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 worried about treatments.
Human hair grows with periods of continuous growth and rest and grows an average of 6-10 millimeters per month. Normally, daily hair loss is 50-100 strands. In cases of abnormal hair loss, this number increases and excessive hair accumulation can be seen on combs, bathroom and sink drains, and clothes.
The life cycle of hair is 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 period to the resting period is called the catagen phase. It takes 3-5 weeks. At this stage, the hair follicles collapse into themselves, starting from the deepest parts.
telogen phase (resting phase): The connection of the hair to 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 stages.
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 disease group, treatment should last at least one year. Topical minoxidil is still the most effective product. 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 hair ratio in the telogen period. There are common thinning and shedding of the hair. Telogen effluvium is the response of hair follicles to events that cause physical and psychological stress. This type of nervous, seasonal hair loss is known among the society. It is more common in women and is especially observed in the 40-60s. It can happen at any age. It can cause hair loss.
Anagen hairs are sensitive to many harmful factors. Hair in the telogen period 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 period 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 spontaneously 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 some 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 psychological stress.
However, in most 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 significant 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, supportive treatment is also applied.
Hair is fed only from the bottom by blood circulation. The effects of externally applied creams and lotions are temporary and do not provide sufficient effect. As long as they are used, they only make the hair look good. The most appropriate treatment is for the cause. The causes of hair loss are investigated. For example, if there is iron deficiency anemia or problems with the thyroid, these problems should be treated.
Effective results are achieved when the substances necessary for the hair are taken orally or injected into the scalp with the mesotherapy method.
Our third disease is Alopecia Areata. It is a hair loss known as ringworm among the people. Patchy spills occur on the scalp, eyebrows and eyelashes, and beard area. In the form of diffuse, diffuse hair loss on the entire scalp, eyebrow, eyelash, beard loss, and arm and leg hair loss may also occur. It was 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: In children, drugs with potent topical cortisone take the first place in the treatment. In adults, a response can be obtained with steroid injections made into the scalp. Topical minoxidil treatment alone is not sufficient in this disease. It has been reported that 30% response in 6 months is obtained by applying contact irritating substances to these areas in common cases. It takes place in the treatment order in daily dose steroid and other immunosuppressive treatments, causes hair and hair growth, but the probability of recurrence is seen above 50%. High success response can be achieved with recently applied mesotherapy and PRP treatments.
Finally, I would like to briefly talk about the PRP treatment, which is successful in hair loss.
PRP (Platelet Rich Plasma) method is a new treatment method that creates a revolutionary development in the development of modern medicine. The PRP method, which has recently started to be used in our country; It is an alternative treatment method applied in areas such as hair loss, rejuvenation and regeneration of the skin layer, healing of wounds, treatment of acne scars.
It is plasma rich in blood cells called thrombocyte, which plays an important role in the healing 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 with special processes, into the diluted or bald area.
The clinical history of the PRP (Platelet Rich Plasma) method has been applied 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 now it is used for cell dissociation in culture media in the laboratory. It is also cosmetic indications as the last area of use. It has been applied as a skin antiaging and rejuvenation technique in many countries since 2004.
The process of applying the PRP method 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 balding area. In the treatment of PRP, white blood cells, platelets, coagulation factors and platelet growth factors (PGF) are found in the plasma obtained with a special process. In this method, growth factor triggers the migration and proliferation of stem cells. In this way, the regeneration process in the tissue begins.
With a total of 3 sessions once a month, 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 due to chronic diabetes, thyroid diseases, loss due to protein, iron deficiency, drugs…).
