Introduction to Alopecia
Alopecia or hair loss is a common and distressing problem both in men and women of any age, particularly when it affects the scalp. The dilemma of lost scalp hair has been well documented throughout the history of modern man. Hair loss can range from a small bare patch to a more diffuse and obvious pattern. Androgenetic alopecia (AGA) is the most common cause of hair loss in women. Although medically benign, alopecia has been shown to have notably deleterious effects on body image, self-esteem and psychologic well-being.1
Although most alopecia is a concern for cosmetic and psychologic reasons, it can occasionally be the initial sign of an important systemic disease.2 A systematic approach to the patient with alopecia will enable clinicians to diagnose the problem accurately in majority of cases. The diagnosis is based on a detailed history, physical examination and in some cases, relevant laboratory tests along with scalp biopsy.
Depending on patient’s age, etiology and distribution of the alopecia, there are different medical and surgical treatment modalities. However, treatment is not mandatory as the condition is benign and spontaneous remissions and recurrences are common. Treatment aims at the regrowth of hair in affected individuals. The available therapeutic modalities may be used alone or in combination and may be individualized to meet the specific needs of the patient.
Evolutionary Trend of Alopecia
Baldness is not specifically a human trait. The human being has evolved to become a naked monkey. Some primates such as chimpanzees and stump-tailed macaques show progressive thinning of the hair on the scalp after
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Normal Hair Growth
Hair is an important emblem of health, youth and vitality. Each day the scalp hair grows approximately 0.35 mm. The scalp sheds approximately 100 hairs per day. Each hair follicle passes through 3 phases of growth cycle as the
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There are many etiologic factors that cause clinical hair loss. These includes genetic predisposition, systemic illness, infection, diet, aging, physiological disturbances (such as stress), trauma, endocrine abnormalities, autoimmune disorders, chemotherapy, exposure of the hair follicles to topically-applied chemicals and structural hair defects.
Androgenetic Alopecia
This typical baldness that accompanies aging in most men usually begins between the ages of 12 and 40 years and is frequently insufficient to be noticed. However, visible hair loss occurs in up to 30 percent over the age of 30
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Androgenetic Alopecia...
Telogen Effluvium
Telogen effluvium is characterized by the loss of ‘handfuls’ of hair, often following emotional or physical stressors. In postpartum effluvium, the normal shedding of hair is inhibited by hormonal influences during the last trimester
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Alopecia Areata
Alopecia areata is a common form of non-scarring alopecia that commonly affects children and adolescents although it may appear equally in males and females of any age.
1The disorder is characterized by limited alopecic patches
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Alopecia Areata...
Tinea Capitis
Tinea capitis, also known as ‘ringworm of the scalp’ is caused by dermatophytes. Apart from hair loss, the condition causes also causes scaling, erythema and impetigo-like lesions. Classic tinea capitis occurs as single or
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Traumatic Alopecia
Traumatic alopecia is hair loss caused by an injury to the scalp, usually caused by styling and grooming methods that attempt to make the hair more manageable. It is a consequence of stress traction injury from tight rollers,
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Anagen Effluvium
Anagen Effluvium is the sudden hair loss which occurs as a result of exposure to chemotherapeutic agents such as antimetabolites, alkylating agents and mitotic inhibitors used in the treatment of cancer. Hair loss usually begins
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Evaluation and Diagnosis of Alopecia
A detailed history and physical examination usually reveals the etiology of hair loss. A careful history should include the duration and pattern of hair loss, patient's diet, medication use, present and past medical conditions, family
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Surgical Management of Alopecia
Surgical hair restoration is the only permanent method of treating alopecia. T he concept behind all forms of surgical hair restoration is redistribution of hair rather than addition of new hair. Surgical treatment of alopecia includes hair transplantation (macrografting and micrografting), bald scalp reductions and scalp-flap surgery.
Hair Transplantation
Hair transplantation, the most common hair-restoration procedure, is a technique in which hair follicles are harvested from the occipital (back) and lower sides of the scalp, and re-transplanted in the frontal bald area.1 There are
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Bald Scalp Reduction
Although hair transplantation is by far the most commonly performed type of surgical hair restoration procedure, some patients may be candidates for scalp reduction or scalp flaps. The procedure is recommended in selected
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Scalp-flap Surgery
Scalp flap surgery is another type of hair restoration surgery. In this technique, a single scalp flap can contain as many as 10,000 hairs, resulting in the creation of a dense hairline in just 2to3 procedures performed in an interval of several weeks. The procedure is rarely performed today as it requires a skilled and experienced surgeon and a highly motivated patient. In the hands of a well-experienced surgeon, scalp flap surgery can be a highly successful approach to hair restoration in carefully selected patients for its ability to create a dense hairline in a very short period.
- Alopecia affects men and women of all ages and often significantly affects social and psychologic well-being.
- Androgenetic alopecia, one of the most common forms of hair loss usually has a specific pattern of temporal-frontal loss in men and central thinning in women.
- Telogen effluvium is characterized by the loss of ‘handfuls’ of hair, often following emotional or physical stressors.
- Alopecia areata, traction alopecia, trichotillomania and tinea capitis have distinctive features on examination that help in diagnosis.
- Early recognition of the cause of hair loss may facilitate timely treatment and prevent further hair loss.
- The evaluation includes a personal and family history, physical examination and laboratory investigations.
- An organized diagnostic and management strategy will help to establish the cause of alopecia and to direct the course of therapy.
- Although alopecia is usually treatable and self-limited, it may be permanent.
- Management should always involve assessment of the psychological effects of alopecia.
- Oral finasteride and topical minoxidil are the only proven medications for AGA.
- Hair transplantation is the most common hair-restoration procedure.
- Follicular-unit grafting is the gold standard for hair transplantation.
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Written by: Healthplus24 team
Date last updated: March 24, 2009