Hair loss is the most common hair disease in dermatology. Hair loss is not a diagnosis, but a problem that needs to be investigated and named. For patients, it is one of the dead ends of the labyrinth. Hair loss patients are overwhelmed and fussy about treatments.
Human hair always grows with periods of growth and rest and grows an average of 6-10 millimeters per month. Normally, daily hair loss is 50-100 strands. In cases of unusual hair loss, this number increases and it can be seen that a large amount of hair accumulates on combs, bathroom and sink waste, and clothes.
The life cycle of hair has three phases.
Anagen phase (growth phase): lasts 3-5 years. It constitutes 90% of the life cycle of the hair.
Catagen phase (transition phase): At the end of the growth phase, the hair follicles prepare themselves for the resting phase. The transition from the growth phase to the resting phase is called the catagen phase. It takes 3-5 weeks. At this stage, the hair follicles collapse into themselves, starting from the lowest areas.
Telogen phase (resting phase): The connection of the hair with the root is loosened. After this period, which lasts about 3-5 months, the hair separates from the root and falls out. A new one emerges from this place where the hair strand leaves and a new cycle begins.
In today’s article, I will examine the 3 diseases that cause hair loss most frequently and give information about the treatment steps.
Androgenic alopecia is the most common cause of hair loss. It is the miniaturization of hair follicles in genetically susceptible individuals under the influence of androgen hormones. Studies have shown that those seen at an early age have an increased risk of cardiovascular disease. In the dermatoscopy examination, there is more than 20% difference in diameter of the hair. In female cases, free testosterone, DHEA-S, and prolactin levels are checked before treatment. In addition, ferritin, which is the storage iron, should be above 70 ng/ml.
In this cluster of diseases, treatment should last at least one year. Topical minoxidil still maintains its place as the most effective work. The 5% form for men and 2% for women is used. After starting the treatment, hair loss called telogen effluvium can be seen in the first 8 weeks, this is a normal process. Another effective treatment option is finasteride, a type 2-5 alpha reductase enzyme inhibitor. With this treatment, progression is stopped in 91% of patients, and clinical improvement is seen in 66% of them. When the treatment is stopped, the hair returns to its original state after 1 year. There are publications on the development of erectile dysfunction and permanent sexual dysfunction related to the use of finasteride. Since changes can be seen in sperm count and quality, it would be more rational to recommend the drug to couples trying to have children after pregnancy. This drug has not been found to be effective in female androgenic alopecia. In studies conducted in women, an effective response can be obtained with the use of flutamide together with strict liver function monitoring.
Our second reason for hair loss is Telogen Effluvium.
It is a sudden and severe hair loss that covers the entire scalp due to the confusion in the hair cycle and the increase in the rate of hair in the telogen cycle. There are common thinning and shedding of the hair. Telogen effluvium is the reaction of hair follicles against events that cause physical and mental tension. This is the type of nervous, seasonal hair loss known to the public. It is more common in women and is especially observed in the 40-60s. It can also be at a random age. It can cause hair loss.
Anagen hairs are sensitive to many damaging factors. Hair in the telogen cycle, on the other hand, is relatively less sensitive to factors that may affect the hair. A hair in the anagen period passes into the telogen period before its time. Thus, the rate of hair in the telogen cycle increases. Telogen effluvium begins 3-5 months after the causative event.
Telogen effluvium is most commonly observed postpartum. It usually starts 2-4 months after birth and resolves itself after a few months. Sometimes spills can continue for up to a year.
Diseases with high fever such as menopause, thyroid diseases (hypo-hyperthyroidism), ovarian, adrenal gland and pituitary tumors, typhoid fever, malaria, viral diseases can create this picture. It is also seen with certain blood pressure, depression and epilepsy drugs, birth control pills, and excessive consumption of vitamin A. Cancers, connective tissue diseases, eating disorders, HIV/AIDS, iron deficiency anemia, deficiency of zinc, biotin, essential fatty acids are also causes of Telogen effluvium. Hair loss is also of this type after heavy diets and protein deficient diets, after surgical operations and accidents, and in cases of mental tension.
However, in a significant part of the cases, no obvious cause can be found. When the cause of telogen effluvium is eliminated, the problem resolves in the following 2-3 months. The ratio of telogen hairs returns to normal. However, it may take 6-12 months for the hair density to return to its initial level. However, this situation may continue in a valuable number of patients who have some hair problems. Shedding lasts for years. In this case, the disease is called “chronic telogen effluvium”.
Although it is a disease that usually resolves itself when the cause is eliminated or treated, the mainstay treatment is also applied.
Hair is fed only from the base by blood circulation. The effects of externally applied creams and lotions are discontinuous and do not provide sufficient effect. As long as they are used, they make the hair look appropriate. The most appropriate treatment is for the cause. The causes of hair loss are investigated. For example, if there is iron deficiency anemia or if there are problems with the thyroid, these problems should be treated.
Effective results are achieved when the essentials for the hair are taken orally or injected into the scalp via mesotherapy.
Our third disease is Alopecia Areata. It is a hair loss known as ringworm in public. There are patches of shedding on the scalp, eyebrows and eyelashes, and beard area. In the diffuse form, widespread hair loss on the entire scalp, eyebrow, eyelash, beard loss, and arm and leg hair loss may also occur. It has been observed that the spills, which were in the form of small patches at the beginning, turned into total shedding in 15-25% of the cases. 34-50% of mild forms resolve within one year. Dermatoscopic examination; the prevalence of yellow dots covering the entire area, hairs in the form of exclamation marks and black dots are seen.
Treatment : Potent topical cortisone drugs take the first place in the treatment in children. In adults, it can be responded with steroid injections made into the scalp. Topical minoxidil treatment alone is not sufficient in this disease. In common cases, it has been reported that 30% response is obtained in 6 months by applying contact irritating substances to these areas. Daily dose steroids and other immunosuppressive treatments take place in the treatment order, cause hair and hair growth, but the possibility of recurrence is seen above 50%. With the recently applied mesotherapy and PRP treatments, high success rates can be achieved.
Finally, I would like to briefly talk about the PRP treatment, which is successful in hair loss.
The PRP (Platelet Rich Plasma) technique is a revolutionary new treatment method in the development of contemporary medicine. PRP technique, which has recently started to be used in our country; It is an alternative treatment technique applied in areas such as hair loss, rejuvenation and regeneration of the skin layer, healing of wounds, treatment of acne scars.
It is a powerful plasma from the blood cell called thrombocyte, which has a valuable role in the beautification of tissues and blood coagulation. In other words, it can also be called autologous (self) blood concentration.
With PRP, it is aimed to revitalize weakened or dying hair follicles and hair strands and restore them to their former health. It is the process of injecting the solution obtained from the blood of the person to be applied and obtained as a result of the separation of white blood cells and platelets through special processes, into the diluted or balding area.
The clinical history of the PRP (Platelet Rich Plasma) method has been used successfully in the 1990s and until today. It has been used frequently in the fields of cardiac surgery, chronic wound healing, sports medicine, orthopedic surgery in the past to accelerate the healing of wounds in facial and maxillofacial surgeries, and is now used for cell dissociation in culture media in the laboratory. In addition, it is cosmetic indications as the last use area. It has been applied as a skin antiaging and rejuvenation technique in many countries since 2004.
The process of applying the PRP technique to the hair: The blood taken from the patient is centrifuged and separated from the red blood cells. The plasma part is subjected to a special process and injected into the thinned or bald area. White blood cells, platelets, coagulation factors and platelet growth factors (PGF) are found in the plasma obtained through a special process in PRP treatment. In this procedure, growth factor triggers the migration and proliferation of stem cells. In this way, the regeneration process in the tissue begins.
With the application, which is done once a month for a total of 3 sessions, the hair follicles are strengthened and weak hair strands do not fall out. The process is completed by applying the 4th session 3 months after the last session. It can be applied to all types of hair loss in men and women (including androgenetic alopecia, hormonal, alopecia Areata, hair loss, chronic diabetes, hair loss due to thyroid diseases, loss due to protein, iron deficiency, drugs…).