Hair Loss; An Overview
By: Ghadah Alhammad*
Hair loss (Alopecia), is one of the most common complaints seen by dermatologists worldwide. It can be associated with a wide variety of medical conditions which can affect the scalp alone or the entire body. There are many types of hair loss with different patterns and causes, this article will be focused on three major types: alopecia areata, androgenic alopecia and telogen effluvium.
Non-scarring sudden acute hair loss, with 75% self-recovery within 2-6 months. It can affect any hair-bearing area, ranging in severity from a solitary localized patch to involvement of the entire scalp “alopecia totalis” or the whole body “alopecia universals”. The etiology of alopecia areata is autoimmune in nature, however, family history and psychological factors also play a major role.
On examination, it manifests as well demarcated non-scarring hairless patch with pathognomonic short stubs called “exclamation point (!)”.
Treatment of alopecia areata is not necessary, as it is benign in many instances, and has high rates of spontaneous remissions. However, management options include; topical or systemic corticosteroids, immunotherapy, anthralin, minoxidil, PUVA and others.
Androgenic Alopecia (Male and Female Pattern Hair Loss)
Non-scarring androgen dependent loss of scalp hair that can affect both men and women with different patterns. In men, it starts with gradual fronto- parietal recession that usually spares the temporal and occipital areas. However, in females, the frontal hairline is preserved and there is thinning only over the crown area. Androgenic alopecia is extremely common and it is caused by a combination of genetic and hormonal factors. There is no cure for androgenetic alopecia. However, medical treatment including minoxidil can improve the condition but should be used lifelong as discontinuation will result in losing all hair that has been restored. Hair transplant is also an option but should be combined with medical treatment even after transplantation.
A common type of non-scarring alopecia where there is diffuse thinning of the hair, rather than defined bald patches. It is a reactive process caused by the body when it goes through a stressful event like; giving birth, crash dieting, major surgery, certain drugs, high fever, severe infection, iron and biotin deficiencies and many other causes. Hair thinning starts usually 3-4 months from the trigger and recovers spontaneously within 6 months. On examination, gentle hair pull test should yield at least two hairs with each pull. This gives a rough estimation of how much hair is being lost. Since it is a self-correcting condition, treatment is limited to reassurance and treating the reversible causes.
King Saud Universiy
Riyadh, Saudi Arabia