Hair Loss Causes, Types & Its Management

Hair Loss Causes, Types & Its Management

The human Scalp contains about 100,000 hairs. Due to enormous social implications of hairs, a tremendous amount of time, energy and money is expended on it in care and grooming. But despite this, many women and men are simply plagued with problems. This article is concern with hair loss, hair loss types, causes, important aspects, its management and treatment.

The two major types of hair loss are diffuse hair loss and alopecia areata. Alopecia androgenetica (male pattern baldness, sometimes known as common baldness because it can affect women) is the most common cause of diffuse hair loss. Other causes of diffuse hair loss include telogen effluvium, hypothyroidism, severe iron deficiency and protein deficiency. Occasionally, diffuse hair loss is seen after pregnancy, in chronic renal failure and with certain drugs and chemical agents.

Alopecia androgenetica may be treatable, but there are currently no treatments that the pharmacy can offer for alopecia areata. Although hair loss has been regarded largely as a cosmetic problem, the psychological effects on sufferers can be substantial. A sympathetic approach is therefore essential.

What you need to know

• Male or female
• History and duration of hair loss
• Location and size of affected areas
• Other symptoms
• Influencing factors
• Medication

Significance of Questions And Answers

Male or female

Men and women may both suffer from alopecia androgenetica or alopecia areata. Alopecia areata can affect people at any age.

History and duration of hair loss

Alopecia androgenetica is characterized by gradual onset. In men the pattern of loss is recession of the hairline at the front and/or loss of hair on the top of the scalp. In women the hair loss is generalized and there is an increase in the parting width. Another pattern of hair loss in women in the 20-plus age group is increased shedding of hair but without any increase in the parting width. This latter pattern is not due to alopecia androgenetica and it is thought that the cause may be nutritional. Hair loss in women is increasingly recognized as a problem. Alopecia areata may be sudden and result in patchy hair loss. The cause of alopecia areata remains unknown but it is thought that the problem may be autoimmune in origin. Telogen effluvium usually occurs 2–3 months after significant physical or emotional stress. The rate of hair loss increases significantly for a period of time before resolving spontaneously and returning to normal. Typically this can occur following major surgery or illness.

Location and size of affected area

If the affected area is less than 10 cm in diameter in alopecia androgenetica, then treatment may be worth trying.

Other symptoms

Coarsening of the hair and hair loss can occur as a result of hypothyroidism (myxoedema) where other symptoms might include a feeling of tiredness or being run down, a deepening of the voice, and weight gain. Inflammatory conditions of the scalp such as ringworm infection (tinea capitis) can cause hair loss. Other symptoms would be itching and redness of the scalp with an advancing reddened edge of the infected area. Referral would be needed in such cases. In women excessive bleeding during periods (menorrhagia) could lead to iron deficiency and anaemia, which in turn could cause diffuse hair loss or aggravate alopecia androgenetica. Absent or very infrequent periods are sometimes due to polycystic ovary disease or elevated prolactin levels which in both cases can result in alopecia androgenetica.

Influencing factors

Hormonal changes during and after pregnancy mean that hair loss is common both during pregnancy and after the baby is born. While this is often distressing for the woman concerned, it is completely normal and she can be reassured that the hair will grow back. Treatment is not appropriate.

Medication

Cytotoxic drugs are well known for causing hair loss. Anticoagulants (coumarins), lipid-lowering agents (clofibrate) and vitamin A (in overdose) have also been associated with hair loss. Such cases should be referred to the doctor. Other medications include allopurinol, beta-blockers, bromocriptine, carbamazepine, colchicine, lithium, sodium valproate.

When to refer

• Alopecia areata
• Suspected drug-induced hair loss
• Suspected hypothyroidism
• Menstrual disorders
• Suspected anaemia
• Treatment timescale
• Treatment with minoxidil may take up to 4 months to show full effect.

Management

Minoxidil

The only treatment licensed for use in hair loss is minoxidil, available as a 2% or 5% lotion with the drug dissolved in an aqueous alcohol solution. Propylene glycol is included to enhance absorption. The mechanism of action of minoxidil in baldness is unknown. The earlier minoxidil is used in balding, the more likely it is to be successful. Treatment is most likely to work where the bald area is less than 10 cm in diameter, where there is still some hair present and where the person has been losing hair for less than 10 years. The manufacturers of minoxidil say that the product works best in men with hair loss or thinning at the top of the scalp and in women in a generalized thinning over the whole scalp – both manifestations of alopecia androgenetica. Up to one in three users in such circumstances report hair regrowth of non-vellus (normal) hair and stabilization of hair loss. A further one in three is likely to report some growth of vellus (fine, downy) hair. The final third will not see any improvement. It is important that patients understand the factors that make successful treatment more or less likely and believe that their expectations are realistic. Some patients may still want to try the treatment, even where the chances of improvement are small. After 4–6 weeks, the patient can expect to see a reduction in hair loss. It will take 4 months for any hair regrowth to be seen, and some dermatologists suggest continuing use for 1 year before abandoning treatment. Initially the new hair will be soft and downy but it should gradually thicken to become like normal hair in texture and appearance.

Application

The lotion should be applied twice daily to the dry scalp and lightly massaged into the affected area. The hair should be clean and dry and the lotion should be left to dry naturally. The hair should not be washed for at least 1 h after using the lotion.

Caution

Irritant and allergic reactions to the alcohol/propylene glycol vehicle sometimes occur. A small amount (approximately 1.5%) of the drug is absorbed systemically and there is the theoretical possibility of a hypotensive effect, but this appears to be unlikely in practice. Minoxidil is also known to cause a reflex increase in heart rate. While this is a theoretical risk where such small amounts of the drug are involved, tachycardia and palpitations have occasionally been reported. The manufacturers advise against use in anyone with hypertension, angina or heart disease without first checking with the patient’s doctor. Although no specific problems have been reported, the manufacturers advise against use when pregnant or breastfeeding. It is important to explain to patients that they will need to make a long-term commitment to the treatment should it be successful. Treatment must be continued indefinitely; new hair growth will fall out 2–3 months after treatment is stopped. 1 year’s treatment costs About £350.

Minoxidil should not be used in alopecia areata or in hair loss related to pregnancy.

Source:

Symptoms in the Pharmacy,A Guide to the Management

of Common Illness 5th Edition.

Family Medical Care by John F. knight

Harrison’s Principle of internal Medicine