Hair loss and Treatments-Updates and Perspectives

 

                               Hair loss and Treatments-Updates and Perspectives

On average, a healthy man or women’s scalp has 80000 to 120000 essential terminal hairs. Keratin is a protein that is formed in the hair follicles and is used to make hair. Hair follicles go through a series of development and rest cycles. The growth rate of hair is roughly 0.3 mm per day during growth phase, which lasts 2-6 years . The maximum length of hair that can be achieved is determined by the length of anagen phase. After a brief intermediary phase, the hair enters a rest phase that lasts 2 to 4 months before falling out . T he approximately 100000 hairs on a person’s head develop autonomously in normal circumstances. Hair growth is cyclic, compraising anagen (enlargement), catagen (involution), and rest periods (telogen). Complex communications between the epithelium and the dermis regulate active growth and rest cycle, which are still poorly implicit . In a healthy scalp, the majority of follicles are developing(92% to 96%), a small amount of involution(less than 1%),in addition to the rest is resting(5.5 to 10.5%). Hair is liberated and shed after telogen, and the next cycle begins. Day to day, till 100 telogen hairs fall out of the head, while nearly the equal number of follicles go through anagen . The length of hair is determined by the length of anagen, while the diameter is firm by the volume of the hair bulb. We are born with 10000 terminal hair follicles on our scalp that are programmed to produce healthy, thick amd long hair. Vellus hair, which is small, fine and light coloured and covers a large portion of our bodiess produced by other follicles. Systemic and local variables that affect the length of anagen and the size of the hair matrix can cause an early transition from anagen to telogen in hair follicles, culminating in visible hair loss 2-4 months later . Hormones, growth factors,medications and the seasons are just a few of the elements that play a role. Hair loss can relate to one of 2 things: an increase in the rate of hair falling out daily or alopecia. Nearby 100 hairs usually fall out every day. Inquiring about the medications that patients are taking is crucial. While almost all package inserts identify “hair loss” as a possible adverse effect, only some medications are genuinely pertinent. Women should be questioned regarding gynaecological issues such as the start or stop of hormonal contraception . Loss of hair is often associated with hair follicles transitioning from anagen to telogen. Transient postpartum effluvium is common: the stress of birth, as well as subsequent hormonal shifts, cause hair loss 2 to 4 months afterward. Chemotherapeutic medications, for example can cause hair loss 2 to 4 months afterward. Chemotherapeutic medications , for example, can cause hursh follicular damage, resulting in hairs falling out of their follicles in 1 to 3 weeks. Patients can be advised that this technique synchronizes the development phases of the follicles, resulting in hair that is frequently thicker than before once it has grow back, But it could have happened that straight regrows as curly and curly hairs regrows as straight hair.

Causes of hair loss

 Hair goes through 3 stages of growth anagen, catagen and telogen. Anagen is the longest phase, which varies by species and body place . That scalp anagen hair can live up to 3 years, where as finger anagen hair only lasts 3 months. Thyroid-stimulating hormones, as well as pregnancy hormones such as androgens, affect human hair growth. Pregnancy hormones keep hair follicles in anagen, then return them to catagen and telogen after delivery, resulting in hair shedding. Androgen, which affects hair development, is influenced by genetics, and male pattern baldness and robust beard growth are related in families . Even though several disorders that cause hair loss have been widely presented and discussed concerning pattern alopecia, as well as hypotheses on skull expansion relating to alopecia and clinical evaluation, AGA is the major focus of this article in terms of clinical significance. Androgen controls the transformation of vellus hair into thicker, terminal hairs, longer and darker in color. On the scalp, however, this hormone has a different effect, causing hair follicles to shrink, changing terminal hairs into vellus hairs. The severity of androgenetic alopecia, often known as male pattern baldness, is closely related to age

Classification of hair loss in men

 To construct the initial MPHL classification, Hamilton studied over 700 people of divers sexes, races and ages. As a result, all types of the scalp were investigated and an appropriate classification from untouched to severely impacted could be determined. The Hamliton categorization divides the scalp into two categories: “not bald” and “bald”. Types I-III are classified as “not bald”, but types IV-VIII are classified as “bald” . Type I There are bilateral recessions at the hairline’s margin in the frontoperiatal region. Type II The triangular zones of the recession on the frontoparietal area are included in this Hmilton classification, but only up to 3-4 cm anterior to line drawn in a coronal plane connecting the external auditory meatuses (middle of the coronal line). The hair on the mid-frontal border of the scalp may be affected, but not as much as on the frontoperietal region. Type III Because of scars, asymmetry, odd types of sparseness and thinning of the hair and other variables, this type reflects borderline situations and hair loss which was difficult to dignose.

 Type IV The least quantity of hair loss measured enough to demonstrate baldness. Deep triangular front temporal recessions extend posteriorly beyond the 3 cm anterior to the mid coronal line point. Furthermore, most patients, similar to type II, will experience hair loss in the mid-frontal area of the scalp. Type IVA hair loss is defined as broad band of hair loss that runs along the entire front edge of the hair line. Additional hair loss on the head can also occur in older people. Kind IV old is the name given to this type. Type V When compared to type IV, this kind has more frontoparietal recessions and hair loss on the crown area. Type VI When compared to type IV, this kind has more frontoparietal area of type VI appears as a horseshoe shape with a small island of hair on the mid- frontal area. The crown does not suffer from frontoparietal recession, but frontal hair loss is similar to type V .The hair on the mid-frontal island of variation type VIA is thin or nonexistent. Type VII and VII Both of these types of hair loss, according to Hamliton, are the most severe. These varieties have a horseshoe-shaped downturn on the frontoparietal region, but the hair loss on the crown area is not separated. The presence of a hair bunch of at least a hundred coarse terminal hairs in the horseshoe-shaped scalp area distinguishes type VII from type VIII. In comparison to the previous varieties, there is also a wider bare region on the scalp.

Classification of hair loss in female Grade 1 From the mid-scalp region to the whorl, the surface reflected light band is visible very clearly. In a U shape, it runs parallel with the parting and does not deviate from it. Grade 2 From the parietal area to the spiral, the surface reflected light band is visible very clearly, running parallel to the parting and curved ia a U shape; nevertheless, it deviates by one or more but two widths. Grade 3 From the mid-scalp area to the spiral, the surface relected light band is visible, however,it is displaced to one side or to the centre with a deviation of two more widths of the surface reflected light band. Grade 4 As the surface reflected light band moves from the parietal area to whorl, it attenuates and breaks more than one width of the light. Grade 5 Surface reflected light is hazy all around the parietal area and whorl. Light now appears as a striped column.

Treatment in men :

Androgenetic alopecia affects men in a variety of ways, from bitemporal hair loss to losing ground of the frontal and vertex area of the scalp to full baldness except the occipital and temporal fringes . Several factors confirm the diagnosis, including hair loss with a pattern, the occurrence of tiny hairs, and a young age of onset. The purpose of treatment is to enhance scalp coverage and prevent additional hair loss. The only medications licensed for encouraging hair growth in males with androgenetic alopecia in the united states are oraly administered 1 gm of finasteride every day and solutions of 2% and 5% minixidil for topical application . Both medicines can boost scalp coverage by expanding existing hairs and can also prevent future thinning in the vertex and frontal areas. If the thinning is minor, the major effect may be a delay in additional thinning. In general, 6 to 12 months , and density of hair will return to where it was before treatment.

Finasteride

 It inhibits the conversion of testosterone to dihydrotestosterone by acting as a competitive inhibitor of type 2 5areductase. Serum prostate –specific antigen levels reduced by 0.2 ng per millilitre in men 18 to 41 years old who took 1mg of finasteride daily, which was not a clinically significant reduction. Finasteride, at doses of 1mg or 5mg daily, reduces blood prostate-specificantigen levels by around 50% in older men with benign prostatic hyperplasia. To account for the drug’s effect, the findings of a prostate-specific antigen test should be twice in older men using finasteride ,

 Minoxidil

 When hair is impacted by numerous disorders, such as androgenetic alopecia, minoxidil increases hair growth. Despite the underlying reason, it lenthens anagen and enlarges undersized and sub optimal follicles. Minixidil, for example, improves hair development in people with congenital hypotrichosis, alopecia areata and loose anagen syndrome, in addition to its efficiency in patients with androgenetic alopecia. Minixidil was created to treat hypertension, and this is the most well- understood part of the drug’s activity. It is a vasidialator and potassium channel opener. It’s mechanism of action is stimulating hair growth is unknown, however, it does not appear to be dependent on vasodialation . 

Treatment in women

 Hair styling can hide androgenetic alopecia, which affects both men and women. Women’s hair thinning is frequent, although it’s most evident in the frontal and parietal areas of the scalp . The progression is milder in women as comparison to males due to differences in the quantities of 5 a-reductase and p-450 aromatase, as well as the number of androgen receptors in the hair follicles of the scalp. Even when the scalp is exposed, women usually leave an edge of hair along the frontal hair line ,

 Minoxidil

 The only medicine that can help women with androgenetic alopecia to grow their hair is topical minoxidil solution. The FDA approved the 2% minixidil solution for this use in 1991 after two week double-blind, placebo-controlled studies of 550 women aged 18 to 45 years old found it to be effective ,

How to use it

 Make sure your hair and scalp are completely dry. Apply the over-the –counter solution twice daily to every region where your hair is thinning, using the dropper or spray pump that comes with it. Massage it gently into your scalp with your fingers to allow it to reach the hair follicles. Then air dry your hair, don’t shampoo for at least 4hours afterwards .

Anti-androgens

 Andrgens, which include testosterone and other male hormones, can hasten female hair loss. Some women who do not respond to minixidil may benefit from adding the anti-androgen medicine spironolactone to their treatment for androgenetic alopecia. Tis is especially true for women with polycystic ovarian syndrome, which produces increased androgen production .

Physical therapy:

 Micro-needling

 It is a technique that involves puncturing the stratum corneum with very thin needles. When combined with other drugs like minoxidil and PRP, it has been shown to increase growth of hair. The needles micro-injuries promote skin permeability, which improves the release of hair growth chemicals to specific locations. In a 12-week randimized, evaluator-blinded study including one hundred male patients with AGA, micro-needling combined with topical minoxidil 5% for 2 times daily was compared to straight topical minoxidil therapy. The micro-needling group had a greater hair count(per cm2 contains 91.4 hair) than the control group( per cm2 contains 22.2 hairs) 

Growth factors

 How to use it: 

Make sure your hair and scalp are completely dry . Apply the over-the –counter solution twice daily to every region where your hair is thinning, using the dropper or spray pump that comes with it . Massage it gently into your scalp with your fingers to allow it to reach the hair follicles. Then, instead of shampooing, let your hair air dry . Certain cells release growth factors, which drive cell multiplication. Platelet Rich Plasma is a related concentrate of human platelets with in a tiny amount of plasma prepared by centrifugation of the patient’s venous blood and injected into the areas of hair loss. Platelets secrete platelet-derived growth factors, TGF-1 and VEGF, basic fibroblastic growth factors, endothelial growth factors and insulin related growth factors, all of which are found in PRP. These cytokines are concerned with cell proliferation .

Treatment by laser therapy

 Low-level laser treatment (LLLT) produces monochromatic, collimated light that is monochromatic and coherent. Tis coherence concentrates the energy and narrows the beam, allowing it to enter into the scalp and the hair follicles. Although the specific mechanism of action is uncertain, evidence shows that LLLT operates on mitochondria, increasing reactive oxygen species, adenosine triphosphate generation,and transcription factor induction leads to gene activation and the constructions of cell-required proteins . The FDA authorized LLLT mediated by a laser comb as a safe treatment for AGA in 2007. LEDs emit light in a variety of wavelengths , by an incoherent and uncollimated beam. They have a far lower power out put than other lasers. As a result of these circumstances, it does not penetrate as far into the scalp.A meta-analysis of the effects of photobiomodulation on AGA indicated that it is an effective therapeutic modality. LLLT was found to be substantially more successful than a laser/LED treatment combination .

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