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Medication and reality

Home > Aesthetic Treatment > Hair Loss

Hair Loss overview

There are many causes of hair loss. Scalp hair-loss is also called ALOPECIA. Alopecia may be temporary or permanent. Temporary hair-loss results in loss of the hair that we see with the eyes i.e. the outside shaft but the roots remain inside. It may be a result of severe illness, malnutrition, anemia, drugs like anti cancer therapy etc. These are reversible causes and the hair grow back once they are treated. On the other hand permanent hair loss occurs when the roots also disappear.

Normal hair have a growth cycle of three phases. 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. Daily a few hair are shed and go into sleeping phase. This loss of 20 to 50 hair every day is nothing t o worry about.

The most common cause of permanent hair loss is Hereditary Androgenic Alopecia commonly called as MALE PATTERN BALDNESS (MPB). 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. Sometimes the pattern of hair loss in females may resembles MPB. 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), which is an active metabolite of testosterone. 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. Permanent hair loss is some thing to worry about because if treatment is not began early the hair will be lost forever.

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.

Why do I care ? What use are hair anyway ?

Well, there is no simple answer to this question. If you think that 'bald is beautiful' then its the end of topic for you but rest of the world may not agree. Scientifically speaking all statistical evidence till date suggests that people with a head full of hair are considered more attractive. Even the computer morphed images of bald celebrities were found to be more attractive.

'Why is it so?' is beyond the discussion here. The philosophy of beauty and the inherent desire to be beautiful has been discussed in the Aesthetics introduction. A full set of hair on the scalp frames the face, they give a signal of youth and vitality. It has an evolutionary significance. To relate it to the modern scenario it has much to do with social, interpersonal and professional interaction.

So, What is the solution for hair loss?

In case of Temporary hair loss such as nutritional deficiency, telogen effluvium or anagen effluvium, Proper nutrition with medication always works. Finding the reason for hair loss is important. The best strategy is to remove the cause and more or less wait and watch. Since it is temporary the hair will grow back eventually.

In cases of permanent hair loss,  person with hair loss actually has two problems. First he is loosing hair, the hair are thinning out and gradually diminishing and second the area where hair have disappeared has become bald and this area is gradually increasing. Both the problems have a different solution, on one hand we have to prevent the hair from falling and on the other hand we have to make some arrangements to fill the bald gap.

Lets address the problem of hair loss first. The hair gradually become thin, thinner and one day just fall off leaving behind a bald area. Hair loss usually does not occur symmetrically throughout the scalp. It has a specific pattern. Most commonly the hairline is affected first, it recedes and the forehead starts to look big. Then gradually the mid-scalp hair, behind the hair line, starts to disappear. In some people hair fall begins at the crown region or they may start loosing hair at both the hairline and as well as the crown region simultaneously. What ever the pattern of hair-loss be, the hair at the back of the head are not lost. Even an extremely bald person has a fringe of hair at the back.

Another interesting point is that not all people progress to severe baldness, most remain somewhere in between even at advanced ages.

Once the hair has fallen and the root of the hair which lives below, inside the skin, is gone no medication or treatment can bring it back. "There is no magic treatment" and anybody claiming otherwise is lying to you.

Medication - [the reality]

With all that said, till date there are no 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.

There are lots of other treatments that are advertised like Homeopathy, Ayurved, Mesotherapy, Stem cell therapy, PRP, Laser Hair Growth and many many more. We do not know whether they work or not since there is lack of proper scientific evidence. The company sponsored research articles claim much more than that is rational. Some are also advertised as FDA approved treatments. FDA approval means that the treatment is safe to use and will not cause harmful effects. It does not guarantee success of the treatment.

The second part of the problem is to address the bald regions. This is managed by hair-transplant surgery. Head over to the Hair Transplant Tab to know details about Hair transplant surgery.