Hair today, gone tomorrow

When your hair let you down

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Dr Vikas Sharma

With two recent movies Ujda Chaman and Bala focussing on the problem of premature baldness, let’s learn a little more about this dermatological condition that mostly affects men.

As in all other tissues in the human body, the hair follicle is susceptible to the ravages of age, stress and environmental factors. A full head of hair contains approximately 100,000 hairs. The loss of up to 30 per cent hair of the number that was present during the peak of adolescence can occur as one reaches mid-40s. Anxiety and cosmetic worry builds when at least 50 per cent of the hairs have fallen out in a particular area. the humans have to encounter various challenges and one realises the paramount importance of scalp hair only when one experiences the hair loss.

Alopecia or hair loss is a common and distressing problem which is often met with feelings of grief, and a lost sense of self confidence. People with alopecia not only face loss of hair, but they also feel isolated, embarrassed to seek care, and may be frustrated by misinformation, misdiagnosis or poor treatment options.

During our life time, each hair follicle undergoes continuous cycles of growth (anagen), resorption (catagen), and rest (telogen). Growth cycles of hair are important because when they go awry, that is one of the reasons we have hair loss.

Whenever anyone experience hair loss, the points to consider are:

• When did the hair loss starts?

•Was the hair loss sudden in onset or gradual? A sudden onset of hair loss is often an indication of disruption of the hair cycle (telogen effluvium) whereas gradual hair thinning typically occurs in male or female pattern hair loss.

• Where most hair loss is noticed?

•Pattern of hair lost: Determining whether the hair loss is patchy, diffused or patterned can help narrow differential diagnosis. Diffuse shedding typically occurs due to hair cycle changes. Patterned thinning involving mainly the frontal or top of the scalp is often indicative of a diagnosis of male or female pattern hair loss.

There are many reasons which cause hair loss: abnormal levels of androgens (male hormones normally produced by both men and women), Stress, illness, drugs- including chemotherapy drugs, blood thinners, and beta-adrenergic blockers used to control blood pressure, and birth control pills, Burns, injuries, and X-rays. In most instances hair grows back normally if the source of the problem is removed. Still, severe damage to the hair or scalp sometimes causes permanent bald patches. Medical conditions such as Thyroid disease, lupus, diabetes, iron deficiency, eating disorders, and anemia can cause hair loss, but when the underlying condition is treated the hair will return. A low-protein diet or severely calorie-restricted diet can also cause temporary hair loss. Autoimmune disorder Alopecia Areata is characterized by coin shaped patches of hair loss over scalp though it can affect other hairy areas over the body too. An early diagnosis and specific management can bring back the lost hair.

Male and female pattern hair loss is also known as androgenetic alopecia, but there are some key differences that are important to note. Pattern baldness due to genetic and hormonal factors tends to affect the frontal and vertex (top) portion of the scalp in men while in females it affects the central portion of the scalp, sparing the frontal hairline.

The pathogenesis involves progressive and gradual miniaturization of hair follicles, which clinically translates into the transformation of terminal follicles into vellus like hair.

When to consult:

• If you notice sudden changes in hair loss pattern, that is excessive hair loss while washing hair, combing or oiling.

• If you notice thinning of hair and visibility of scalp skin which was not visible earlier.

• If you notice textural changes in your hair.

• If you notice small areas of partial or complete hair loss over scalp.

• If you notice excessive scaling associated with itching over scalp.

After the complete hair analysis and investigative work up the treatment modalities can be worked out. If hair loss disorder is detected earlier and the severity is not much the medical treatment options are effective. The topical medicines in Androgenetic Alopecia help in increasing blood supply to hair follicles while oral medicines help by blocking conversion of testosterone to Dihydrotestosterone. Platelet rich plasma (PRP) contains a high concentration of thrombocytes. PRP carries various growth factors (GFs) that stimulate cell proliferation and differentiation thus promoting hair growth.

Hair transplant is the surgical treatment option. Since the genetic and hormonal factors do not influence the hair follicles in the occipital region (back of scalp) therefore follicle units are extracted from the occipital region of the scalp which thus becomes the donor site and relocating them to the bald area at front and vertex of scalp.

Follicular unit extraction (FUE) is preferred technique because it avoids making a linear donor site scar.

A 3000–3500 follicular-unit graft procedure via FUE typically requires 5-6 hours. However the advent of robotic arm assisted hair transplant has reduced the procedure time via couple of hours.

For 7-10 days prior to surgery the patient should refrain from using any medicines which might result in intra-operative bleeding and resultant poor grafting. Alcohol and smoking can also contribute to poor graft survival.

— Dermatologist, National Skin Hospital, Mansa Devi Complex, Panchkula