Medical therapy

Effective ways of combatting hair loss

Even just a few years ago it was very difficult to obtain effective medication against hair loss - there just were not very many medicines available on the market. This situation has since changed, with a large range of different medicines now available. Treating hair loss through medication can lead to already lost hair growing again, though it is just as important to stop or at least reduce hair loss. An important part of any medication for hair loss therefore involves not unduly overstressing existing hair in an attempt to preserve it, i.e. taking preventive measures against hair loss. Drug-based treatment has a major influence on any subsequent surgical intervention, and the results of medication can often be so good that patients decide against a hair transplant. Or the results of the drug-based treatment are so good that only minor surgery is necessary. At the time of writing there are two medicines available on the pharmaceutical market which can be recommended for treating hair loss: Minoxidil (Rogaine®) and Finasteride (Propecia®).

Minoxidil (Rogaine®)

Originally developed as an oral medicine for reducing blood pressure, it was observed that this vasodilator drug had an interesting side effect: it encouraged hair growth. The drug was first introduced in the USA in 1988 under the name Rogaine and in Europe under the similarly protected brand name Regaine. It is available as a lotion and contains Minoxidil. The lotion is offered as a 2 %, 5 %, 12 % or 15 % solution, whereby a higher percentage achieves a greater effect. The 2 % solution is available in European pharmacies without a prescription, whereas the solutions with higher percentages require a prescription. The difference becomes clear when considering that the 5 % solution is 45 % more effective than the 2 % one. Minoxidil should however only be used in the 5 % (or higher) solution in consultation with one’s doctor.

Convincing results In contrast to many other medicines used to combat hair loss, the Minoxidil lotion contains no hormones at all. It has no negative effect on hormonal activity and can therefore be applied to various kinds of hair loss without problem.Minoxidil (Rogaine®) is suitable for use in both men and women. Results show that in 80 % of cases hair loss is more or less stopped, with hair growth being clearly stimulated. 8 - 30 % of users were pleased with the results. However no new hair growth occurs on completely bald patches. Very good results were achieved with patients - both men and women - who had only been suffering from hair loss (mainly at the top of the head) for the last 5 - 10 years.To achieve long-term results, Minoxidil needs to be applied directly to the scalp twice a day (morning and evening). Best results are achieved when hair has just been washed, i.e. when the scalp is wet. The treated areas of the scalp become “addicted” to Minoxidil, with hair loss restarting once the treatment is stopped. This is also the case when a combination of medicines is used. Androgenetic hair loss can be counteracted to a certain extent by the lotion, but not completely prevented. A combination of the Minoxidil lotion with other drugs such as Finasteride is often used to treat androgenetic hair loss. Studies and experience have shown that this combination is more effective than when applied separately. Minor side effects when using Minoxidil When Minoxidil is correctly used, i.e. topically and not orally, it is a very safe agent whose only possible side effects are dry skin, irritation, dizziness and headache. A slight increase in body hair and increased beard growth can occur, as, even when applied topically, small amounts of the lotion can get into the bloodstream.When taken orally it can cause unwanted hair growth of body hair. Certain doctors are of the opinion that people suffering from heart or vascular conditions may be endangered by Minoxidil.Better tolerated and easy to use - Rogaine Foam A new application form, Rogaine Foam, has recently become available on the US market. This is easier to use and is preferred by patients. Unlike Rogaine solution, the foam does contain any propylene glycol, an agent that commonly causes irritation.The foam consists of a 5% Minoxidil solution and targets men, though it can also be used by women. We will inform you as soon as Rogaine Foam becomes available on the European market.

Finasteride (Propecia®)

In most cases hair loss is hereditary, with the so-called DHT (dihydrotestosterone) playing a major role. DHT is produced with the help of the enzyme 5α-reductase out of the male testosterone hormone. It influences the growth phase of hair, contributing to the gradual demise of the hair roots. Finasteride suppresses the 5α reductase enzyme, without affecting the male hormone testosterone. Finasteride does not naturally exist in the hormonal balance, and its intake slows the action of the enzyme and decreases the concentration of DHT in the scalp. The demise of further hair roots is reduced, with already dead hair roots being stimulated to produce new hair.

Finasteride: usage and side effects Finasteride is a prescription-only drug suitable for the treatment of both men and women. Generally speaking, Finasteride tablets need to be taken once a day over a 3 - 6 month period before any visible effect can be seen. To achieve best results, Finasteride needs to be taken permanently. It is recommended that a doctor be regularly consulted during treatment. Prescription drugs can unfortunately have negative side effects. Those of Finasteride are only minor, and generally speaking toleration is very good, with any side effects only occurring during the actual treatment. The vast majority (96 %) of patients do not suffer from any side effects. Clinical studies show that a mere 3.8 % of men treated suffer from sexual side effects (decreased libido, erectile dysfunction, reduced ejaculation), all of which disappear completely after the patient stops taking the drug, even after longer-term use. Successfully fighting hair loss 86% of men participating in a study of Finasteride drug treatment and showing hair loss in the crown area noted no further hair loss or even perceived new hair growth. Studies also show that some 50% of participating men noted they had more hair within 12 months. A third study, in which men with a receding hairline and hair loss on the top of their heads participated, showed increased hair growth in 37% of all participants. Topical Finasteride Although topical Finasteride is not FDA approved yet, there have been several studies resulting in the effectiveness of topical Finasteride being very similar to oral Finasteride but with fewer side effects. Any additional information about topical Finasteride can be provided by the clinic.

Over-The-Counter drugs (OTC)

NOT VERY EFFECTIVE AGAINST HAIR LOSS! Most substances against hair loss available on the market are prescription-only. Nevertheless a number of pharmacies, drugstores and supermarkets sell over-the-counter products supposed to stimulate hair growth and at the same time counteracting any deficiencies causing hair loss. Such products are not drugs. For example, products promise to reactivate damaged hair follicles. Other products - shampoos and hair water - claim that the vitamins contained in the products renew hair. Other ingredients in dietary supplements or cosmetics (for example, tinctures or sprays), are supposed to prevent or stop hair loss. These include caffeine, hops, ginseng or other ingredients, all of whose effectiveness is unproven. The effect of these prescription-free products in preventing hair loss is only partially proven or completely unproven. Even if their descriptions appear plausible and the products come from reputable companies, there are no significant success stories attributable to prescription-free products.  Dermatologist & Hair surgeon – a winning combination for hair loss Important to recommend and clearly proven its efficiency with every type of hair loss is a visit to a dermatologist, who will provide the patient with further advise. This includes also the consideration of a dermatologic and aesthetic surgeon, who could competently consult the patient and help him through a hair transplant surgery.

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Trichotillomania

Trichotillomania (from the Greek thrix: hair and tillein: to pull and mania:mania) is not really a hair disease. It is cauded by an uncontrollable impulse to pull out one's own hair, eventually leading to patchy hair loss. In most cases psychological factors are the cause.

Trichotillomania may occur in both adults and children, i.e. it is not age-dependent. 70 - 90 % of patients are women. The age at which trichotillomania can break out varies greatly, with cases known of it affecting children of 2 or even under, or adults over 60. The basic pattern of hair loss in those suffering from trichotillomania can be very similar to that of alopecia areata. However when suffering from . There is no medication available for this disorder, with patients often needing to be referred to a psychiatrist or psychologist. The only way to solve the problem is to stop pulling out one's hair. In certain circumstances the hair follicles have already suffered irreparable damage, meaning that complete restoration of hair growth is impossible.

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Psychology

There are different causes for hair loss, ranging from genetic, hormonal or environmental ones to the concrete effects of an accident or medical treatment such as chemotherapy or an operation leaving scars. It’s no use turning to alleged miracle cures. The only way to gain certainty about the causes of hair loss, thinning hair, baldness or bald spots and its possible solutions is to consult a doctor and have our hair/scalp checked

Hair - a mirror of our health and vitality

Our appearance is influenced to a great extent by our hair. It should be seen as strong and healthy, mirroring our success and vitality and making us look young. With this in mind, we invest a lot of time, money and energy in hair care and hairstyle. From a medical/biological perspective, hair is not something we actually need. Even so, hair plays a major role in our lives, especially from a social and psychological perspective - as witnessed by the amount of attention we pay to our hair. Clichés say that it is women who spend months, if not years, of their lives looking after their hair. This is not entirely true, as this also applies – at least to a certain extent - to men. For most people, having nice hair is important. Only very few - whether men or women - are happy with what they’ve got on their heads. All sorts of products are used to dye and tint hair or to curl it. Things don’t always work out the way we want or expect, and sometimes we start losing our hair - for genetic reasons. It is men who are most afraid of this (seen as a sign of waning virility), though women are also affected.  

Hair - a status symbol

Whether our hair is straight or curled, long or short - we all want our hair to be healthy, thick, glossy and shiny. Our hair has an important role to play in the overall impression others have of us. Hair is a status symbol, mirroring our state of health, our success, our aura and our personality. Losing our hair makes us not just feel ill, it can often be the cause of major psychological problems. There are different causes for hair loss, ranging from genetic, hormonal or environmental ones to the concrete effects of an accident or medical treatment such as chemotherapy or an operation leaving scars. It’s no use turning to alleged miracle cures. The only way to gain certainty about the causes of hair loss, thinning hair, baldness or bald spots and its possible solutions is to consult a doctor and have our hair/scalp checked

Hair - a part of you

Fear of losing one’s hair is nothing new. Back in ancient Egypt, tinctures and formulations to prevent baldness were being tried out. For centuries now, attempts - many of them ripe for the curiosity cabinet - have been made to come up with a cure for hair loss. Last but not least, one’s hair is a statement of one’s personality, indicating one’s background and social status and underlining one’s individuality. Hair loss is unquestionably in most cases unpleasant, and in a number of cases associated with psychological problems and with possible negative consequences for one’s social and professional life. Men with a receding hairline, hair growing thin, a horseshoe-shaped fringe of hair or completely bald men are said to be prone to uncertainty, with fewer chances of success at work or with women - although this cannot be substantiated in any way. It is however understandable that men and women with hair growing thin are inhibited, for it is the psyche which suffers most from hair loss. Quality of life declines, and in many cases a person will feel less attractive and become hesitant.

Hair loss - bad for one's ego

The psychological effects of alopecia however go even deeper, as hair loss determines the effect we have on others and thereby our external image - an image closely related to how we see ourselves. The social consequences arising from alopecia with respect to career and partnership can often only be overcome with the help of trained therapists. If we think about the effect a full head of hair has in all walks of life, it soon becomes clear why mankind, in all cultures, has been continually looking for ways of combatting impending hair loss.

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Alopecia

Hair loss, or alopecia as it is known in medical circles, is a widespread problem of our society, affecting not just men but to an increasing extent also women. Full hair is seen as an ideal of beauty, a symbol of a dynamic character, youth and success. It therefore comes as no surprise that hair loss is often experienced as disturbing by those affected. The morning glance in the mirror gives witness to the hair loss, often causing a loss in self-confidence and consequently in quality of life.

Androgenetic alopecia in men

Androgenetic alopecia in women

Alopecia areata

Cicatricial alopecia and Pseudopelade Brocq

Alopecia diffusa

Traumatic alopecia

Androgenetic alopecia in men

Male pattern baldness or androgenetic alopecia is the most common form of permanent hair loss. This form of male baldness is for the most part attributable to hereditary factors. About one third of all men between 25 and 40 suffer from hair loss. Androgenetic alopecia in men is classified according to the severity of baldness using the Norwood Hamilton scale (see image below). This scale allows a classification of the current stage of baldness. Male baldness generally starts with a receding hairline at the temples as well as in the middle of the scalp. It then progresses until all that remains is a horseshoe shaped fringe of hair, sometimes referred to as a “tonsure”.  

  A factor contributing to baldness is the so-called dihydrotestosterone, or DHT for short. This is produced with the help of the enzyme 5α-reductase out of the male testosterone hormone. The hair on top of men's heads is particularly sensitive to this hormone. The growth phase of individual hairs becomes shorter, with hair falling out prematurely. 

Androgenetic alopecia in women

Although androgenetic alopecia is generally referred to as the male form of baldness, women can also suffer from it. Androgenetic alopecia in women is classified according to the Ludwig scale.

Androgenetic alopecia in women is characterised by thinning hair, often concentrated exclusively on the top of the head. Androgenetic alopecia in women usually appears during menopause and is only seldom seen as an indication of an undetected illness. When androgenetic alopecia appears in women before menopause is reached, it may be a sign of a hormonal disorder. In such a case - especially when the person is exceptionally hirsute or suffers from acne - an endocrinological examination is recommended to establish the cause of the hair loss. In contrast to other forms of hair loss, androgenetic alopecia is an irreversible process - once a hair has fallen out, no new hair will grow.

Alopecia areata

In most people suffering from alopecia areata, hair is lost in certain patches, only to grow again 1 - 2 years later. Such patches can be anywhere on the scalp and multiple, with a diameter of 2.5 - 5 cm. Hair can regrow in one patch, while again falling out in another patch. Alopecia areata totalis results in the scalp losing all its hair. However only a small percentage of all hair loss patients suffer from this form of baldness. In most cases, hair loss is restricted to the head. There is however one form of hair loss - Alopecia areata universalis - where all body hair (including eyebrows, beard and pubic hair) is lost. Alopecia areata is probably an auto-immune disease where the body itself attacks the hair in a destructive and sometimes irreversible manner, as if seeing hair as something alien to the body. In many cases alopecia areata is an incurable and irreversible process. This is especially the case when alopecia areata occurs when the person is still a child or when the patient suffers from other auto-immune disorders such as thyroid disease, vitiligo or allergies.

Alopecia cicatricialis & Pseudopelade Brocq

Cicatricial alopecia is a form of baldness resulting from scarring (on the scalp). Such scars can be caused by an accident, radiotherapy, burning or scalding, certain infections (including fungal infections) or a congenital anomaly. Cicatricial alopecia is easily diagnosed, as the scar tissue is smoother and often of a different colour to the surrounding skin. Pseudopelade of Brocq is a special form of cicatricial alopecia, possibly the consequence of an inflammation of the scalp, the cause of which is usually unknown. One theory is that it is caused by a disorder of the autoimmune system. Pseudopelade of Brocq leads to a scalp which in most cases is whiter and smoother than usual, due to a lack of follicle openings and scarring occurring in places. Immediately after the disorder breaks out, a dermatologist should be consulted to limit damage.

Alopecia diffusa

Most people experience a phase where excessive hair loss occurs unexpectedly. Such phases are referred to as alopecia diffusa or effluvium. Hair loss affects the whole scalp and not just patches as is the case with alopecia areata. In such a case, the number of hairs in the resting phase is higher than usual. The scalp generally shows no sign of a rash, scaling or inflammation. The causes of alopecia diffusa are not necessarily connected with the skin, but can for example be connected with a metabolic disorder. A thyroid disorder, the use of medicines in high doses, such as vitamin A and retinoids (medicines derived from vitamin A and used in the treatment of leukaemia), iron deficiency (due for example to a strict slimming diet), stress, significant vitamin deficiency, certain medications and even pregnancy are all possible causes of alopecia diffusa. Hair loss can continue 3 - 4 months after the disappearance of the disorder. Alopecia diffusa treatment targets the causes: adjusting medication, improving eating habits or avoiding contact with certain substances.

Alopecia traumatica

Traumatic alopecia is often a consequence of external factors, such as straightening curly hair, perming, colouring or dyeing hair or over tight braiding. When having a permanent wave done, the elastic band of the curler can be placed too close to the skin, leading to the hair being over-extended and possibly breaking (though it will grow again). This can happen especially with thin hair. If a hair treatment liquid is used improperly, damage may occur to the skin and / or hair. The improper use of such strong substances can cause hairs to break. Dryness, especially when thin hair is involved, can be a cause of hairs breaking off when dyeing or colouring. Hair tends to become increasingly sensitive the older you get. This means that greater account should be taken of a possible traumatic alopecia in later years when using hair care products. Hairs that have broken off can also fall out, meaning that proportionally more hairs are lost than grow again. This in turn causes hair to get thinner. Everyone has his own particular type of hair, sensitive to certain external factors. Traumatic alopecia is easily recognisable, as a large number of broken off hairs are always to be seen. The scalp looks normal, though there are differences in the number of hairs and the way these grow on the scalp. Generally speaking, there is no treatment available for traumatic alopecia. However, one can attempt to stabilise the situation by not tightly braiding hair or not subjecting one's hair to a permanent wave, dyeing or colouring.

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Learn about hair

Hair - a mixed bag A single hair contains a number of different substances, including carbon, oxygen, nitrogen, hydrogen and sulphur - and on average about 10 per cent water. The main constituent of any hair - some 90 % - is the so-called keratin, a highly structured protein also found in our upper layer of skin and in our nails. Hair - constituents like beads on a string As a molecule, keratin is made up of smaller units, amino acids, resembling beads on a string. The diameter of an individual hair varies from one person to the next, with the average somewhere between 0.05 and 0.09 mm. Keratin is a very durable substance, as witnessed by the virtually intact hairs found in Egyptian graves dating back centuries. The hair follicle The hair root is te part of the hair located in the follicle beneath the skin. It is the living part of any hair. The end of the hair follicle, also known as the hair bulb, is the part of the hair implanted in the skin. Each hair bulb contains a dermal papilla, consisting of a number of small blood vessels. Inside the skin, a hair follicle is covered by internal and external root sheaths, with the external sheath reaching up to the epidermis or upper skin layer. The hair shaft The hair shaft is the visible part of any hair, i.e. outside the skin. From a technical perspective it is dead material, containing no blood vessels or nerves. This explains why having our hair cut doesn't hurt. The hair shaft consists of three layers: An inner layer, the medulla, consisting of soft keratin and only found in thick, strong hair. The middle layer, better known as the cortex and responsible for giving hair its strength, elasticity and texture. The cortex also produces melanin, the substance responsible for hair colour. The outer layer is the cuticle layer. This is thin and transparent, consisting of several layers of flat, thin cells laid out overlapping one another as roof shingles. The purpose of this layer is to protect the cortex.

Human hairs do not grow at the same speed and intensity throughout one's life. Growth takes place in phases, in constantly repeating cycles, which are not always of the same intensity and regularity. A single hair cycle consists of 3 phases: 1. The anagen or active growth phase The first phase is also known as the active phase, as it is the only phase during which the hair root cells actually produce hair. In this phase the hair bulb remains deep in the skin, where it remains until the resting phase. Some 85 % of all hair on the head will be in the active phase at any one time. The anagen phase can last 2 - 6 years. Hair grows on average 10 cm per year, and any single hair can grow to be over one metre long. A scalp contains about 1 million hair follicles / hair roots, though generally speaking only 100,000 - 150,000 hairs are actually visible. This gives us an indication of how many hair follicles are not active. 2. The catagen or transition phase At the end of the growth phase, hair moves into a short transition phase lasting 1 - 2 weeks. In this period the hair follicles get ready for the resting period. At any one time, some 2 % of all hairs will be in this transition period. During this phase, hair growth stops, with hair follicles shrinking to about 1/6 of their normal length. 3. The telogen or resting phase Coming at the end of the transition phase, the resting phase generally lasts 5 - 6 weeks. During this period a hair does not grow at all. It nevertheless remains connected to the follicle, while the dermal papilla sinks down to the bottom, going into a resting phase. Some 13 % of all hair will be in the resting phase at any one time, though this percentage can vary between 4 % and 24 %. At the end of this phase the older hair falls out, with a new hair finding its way through the skin to the surface, where it will remain for the next few years. The hair bulb returns to its usual place and the hair re-continues its healthy growth. In the course of a person's life this cycle will be repeated 20 times on average.

Hair - good to have but not essential Hair fulfils a number of functions, meaning that it does have a purpose, though without being essential. For example, hair provides warmth when days get colder and protection when days get hotter. It doesn't matter at all whether our hair is straight or curly - hair composition and growth are very similar. Hair biology - a lifelong story Hair follicles start developing in the third month of pregnancy. By the time a child is born, on average 100,000 hair follicles have developed on its head, equivalent to 1,000 follicles per square centimetre of scalp. Follicle density declines from birth onwards, in line with the growth of a child's scull. As an adult, the total number of follicles declines to some 500 follicles per square centimetre by the time a person reaches the age of 25, to 150-250 between 30 and 50, further declining as we get even older. Peer pressure on the head - hair in bunches Hair follicles grow in random groups over the whole scalp. These groups are known as "follicular units" and consist of 1-5 hairs. On average, each follicular unit has 2-3 hairs. 3 different types of hair found in humans Lanugo hair is the fine, soft woolly kind of hair that grows all over the human foetus. In most cases, this is replaced shortly before birth by vellus hair, fine “peach fuzz” without pigment. During puberty, the increase in androgenic hormone levels causes the thinner and shorter vellus hair to be replaced with terminal hair in certain parts of the human body. Terminal hair is found not just on the head - beards, nostril and ear hairs, eyelashes, eyebrows, armpits and pubic hair as well the hair on our arms and legs all consist of terminal hair.

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