Alopecia (Hair Loss)

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Last Medical Review: April 5, 2020
Medically Reviewed by Dr. Elisabeth Vincent Hamelin
Hair Loss Treatment (April 5, 2020)

What it is and how it manifests itself

It is normal for an adult person to lose a certain number of hairs every day and that this loss may become more consistent with advancing age. There is talk of alopecia, however, when the fall intensifies to determine more or less large areas of the head without hair. There are several forms of alopecia: in humans, the most frequent form is the androgenic alopecia, the common baldness, which affects 80% of males by age 60 (but also afflicts many women after menopause). Male hormones, androgen (hence its name) and genetic predisposition play an important role (it is more frequent in people with a bald father). In humans it manifests itself in a typical way, with a slow and progressive retreat of the front-temporal line and thinning at the top: the hair of these areas would seem genetically predetermined to fall due to the presence in the bulb of particular structures (receptors) sensitive to hormones. In women, hormonal changes after menopause can lead to an increase in hair loss which manifests itself as widespread thinning.  

Hormone Substance, produced by a gland, which is introduced directly into the blood and affects the activity of one or more organs of the body.

Another less frequent form of alopecia is the so-called aerated alopecia, in which a rapid hair loss is observed from well delimited areas of the head, often circular and with rather sharp limits. In aerated alopecia, hair loss can affect not only the head but also the beard and other hairy surfaces. It suddenly arises and has an unpredictable pattern. The cause is unknown and often the disorder resolves on its own within a few months, especially if it affects an adult, but the hair that grows back looks different from the normal one, being more similar to a fine hair. Relapses are frequent. Other causes of alopecia can be infectious diseases or certain pharmacological treatments. In fact, many medicines cause hair loss which, however, is generally reversible when treatment is stopped. This phenomenon is frequent especially with anticancer drugs but it can also be induced by antithyroid drugs, derivatives of vitamin A taken by mouth, anticoagulants, oral contraceptives and some pressure medications (beta-blockers).  

Telogen effluvium

It is a very particular condition of alopecia that occurs when a large number of scalp follicles pass simultaneously in the telogen phase (death of the hair). There is then an abundant hair loss with thinning and appearance of alopecic patches. Telogen effluvium usually follows, after 2-4 months, a stressful event, such as an illness, psychic trauma, childbirth. It can affect adults and children regardless of gender. It does not require any treatment. Hair loss due to its size can alarm but is generally transient, lasting for 2-3 months and then resolving spontaneously.

What are the risks

No form of alopecia represents a real health risk. The consequences are purely aesthetic. Hair problems, however, are often experienced with excessive apprehension with respect to actual gravity and can lead to psychological problems.  

The treatments

  • Above all, the treatment of androgenic alopecia enjoys a thriving market where the promises far outweigh the actual possibilities of treatment. Baldness does not have a definitive treatment and you need to be very careful with the “miraculous cures”. There is no scientific documentation of efficacy for vitamins, minerals (such as zinc, iron, copper), amino acids (such as cystine and proline) and the reality is very different from the results of many products. A study was recently conducted whose purpose was to establish the effectiveness of unconventional therapies such as aromatherapy (frictions with essential oils of thyme, rosemary, lavender, etc. on the scalp) in patients with alopecia areata: the results are have been quite encouraging, but further investigation will certainly be needed to evaluate the real effectiveness of these alternative treatments.
  • For those who do not resign themselves to a “physiological” phenomenon, as genetically determined, in recent years products have become available that can give discrete results in male pattern baldness, but to maintain the results that are obtained it is necessary to continue the use for life. A medical prescription is required for their purchase.
    The minoxidil, available in 2 and 5% lotion (Aloxidil), is a powerful vasodilator used for years in the treatment of hypertension. Its use in the treatment of androgenic alopecia is based on the occasional observation of abnormal hair growth in a number of patients taking the drug to control high blood pressure. It is not known exactly what is the mechanism behind this effect: it is believed that the drug increases the size of the hair follicles. However, the results are not guaranteed for everyone. In fact, studies indicate that only about a third of treated patients obtain the growth of a cosmetically acceptable hair, generally the younger subjects with a still reduced baldness. The effects are visible only after a few months of treatment but the application of the drug must be continued indefinitely because if you stop it, a recovery of hair loss is observed after a short time.
    The side effects are mainly contact dermatitis, local irritation, itching, dry skin and erythema. Dizziness and an acceleration of the heart rate, and a drop in blood pressure in the event of an overdose may appear.
    There finasteride (Propecia), was recently marketed in a 1 milligram tablet formulation for the oral treatment of androgenic alopecia. Also in this case the discovery of the potential utility in baldness was accidental: the drug was in fact created to treat the enlargement of the prostate (e.g. Proscar, commercially available at a dosage of 5 milligrams not suitable for anti-baldness use). Patients taking the drug reported noticing hair growth within a few months and this stimulated researchers to study its possible use in alopecia.
    Finasteride acts with a hormonal mechanism by blocking the formation of the hormone that induces hair loss. Almost half of the men treated considered their hair satisfactory after a year of treatment.
    The drug must be prescribed by the doctor and can only be taken after prostate problems have been ruled out because the treatment may hide them. The most ” relevant ” side effects that emerged during the studies are: reduction of sexual desire, impotence and decrease in sperm fluid. The effects disappeared after stopping the drug.
    In women of childbearing age, the drug is absolutely contraindicated for the possible appearance of malformations of the genitourinary system of male children. The women themselves, according to a warning from the manufacturer, should not even handle broken or chopped tablets. Whoever thinks of undertaking this treatment must also take into account the economic burden to be sustained for life as the treatment cannot be interrupted, on pain of losing any results achieved.
  • In cases of aerated alopecia, many treatments are limited to inducing an inflammatory reaction on the lesion. Retinoic acid is one of the substances used, among others we mention stearic acid, squaric acid, diphencyprone. In fact, however, in most cases the disease continues in its bizarre and unpredictable course without being greatly influenced by the drugs and no treatment seems effective in the long run, even those that achieve some immediate results. Even in aerated alopecia there are treatment options that must be used by experienced doctors and specialists in dermatology.
  • Autotransplantation, skin expansions, real or artificial hair implantation, scalp lifting are all transplantation techniques performed in a myriad of Trichological Centers that have sprung up all over Italy. For those who choose such a route, only one recommendation applies: check the seriousness and professionalism of those you rely on by giving preference to the most proven techniques.
  • In all cases where it is possible to identify the cause that causes hair loss, it will obviously be necessary to intervene on it.

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