Medical Analysis for Baldness

Medical Analysis for Baldness

The following is a brief medical discussion and outline of Baldness, its terminology, classification, diagnosis, and treatment. It was prepared for informational purposes only by a well-respected physician, who strongly advises that all individuals seeking treatment for baldness or baldness-related problems, undergo a complete medical evaluation for such problems, by a board-certified dermatologist, before initiating any treatments for these conditions.

Hair growth occurs in cycles. Every cycle consists of:

A long growing phase called anagen, followed by;

A short resting phase called telogen, after which the hair falls out. This falling out is called catagen.

Following catagen a new hair begins growing in the follicle, thus starting a new cycle. Anagen for eyelashes and eyebrows is about one to six months; anagen for scalp hairs is about two to six years. Normally, 100 scalp hairs reach the end of telogen daily and fall out. When more than this number go into telogen daily, this is called telogen effluvium, and noticeable hair loss occurs.

Growth of hair in men and women is controlled by androgens (male hormones). The androgen testosterone stimulates hair growth in the pubic area and under arms; and the androgen dihydrotestosterone (DHT) stimulates growth of the beard.

Baldness (alopecia) is of cosmetic or psychologic concern; but at times may be a major sign of systemic disease.

Alopecia may be:

Nonscarring and Diffuse
Nonscarring and Focal
Scarring and Focal

Nonscarring Diffuse Hair Loss

Male Pattern Baldness (androgenetic alopecia); common; familial; related to male hormone; genetic; starts at temples or top of crown and can spread causing widepread thinning or nearly total loss.

Female Pattern Baldness involves hair thinning frontally, parietally, and on the crown, and is also related to male hormone and genes.

Telogen Effluvium refers to loss of scalp hairs because many hairs enter the resting phase simultaneously; often caused by drugs such as anti-cancer drugs, ACE inhibitors, beta blockers, oral contraceptives, lithium, warfarin, H2 blockers, and others; it also may be caused by nutritional deficiencies and by stressors like surgery, psychiatric problems, thyroid disease, other hormonal conditions, childbirth, and menopause.

Anagen Effluvium refers to loss of scalp hair in its growth phase and is commonly caused by radiation, by anti-cancer drugs, mercury, thallium, boric acid, and vitamin A toxicity.

Trichodystrophies (primary hair shaft abnormalities) include bamboo hair, bubble hair (related to excessive hair dryer use), knotting of hair (due to excessive scratching or rubbing), and beaded or brittle hair (a rare genetic disorder).

Congenital Disorders of Hair include wooly hair nevus (tight coils of hair); the uncombable hair syndrome; hair shafts that break easily leading to broken stumps; and brittle hair due to an error of sulfur metabolism.

Nonscarring Focal Hair Loss

Traction Alopecia is frontal, and temple hair loss is due to traction from pony tails, braids, and hair rollers.
Tinea Capitis refers to hair shaft and scalp infection by various molds or fungi.
Trichotillomania is a psychiatric disorder due to hair teasing, pulling, or twisting and has obsessive-compulsive features.
Alopecia Areata is probably an autoimmune disorder with genetic components, and is treated with corticosteroids.

Scarring Focal Hair Loss

This involves destruction of hair follicles by a number of unusual primary disorders as well as by burns, injury, radiation therapy, infections, cancer, and lupus erythematosus.

Diagnosis of alopecia

This involves the following:

Noting the pattern of baldness
Looking for possible underlying systemic disease
Taking a drug history
Taking an endocrine or hormone history
Doing the “pull” test: extraction of greater than 6 hairs in the telogen phase is abnormal
Doing the “pluck” test
Performing microscopic examination of hair
Doing a scalp biopsy
Performing fungal and bacterial cultures of hair
Doing immunofluorescence studies of hair
Counting lost hairs daily

Treatments of alopecia

The treatments for alopecia are:

Finasteride (never used in women because of possible ill effects on a male fetus’ developing external genitals); is a 5-alpha reductase inhibitor that interferes with DHT production, which, in turn stimulates androgenetic alopecia
Minoxidil increases blood flow to the hair follicle; new hair falls out 3-4 months following its discontinuation
Hair follicle transplants (surgery)
Scalp flaps used (surgery)
Alopecia reduction (surgery)
Wigs and toupes
Alternative and complementary topical products, many of which contain various herbs, and which may or may not have undergone random, placebo- controlled clinical trials or tests for safety.

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