Hair loss (alopecia) – symptoms and treatment

Moderate Hair Loss: Causes and Concerns

Moderate hair loss is a natural physiological process. On average, a person loses about 100 hairs per day, often going unnoticed. The hair’s life cycle consists of asynchronous periods, where a small percentage of hair is in the shedding phase while new hair begins to grow in its place.

Typically, individuals become concerned about hair loss when experiencing:

• Increased hair shedding over a certain period.
• Aesthetic changes, such as visual widening of the part, scalp visibility through the hair, complete absence of hair in a particular area, thinning, bald patches, or total hair loss on the scalp or other parts of the body.

Prevalence:
Hair loss issues are prevalent worldwide: statistics show that approximately 60-70% of men and 25-40% of women experience some form of hair loss. Hair-related conditions account for about 8% of all dermatology and trichology consultations.

Causes of Hair Loss:
Several factors can contribute to excessive hair loss or thinning, including:

• Physiological states associated with hormonal changes: newborn period, postpartum period, post-pubertal period, and old age.
• Psychological stress: Stressful situations trigger the release of cortisol, which can negatively impact hair follicles.
• Nutritional deficiencies.
• Period following surgeries or trauma.
• Illnesses accompanied by a fever above 38.5°C, with hair loss potentially worsening even after a brief temperature rise.
• Use of certain medications, including fibrates, vitamin A and its derivatives, nonsteroidal anti-inflammatory drugs (NSAIDs), anti-estrogen drugs, antidepressants, cytostatics, lithium preparations, beta-blockers (selective and non-selective), anticoagulants, derivatives of 6-aminoquinoline, thyroid drugs, interferon-alpha preparations, anticonvulsants, anti-Parkinson drugs, anthelmintics, antiviral and some antibacterial drugs, neuroleptics, derivatives of hydroxychloroquine, triazole derivatives, oral contraceptives, dopamine agonists, and others.
• Problems with the hair follicles, such as a hereditary increased sensitivity of follicles to hormonal effects.
• Local scalp skin diseases: seborrheic dermatitis, microsporia (fungal infection of the skin, hair, and nails), erythroderma, and others.
• General body illnesses: endocrine, immune, hormonal, genetic, etc.
• External trauma and damage to the scalp.

The simultaneous combination of several causal factors and similar issues in parents increase the risk of active hair loss.

This illustrates the complexity of moderate hair loss, which can be influenced by various internal and external factors. Understanding these factors is crucial for appropriate management and treatment strategies.

Symptoms of Hair Loss

Hair loss can be either physiological or pathological. Physiological hair loss is associated with the hair’s life cycle, during which approximately 60 to 100 hairs are shed per day, which is considered normal.

There are situations when the biological equilibrium is normal, meaning not more than 100 hairs are lost per day, but it occurs simultaneously, making it seem like hair is falling out in clumps. This typically happens in the following cases:

• When the hair has been tightly styled all day.
• When there has been a long interval between hair washes or brushing.

Sometimes, the number of fallen hairs is much less than 100, but the overall appearance of the hair deteriorates, and thinning is observed. This can occur in the following cases:

• No new hair grows in the place of fallen hair.
• The hairs themselves become thinner.

Pathological hair loss can manifest differently depending on the underlying condition. In some cases, the deterioration of the hair’s condition is gradual, and individuals may not immediately notice the problem. In such cases, some characteristic signs can be observed.

Hair Loss Symptoms in Men:

• The hairline gradually recedes higher, moving away from the eyebrows and temples.
• Hair gradually becomes thinner and lighter, and the amount of hair decreases, visually manifesting as areas of thinning.
• Without correction, thinning becomes more pronounced and noticeable. This negative trend is observed not throughout the entire scalp but only in specific areas, while hair continues to grow in the same volume and quality in other areas.

Hair Loss Symptoms in Women:

• Unlike men, hair thinning in women usually begins in the frontal area. Sometimes it can take on the characteristic appearance of a “Christmas tree”: hair thinning and loss are more pronounced in the central part closer to the forehead, and then the thinning area narrows along the hairline, taking on a triangular shape.
• Without correction, the negative trend worsens, and hair becomes sparser and thinner, making it more difficult for patients to grow their hair longer.
• Gradually, the hairline widens, and the scalp becomes visible through the hair. Hair length does not recover.

Another scenario is when hair starts falling out very suddenly and abundantly. In such cases, the symptoms may include:

• A large amount of hair remaining on combs, bedding, towels, in the bathtub drain, and on everyday objects.
• Areas of thinning or bald patches appearing on the scalp.
• Rashes and redness on the scalp.
  Patients can self-assess whether hair loss is pathological by:

1. Recalling events from several months ago. Was there significant stress, a rise in body temperature, or the use of any medications or supplements?
2. Analyzing how long the active hair loss has been going on. Has this period exceeded 3-4 months?
3. Taking a small lock of hair (about 50-100 hairs) from the temple area, running it between the fingers, and gently pulling it. Then doing the same with a lock from the crown area. If after this test, more than 5-7 hairs remain in the hand, then the problem exists.
4. Observing the condition of the temples (particularly relevant for men and women in menopause). If there are temporal recessions (hair loss around the temples), then the problem likely exists.
5. For men: comparing hair density on different areas of the scalp. If there are areas with significantly less hair, the condition is considered pathological.
6. For women: dividing the hair on the head into two parts and evaluating the resulting hairline. If it significantly widens towards the forehead, the problem likely exists.

Complications of Hair Loss

The main complication of hair loss is a decrease in quality of life and emotional dissatisfaction with one’s appearance, which can affect self-confidence.

While increased hair loss and thinning do not pose a direct threat to health, many patients, especially those who are emotionally sensitive, may develop an exaggerated concern about the issue. Constant attention to the quantity and quality of fallen hairs, anxiety about the expected deterioration in the process, and the spread of affected areas contribute to even greater psychoemotional tension and can lead to a vicious cycle. All of this can result in social maladjustment, depressive states, and apathy.

Diagnosis of Hair Loss

Various methods are used for diagnosing conditions characterized by hair loss, including collecting medical history, physical examination, and laboratory and instrumental studies.

Medical History

During patient interviews, attention is paid to factors that could have triggered various forms of alopecia. These factors may include past, concurrent, or chronic illnesses, the use of medications and dietary supplements, as well as the presence of similar problems in close relatives.

Physical Examination

Visual examination of the scalp is conducted to identify any signs of skin lesions, assess the severity of thinning, and evaluate the overall condition of the hair. It is also important to examine other parts of the patient’s body, including the nails, as changes in nail plates can be an important diagnostic criterion.

The pull test or hair pull test is a subjective method for assessing the activity of hair loss. The physician takes a strand of 50-70 hairs and, gently pulling it between their fingers along the entire length of the hair. The test is considered positive if more than 6 hairs fall out. This test allows for a preliminary assessment of hair loss activity in different areas of the scalp.

Instrumental Diagnosis

Diagnostic trichoscopy is performed using a special device called a trichoscope. The image from it is displayed on a computer screen. This method allows for imaging of the hair structure, assessment of the condition of the scalp, the degree of hair loss, follicle status, and sebaceous gland activity. Trichoscopy is painless, does not cause discomfort, and has no side effects. No special preparation is required for the examination.

Laboratory Diagnosis

• If necessary, clinical and biochemical blood tests are performed to check ALT, AST, total protein, bilirubin, cholesterol, blood sugar, and alkaline phosphatase levels.
• Iron deficiency conditions are often ruled out by determining hemoglobin, ferritin, transferrin, and total iron-binding capacity in serum.
• Thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), and their free fractions, as well as antibodies to thyroid structures, may sometimes need to be determined.
• Additional tests, including hormone level determination, antibodies to DNA, and antinuclear antibodies, may be prescribed to exclude conditions such as lupus erythematosus in cases of additional complaints from the patient.

In diagnostically challenging cases, histological examination may be performed for differential diagnosis and diagnosis confirmation.

Treatment of Hair Loss

The choice of treatment strategy for hair loss depends on the type and activity of the process. Some factors are temporary, and hair growth resumes to its previous volume after their cessation. Other factors require correction and treatment, and the earlier therapy is initiated, the fewer hair follicles will be involved in the pathological process.

Medicinal Treatment

Medications used to treat hair problems include:

• Inhibitors of androgen metabolism: These are first-line drugs for treating androgenetic alopecia.
• Stimulators of growth factors: The only substance from this group that is successfully used to correct androgenetic alopecia is minoxidil. To achieve a visible effect, the drug must be used for a minimum of 9 months. However, hair loss resumes after discontinuation.
• Hormonal and non-hormonal anti-androgenic drugs.
• Glucocorticoids: Successfully used to treat patchy alopecia.
• Antimetabolites and immunosuppressants for the treatment of common forms of patchy alopecia.
• Biological preparations, such as Janus kinase inhibitors, may be used in special cases.
• Platelet-rich plasma (PRP): This method involves using plasma enriched with platelets, which are rich in growth factors that stimulate tissue regeneration. The resulting solution is injected intradermally or subcutaneously.
• Mesotherapy: This method involves the injection of various medicinal substances intradermally. The effectiveness is based on the reflexogenic effect of the injections and the pharmacological action of the drug.

Surgical Treatment

In addition to therapeutic methods, surgical procedures such as autologous hair follicle transplantation from areas where hair growth and quality are not compromised are used. The downside of the method is the non-guaranteed viability of follicles in new areas.

Physiotherapy

Physiotherapeutic methods are used as part of the comprehensive treatment of alopecia. These include cryomassage, darsonvalization, PUVA therapy, galvanization, electrophoresis, and phototherapy. However, there is currently insufficient scientific data to prove the effectiveness of these methods.

Prognosis and Prevention

It is impossible to predict the course of the disease with certainty. With timely detection of the problem and initiation of treatment, the prognosis in most cases will be favorable. However, the prognosis for hair loss depends largely on the underlying condition:

• For diffuse alopecia: The prognosis is favorable. After identifying the negative factor and discontinuing its effect, hair may resume growth in its previous volume and quality.
• For androgenetic alopecia: The process will be favorable with timely correction. The earlier the treatment is started, the more healthy follicles will remain.
• For patchy alopecia: The prognosis depends on the extent of the lesion and the presence of damage to the nail plates. If there are single patches on the scalp, the prognosis is favorable: after medical correction, hair will regrow in the previous quantity. If a patient has subtotal, total, or universal forms, the likelihood of complete hair regrowth is 10%.
• For persistent, stubborn hair loss, with no rational treatment: The prognosis may become unfavorable, and the patient may completely bald.

Hair regrowth may be worse if the patient has concurrent diseases or a family history of hair loss. Late initiation of alopecia treatment and psychoemotional stress caused by concerns about hair loss also have a negative impact.

As prevention of hair loss, it is recommended to:

• Timely treat concurrent diseases.
• Take medication only as prescribed by a doctor.
• Avoid stress.
• Include more fresh herbs and vegetables in the diet.
• Perform scalp massage.