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.
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.
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.
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.
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.
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.
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.