The interest thing however, is that they still respond to the use of these agents. Why this is so, is still being determined scientifically.

Finasteride (Proscar/Propecia)

Finasteride is also used for Female Pattern Hair Loss. This agent is a 5 alpha reductase antagonist. This therefore blocks the formation of dihydrotesterone from testosterone, stopping the more potent androgen from acting on the hair follicle. The optimal effect is at a much higher dose than what is used in men. Again, like with men, it takes about 4 months to see the benefit.

It is not recommended in women who plan to get pregnant. Persons who are in that stage of their life are advised strongly to not get pregnant whilst on the drug as because it is an anti- male hormone drug, it potentially could affect male foetuses. It however, does not stop someone from getting pregnant. In fact we advise persons to try starting conception at least 1 month after stopping the medication.

Dutasteride (Avodart)

This is another 5 alpha reductase inhibitor. However, it is more potent as an anti-androgen as it acts on two forms of the enzyme that converts testosterone to dihydrotestosterone. It is a newer agent that is use off-label mainly for post-menopausal women as it stays in the body for a much longer time than Finasteride. Again, the time to see a difference is up to 4 months of using the medication continuously.

Spironolactone (Aldactone)

Spironolactone is an anti-hypertensive diuretic aka a “water pill” that promotes loss of Sodium in the urine to help aid in dropping the Blood Pressure. It, at a low dose has been used for this indication in both men and women for more than 50 years. At much higher doses, it has anti-male hormone effects. Again, it takes 4 months to see any difference.

It is used more in women with an underlying cause of Female Pattern Hair Loss such as Polycystic Ovarian Syndrome (PCOS). It can reduce body hair on the chin and chest BUT it increases the growth of hair on the head. It is used more in pre-menopausal women.

This medication is used a lot in the United States where Diane 35 is not available.

Cyproterone acetate (Androcur)

This is another anti-male hormone medication that has been used in pre-menopausal women. It is present in low doses in certain contraceptive pills such as Diane 35 which is found in many countries other than the United States. For effective control of hair loss, Androcur is used because it is at a higher dose. Again, women are advised not to get pregnant whilst taking the medication.

Flutamide

This is another anti-androgen medication that is available in the arsenal of medication for Female Pattern Hair Loss. The problem with this medicaiton is that it can cause severe liver toxicity. Most use this as a last resort.

To get optimal effects, a combination of topical and oral modalities is preferred especially since in women the true nature of the cause of Female Pattern Hair Loss is not known.

Surgical Management

Like with Male Pattern Hair Loss, sufferers of FPHL can also benefit from hair transplantation. However, women can be poorer candidates than men because their hair loss tends to cover a much larger area from very early. It is quite a successful operation as more than 95% of the transplanted hairs will grow and stay. The main problem is that the original hairs surrounding the transplanted hairs are still being affected by Female Pattern Hair Loss. These hairs will have to be addressed using some sort of medical management or the person will have to end up doing more than one hair transplant in their lifetime. Hopefully hair cloning will be successful and will be available in the future.

Treatment of Female Pattern Hair Loss can be quite tricky, however, the results can be so life changing for women who suffer from this condition.

Female Pattern Hair Loss

Female Pattern Hair Loss is more common than people think. With men, the hair loss is quite obvious. For women, Female Pattern Hair Loss presents with general thinning across the top of the scalp and may take years before it is quite evident.

What causes Female Pattern Hair Loss?

The exact cause of Female Pattern Hair Loss has not been delineated. Unlike Male Pattern Hair Loss, where excess of Dihydrotestosterone (a male hormone) has been shown to be the main causative factor, there has been no direct association with hormonal imbalances in women. In fact, most women with this condition have normal levels of androgens (male hormones). Female Pattern Hair Loss does worsen after menopause, giving some the theory that there could be a role for a relative decrease in oestrogen, and consequently relative rise of androgens, cause hair loss.

There is, however, an inheritance pattern. Like men, women can inherit Female Pattern Hair Loss from either their mother or father. The number of genes inherited will determine how thin the hair becomes.

Presentation of Female Pattern Hair Loss

For most women, they will find that their centre part will be wider than usual. In general, they will find that the top and crown of their scalp is quite thinned out. For some they may have a more “Male Pattern” type of hair loss, with thinning and recession to the temples. The staging system used is the Ludwig Classification:

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Next month : Treatment

September’s QOM- What is Aminexil?

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Hi Doc,

Could you give me some information on Aminexil Force R capsules? What is aminexil?

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Hiya!

Aminexil Force R is a relatively new topical hair loss product produced under the L’Oreal group. Aminexil,, 2,4-Diamino pyrimidine-3-oxide, is a derivative of Minoxidil.

Minoxidil

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Amenixil

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It has been marketed as having the same positive effects as Minoxidil, i.e. hair growth, without the side effects. It is also claimed to help prevent fibrosis or scarring around the hair follicles which can be seen in late stage Androgenetic Alopecia. There has only been a few studies done on the efficacy of this molecule. Therefore, it has not been rigorously examined when compared to Minoxidil.

Is it worth trying? Only if you have already exhausted available topical and oral options.