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Alopecia Causes, Symptoms and Treatment

What is alopecia?

The alopecia is a medical term for a hair loss leaving the skin partially or completely naked. The pattern baldness , or androgenetic alopecia, is the most common form of

alopecia. It affects men especially. Hair loss is a natural phenomenon strongly determined by heredity . Other forms of alopecia can reveal a health problem or be caused by medication, for example.

Some people choose to start treatments to stimulate regrowth or limit the fall. Hair being culturally associated with seductive power , health and vitality , the treatment of alopecia arouses a keen interest. However, you should know that the result is not always satisfactory. The hair transplant can then be the last resort.

Types of alopecia

Here are the main forms of alopecia and their causes. Although alopecia primarily affects the hair, it can occur on any hairy area of ​​the body.

Baldness or androgenetic alopecia

Approximately one-third of Caucasian men are bald at the age of 30, half by the age of 50, and about 80% from the age of 70. In men, baldness is characterized by a gradual decline in edge of the hair, at the top of the forehead. Sometimes it occurs rather at the top of the head. Baldness can begin as early as the end of adolescence;

Women are less likely to suffer from baldness. At the age of 30, it affects 2% to 5% of women, and nearly 40% at age 70 . The female pattern baldness looks different: all of the hair from the top of the skull becomes increasingly sparse. Although it is often reported that hair loss tends to increase after menopause, this is not apparent in the epidemiological studies conducted to date;

Several studies are underway to better understand the causes of baldness. Heredity seems to have a major influence. In men, baldness is influenced by male sex hormones (androgens), such as testosterone. Testosterone accelerates the life cycle of hair. Over time, these become increasingly thin and short. The hair follicles shrink, then stop being active. It also seems that some types of hair are more influenced by testosterone levels. The causes of baldness in women have been much less studied. Women also produce androgens, but in very small quantities. In some women, baldness may be related to higher androgen levels than the average but the main cause is

Cicatricial alopecia.

Alopecia can be caused by permanent damage to the scalp due to a disease or infection of the skin (lupus, psoriasis, lichen planus, etc.). Inflammatory reactions that occur in the skin can destroy the hair follicles. Ringworm, a fungal infection of the scalp, is the most common cause of alopecia in children. However, at home, it is regrown in most cases;

Ringworm.

Ringworm, a fungal infection of the scalp, is the most common cause of alopecia in children. However, at home, it is regrown in most cases;

Alopecia areata. 

Alopecia areata is an autoimmune disease. It is recognized by the complete fall of hair or hair on small areas of skin. There is sometimes regrowth, but a relapse is still possible months or years later. Universal alopecia (loss of all body hair) is very rare. To learn more, see our page Pelade;

Telogen effluvium.

It is a sudden and temporary fall of hair, following a physical or emotional shock, a pregnancy, a surgical operation, a significant loss of weight, a high fever, etc. Up to 30% of the hair prematurely enters the resting phase and then falls. Once the stress is over, the hair follicles return to the active phase. However, it may take a few months;

Congenital alopecia. 

Very rare, it may be due to the absence of hair roots or an abnormality of the hair shaft. Mutations in the P2RY5 gene may be responsible for one of these inherited forms called hypotrichosis simplex, which begins in childhood in both sexes. This gene would participate in the formation of a receptor that plays a role in the growth of the hair;

Drugs, chemotherapy, etc.

Different situations can trigger hair loss. For example, nutritional deficiencies, an imbalance of the hormonal system, chemotherapy or radiotherapy treatments to treat cancer, drugs (for example, warfarin, an anticoagulant, or lithium, used in the treatment of bipolar disorders).

When to consult?

  • If your hair begins to fall by hand or plate, for no apparent reason;
  • If you want to experiment with a treatment in order to mask baldness.

The opinion of our doctor

As part of its quality approach, Passeportsanté.net invites you to discover the opinion of a health professional. Dr. Dominic Larose, emergency physician, gives you his opinion on alopecia:

Symptoms

  • Partial or generalized loss of hair or hair ;
  • Alopecia can develop in an acute or progressive way.

Precursor signs that may be related to alopecia: dull hair, itchy scalp, painful roots, excess sebum or dandruff.

People at risk

  • Family history. The men with a family member due to baldness are more likely to make too. The researchers discovered genes involved in baldness on chromosome 20 (transmitted by the father or mother), as well as on the X chromosome (transmitted by the mother). The X chromosome variant concerns genes involved in the functioning of male sex hormone receptors (androgens);
  • The Caucasians are at greater risk of baldness that Asians, Native Americans and Africans.

Risk factors

The heredity is a risk factor for androgenetic alopecia and history of autoimmune disease may be associated with alopecia areata.

Pharmaceuticals

Note that minoxidil and finasteride, even if they help to curb hair loss and stimulate regrowth , are not able to reproduce the initial hair.

Topical solution of minoxidil (Rogaine) . This medicine slows hair loss and stimulates hair growth. It may be suitable for men and women with baldness. It is used as a liquid (2% or 5% concentrate) or foam in Canada (concentrated at 5%) to be applied twice daily to the bald parts of the scalp. Hair that repels with minoxidil is less thick. The results can be judged after about 4 to 6 months. If the results are positive and you want to keep the gains, you must continue the treatment. Minoxidil is generally well tolerated. It can cause local irritation. This medicine is obtained over the counter.

Finasteride (Propecia, Proscar). Taken in the form of oral tablets, finasteride is intended for menwith baldness. Approved in 1998 to treat baldness, finasteride was first used for the treatment of benign prostatic hypertrophy. This medicine works by inhibiting the enzyme that converts testosterone into dihydrotestosterone (DHT), the form of hormone that can stop the activity of hair follicles by over stimulation. According to clinical studies, finasteride mainly slows down hair loss. It promotes hair regrowth for some only. The therapeutic effect ceases as soon as the treatment is stopped.

Spironolactone (Aldactone). For women with androgenetic alopecia in whom minoxidil is not effective, the doctor may suggest taking spironolactone as well. This molecule has an anti-androgenic effect, thus blocking hormones that play a role in hair loss.

Contraceptive pill. Some birth control pills may have anti-androgenic effects (Yasmin, Diane-35, and all pills containing desogestrel and norgestimate). This option may be interesting for a woman who, in addition to wanting oral contraception, has clinical signs of an excess of androgen: alopecia, acne, seborrhea, hirsutism (excess of hairiness), etc.

Antifungal. In case of ringworm, oral antifungals treat the infection. Local treatment is inefficient.

Surgery

Some surgical methods can be used for hair replacement, the most popular being the micrograft technique. This sustainable treatment requires time and money. The hair is removed and transplanted one by one, or in the form of small clusters, which include some skin tissue on the sides and back of the head.

Stem Cell Research

Preliminary studies suggest that it will one day be possible to make baldness reversible. In fact, according to studies conducted in the United States, the stem cells housed in the hair follicles – from which the new hair is formed – are intact in the bald areas of the skull. On the other hand, they are “inactivated”. The researchers hope to find a way to reactivate them. It will take a few more years to see the results of this research.

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