Hair Loss and Medical Treatment

Understanding Hair Loss

Scalp hair-loss is also called ALOPECIA which may be temporary or permanent.  

All hair go through a cycle of growth and fall. During the first phase they grow for 3 to 7 years it is called Anagen phase, during the second phase they gradually thin out and fall this is the Catagen phase and lasts for around 3 weeks. After that They go into resting or sleeping phase which is called the Telogen phase and lasts for 3 months and then the cycle is repeated. At a time around 10% to 20% hair are in sleeping phase. A few hair are shed Daily and go into sleeping phase. This loss of 20 to 50 hair every day is nothing to worry about. 

Temporary hair-loss : Hair falls off but the roots remain like in severe illness, malnutrition, anemia, drugs like anti cancer therapy etc. These are reversible causes and the hair grow back once they are treated. 

Permanent hair-loss : Occurs when the roots also disappear. Permanent hair loss is some thing to worry about because if treatment is not began early the hair will be lost forever.

The most common cause of permanent hair loss is Hereditary Androgenic Alopecia commonly called as MALE PATTERN BALDNESS (MPB) among men. In MPB hair is lost at the front, sides and crown region (i.e. the top of the head). Women are usually affected with Female Pattern Baldness where there is diffuse hair loss through out the front scalp region. 

Factors causing and exacerbating Hair Loss

Temporary Hair Loss

Nutrition : Poor nutrition causes protien and vitamin deficiencies. hair are made up of protiens and vitamins and minerals help the enzymes to make these protiens so it is only logical that proper nutrition is most important for hair growth. 

Disease : Severe illness of heart kidneys and liver, anemia, drugs like anti cancer therapy etc cause temporary hair loss. These are reversible causes and the hair grow back once they are treated. 

Habits : Pulling hair tightly while braiding may cause hair loss at the hair line which is called  traction alopecia. 

Genetic makeup : Some people have sparse hair or thin hair that is determined by the genetic make up.

Smoking : smoking accelarates the natural aging process by restricting the blood flow to the skin. this increased aging of the skin as decreased collagen and elastin fibres resulting in loose wrinkles skin.

Anxiety and stress : strong emotional states are associated with increased catecholamine levels in the body which cause sytemic changes resulting in hair loss. 

Permanent Hair Loss

Recent scientific research suggests that in both males and females hair loss has a strong genetic basis along with the role of hormones. The male hormone Testosterone gets converted to Dihydrotestosterone (DHT). It interacts with the susceptible hair follicle in people who are affected by the gene and causes programmed cell death (apoptosis) resulting in hair loss. 

There are other causes of permanent hair loss as well such as trauma, invasive infections, post burn scar etc. but these constitute a very small percentage.

Medical management of Permanent Hair Loss

Even after extensive research there are only two group of medicines which are FDA approved and work in hair-loss, Minoxidil, which is available for local application, and Finasteride which is available as a pill. 

Both have a different and complicated mechanism of action but a simplification would be that they stop or prevent DHT from acting upon the hair follicle/ roots. 

So as they start working they make the hair thick again, in newly balded areas where the hair root may still be present inside they make the hair grow back again and they keep the present hair intact.

  • These medicines don't work equally in all the people. They may work very well in some and not at all in others.
  • There is no way of knowing whether they will work or not in a person in advance. They don't work equally in all the areas of the scalp.
  • They work well in the mid-scalp and crown region but less so in the front and hairline region.
  • Finasteride interferes with hormonal metabolism inside the body so it is usually not used for women.
  • Since the body continuously produces hormones and the genetic makeup can not be changed, if the medicines are working, one has to use them indefinitely. If the medication is stopped the effect will go away and hair-loss will begin again. So far this is the only solution to hold back the hair that are about to fall.

Other treatments that may be of benefit in hair loss are PRP therapy, Mesotherapy and Hair Transplant.