Hair Loss
A look at the biology of hair loss. Male-pattern hair loss or androgenic alopecia may often make individuals anxious.
Types of Hair Loss
Hair loss may be divided into two broad groups based on the appearance of the scalp skin. In non-scarring alopecia, the scalp skin appears normal. In scarring or cictricial alopecia, there is change in the scalp skin and subsequent permanent loss of the hair follicles. This in turn leads to atrophic areas of baldness on the scalp which appear shiny due to lack of follicle openings.
Non-Scarring Alopecia
Male Pattern Baldness – Androgenic alopecia
Male pattern baldness is alluded to medically as ‘androgenic alopecia.’ It forms the most common type of hair loss and is due to abnormal sensitivity to androgen hormones. Genetic factors also play a role as evinced by strong family histories. The clinical picture is of frontal recession of hair and thinning of the crown. In females, the frontal recession is often less marked and occurs at a later age. In females, this type of hair loss may be part of a wider endocrine pathology such as polycystic ovary syndrome. If this is the case, patients may often have acne and menstrual problems.
Treatment of male-pattern baldness is not highly successful with non-responder rates around 30-40%.
Topical 5% minoxidil lotion is one medication of choice which also acts on potassium channels. Oral finasteride at a dose of 1mg daily may also be used. This drug acts by inhibiting the enzyme 5-alpha reductase type II and as such may cause loss of libido as a side effect.
Alopecia Areata
This is hair loss which is part of an autoimmune disease. It often affects children leading to patches of alopecia. Regrowth of hair may occur, often followed by new patchy hair loss. The hallmark of this disorder is tapered hairs, which are thicker and more pigmented at the tip. These are referred to as exclamation mark hairs. Sometimes, total scalp hair loss or total body hair loss may also occur. Fingernails may also undergo changes and appear pitted.
Treatment of this condition is often unsuccessful. Despite being immune-mediated, steroids are of little use. The same can be said for topical immunotherapy such as diphencyprone. Wigs and pastoral support are often of benefit to patients.
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