Hair and Scalp Disorders Treatment- Dermatology, Hair Restoration/ Transplant

Hair is an important aspect of one’s appearance. It contributes to an individual’s self-confidence and personal style. Aside from this, our hair also protects the scalp from the sun’s ultraviolet rays. Since the hair is easily visible, disorders that affect the hair and scalp can cause not only physical disfigurement but also emotional and psychological issues.

What is hair loss?

It is normal for people to lose about 50-100 hairs per day. Excessive hair fall (>100 hairs per day) warrants a visit to the dermatologist for further examination and proper management.

Causes of hair loss

There are many factors - both intrinsic and extrinsic, that can cause hair loss. These include:

• Family history
• Hormonal changes
• Other medical conditions
• Medications
• Stress
• Various hairstyling techniques and treatments

Diagnostic tests for hair loss

Multiple tests are available to evaluate hair loss conditions. Depending on your symptoms, your doctor may perform or encourage any of the following tests:

• Hair pull test – usually done by your doctor at the clinic. Approximately 50-60 hairs are grasped and pulled by your doctor. A positive test denotes active shedding.
• Dermoscopy/ Trichoscopy – involves the use of a special instrument called a dermatoscope, which allows magnification and easier examination of the scalp skin, hair follicle openings, and hair shaft.
• Blood tests – done to check for any underlying medical conditions (such as thyroid problems) that could cause hair loss.
• Biopsy – a skin sample is taken from the scalp. This allows your doctor to view the specimen under a microscope.

Types of hair and scalp disorders

1. Androgenetic alopecia (AGA)

AGA or female/male pattern baldness is the most common type of hair loss. This occurs due to a genetic predisposition, especially in men. There is gradual hair loss that follows a specific pattern distribution. For men, hair typically begins to recede at the frontal hairline, mainly in a triangular pattern. Then the hair on the top of the head (vertex) will begin to thin, until the top of the scalp is completely bald. For women, the frontal hairline is spared, but there is thinning of the hair on the centroparietal region of the scalp.

2. Telogen effluvium

Telogen effluvium is an abrupt type of hair loss that mostly affects women aged 30-60 years. There is significant, diffuse hair shedding, usually described as hair coming out in handfuls. This happens when the body experiences a “shock” to the system or from a stressful event usually around 1-3 months before the hair fall started. There is a wide variety of triggers which include hormonal changes, childbirth, stress (physical or psychological), drastic weight loss or crash diets, certain medications, major surgery, accidents, endocrine and thyroid disorders, nutritional deficiencies, severe infections, chronic illnesses, and many more. Telogen effluvium can last for several months, but once active shedding is over, the scalp hair thickens once again. This condition does not cause balding and is mostly only temporary.

3. Alopecia areata

Alopecia areata is an autoimmune disease wherein the immune system mistakenly attacks the hair follicles, which causes inflammation and leads to hair loss. There is loss of hair on oval or round patchy areas on the scalp, but it can also affect other parts of the body. Nail changes such as nail pitting can also occur. More severe cases of alopecia involve the loss of all the hair on the scalp (alopecia totalis) or loss of hair on the entire body (alopecia universalis).

4. Traction alopecia

Traction alopecia occurs when there is chronic tension on the hair shaft. This happens when hair is often braided or tied back too tightly.

5. Scarring alopecias

Scarring alopecias destroy hair follicles irreversibly and cause permanent hair loss. Some examples include:

• Folliculitis decalvans – results from an abnormal immune response to bacteria (Staphylococcus aureus) that destroys the hair follicles and skin of the scalp. It appears as atrophic, red patches on the scalp, with inflamed margins. It can be associated with itch and/or pain.
• Frontal fibrosing alopecia – appears as hair loss on the scalp, starting with a receding hairline and eventually hair loss on the frontal and temporal areas of the scalp. Other body parts may also experience hair loss, such as the eyebrows, beard area, arms, legs, and pubic area. It is believed to be an autoimmune condition, but the cause is still relatively unknown.

Treatment options

• Minoxidil solution – a topical solution that helps in the regrowth of hair. Twice daily application for at least 6 months is one of the most effective ways to stop hair loss and increase the thickness of the hair in cases of AGA. Possible side effects include contact dermatitis, irritation, and unwanted hair growth on the temples or on the sides of the face where the solution may drip.
• Finasteride – is an alpha-reductase inhibitor. It is given at a dose of 1mg per day, and is effective in treating AGA in men. Some side effects include diminished sex drive and sexual function, gynecomastia, as well as a decrease in libido. Finasteride is not approved for use in women.
• Anti-androgens – may be given to female AGA patients with hormonal problems.
• Topical/ Intralesional injection of corticosteroids – can be used to treat alopecia areata, especially for patients with few hairless patches on the scalp.
• Antibiotics – given to patients with folliculitis decalvans for a duration of months to years, as treatment of this condition may be long and difficult.
• Hair restoration surgery – a supplementary procedure usually done for AGA patients. The patient’s existing hair from healthy parts of the scalp is redistributed to the balding areas. Studies show that this procedure helps thicken the hair of men and women affected by AGA.
• Platelet-rich plasma (PRP) injections – Plasma (liquid portion of blood) is injected into target areas in the scalp of patients with AGA. Studies on PRP are very promising as it is shown to promote hair growth and prevent hair loss.
• Camouflage techniques – using appropriate hairstyles, wigs, and other hair extension techniques affected areas can be camouflaged, especially for conditions with permanent hair loss.

Take-Home Messages

There are different kinds of hair and scalp disorders with each having its own treatment options. It is important to inform your doctor about other medical conditions you may have, as well as any maintenance medications, smoking habits, family history of hair problems, and stressful events that may have triggered these issues. A consultation with a dermatologist is recommended in order to get to the root of the problem and tackle the treatment options available for your condition.

References:

• Alopecia Areata - Hair loss Causes & Living With It | NIAMS. (2017, April 4). National Institute of Arthritis and Musculoskeletal and Skin Diseases; NIAMS. https://www.niams.nih.gov/health-topics/alopecia-areata
• Hair loss - Diagnosis and treatment - Mayo Clinic. (2022, March 26). Mayo Clinic - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hair-loss/diagnosis-treatment/drc-20372932
• Hair loss types: Frontal fibrosing alopecia overview. (n.d.). American Academy of Dermatology. Retrieved April 4, 2022, from https://www.aad.org/public/diseases/hair-loss/types/frontal-fibrosing-alopecia
• Jimenez, F., Alam, M., Vogel, J. E., & Avram, M. (2021). Hair transplantation: Basic overview. Journal of the American Academy of Dermatology, 4, 803–814. https://doi.org/10.1016/j.jaad.2021.03.124
• Platelet-Rich Plasma (PRP) Injections | Johns Hopkins Medicine. (n.d.). Johns Hopkins Medicine, Based in Baltimore, Maryland. Retrieved April 4, 2022, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/plateletrich-plasma-prp-treatment
• Telogen Effluvium: A Review - PMC. (n.d.). PubMed Central (PMC). Retrieved April 4, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606321/
• Telogen Effluvium Hair Loss. (n.d.). American Osteopathic College of Dermatology. Retrieved April 4, 2022, from https://www.aocd.org/page/telogeneffluviumha
• Telogen effluvium (hair shedding)  | DermNet NZ. (n.d.). DermNet NZ – All about the Skin  | DermNet NZ. Retrieved April 4, 2022, from https://dermnetnz.org/topics/telogen-effluvium#:~:text=Telogen%20effluvium%20is%20the%20name,the%20shape%20of%20the%20root
• UpToDate. (n.d.). UpToDate – Evidence-Based Clinical Decision Support | Wolters Kluwer. Retrieved April 4, 2022, from https://www.uptodate.com/contents/folliculitis-decalvans#H472589760
• Wolff, H., Fischer, T. W., & Blume-Peytavi, U. (2016). The Diagnosis and Treatment of Hair and Scalp Diseases. Deutsches Ärzteblatt International. https://doi.org/10.3238/arztebl.2016.0377

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