Hair Loss: What Men And Women Should Know? Hair loss can have many causes and lead to hairlessness (alopecia). What stops hair loss? Where are the boundaries between normal and pathological? overview
What is hair loss?
- A single hair on the pillow, three more in the sink and five in the hairbrush – this is not hair loss yet, but completely normal. Each hair has a limited lifespan, stops growing, falls out, and a new one grows back. And: with increasing age, the hair in most people becomes a little lighter.
- If more than about 100 hairs are lost every day – in children: more than 50 to 80 –, and that over a few weeks, or if individual hairless areas arise, then one can speak of hair loss. It is only too understandable that he puts a lot of strain on those affected, especially at a young age.
- Hair loss can lead to hairlessness. The technical term for this is alopecia or alopecia. The hair loss itself (technical term: effluvium) can be temporary, then the hair grows back on its own. However, if the hair roots have been irrevocably damaged, for example by burns or diseases with scarring hair loss, then no new hair will form on the affected area.
The following animation shows you the main forms of hair loss, the following text goes into more detail. The other chapters of the article supplement this information, including with regard to diagnosis and therapy.
Hair loss: the main forms and causes
Plant-related hair loss (androgenetic alopecia): the very common hair loss in men and women
Hair Loss: What Men And Women Should Know? Plant-related hair loss affects – with a typical appearance in each case – about two-thirds of men and almost every second woman. With a presence of 95 percent in both sexes, it is the most common form of hair loss ever.
Even if the suffering pressure – in both sexes – is often very high: pathological hair loss is not caused by the plant. The health insurance companies, therefore, do not cover any costs for the treatment.
Plant-related hair loss: men
- Symptoms: receding hairline at the temples and/or thin hair in the area of the upper head. Over time, this can expand into baldness on the forehead and back of the head until only a hairline is left (male pattern baldness). The first signs usually appear already in adolescents. With aging, hair glades increase. The earlier the onset – this is determined genetically – the more pronounced the course will be.
- Causes: Progressive shrinkage of scalp hair roots that are hypersensitive to the male sex hormone dihydrotestosterone (DHT, an androgen) and no longer form strong hair. The blood hormone levels are normal.
- Diagnosis: See the section “Hair loss: Diagnosis” below.
Note: If therapy is desired, ask the doctor or pharmacist beforehand exactly what effects and side effects can be expected.
Suitable is minoxidil solution 2% or 5% or minoxidil foam 5%, in each case 2-x per day, or finasteride 1 mg (oral tablets, important information on this in the chapter “Plant-related hair loss” in this article), if necessary also a hair transplant. More about hair transplantation is also in the chapter “Plant-related hair loss”.
Plant-related hair loss: women
- Symptoms: Thinning hair, especially in the vertex area. It can also gradually lighten more to the rear and sideways here. However, baldness usually does not occur. Even if some sufferers already notice a tendency to have finer hair on the top of the head in their teens, androgenetic hair loss usually only becomes more noticeable after menopause.
- Cause: The extent to which an increased androgen sensitivity of the hair roots also plays a role in women is still unclear in detail.
- Diagnosis: See the section “Hair loss: Diagnosis” below.
- Therapy (see also note on therapy for men above): Minoxidil solution 2% or 5% or minoxidil foam 5%, depending on the preparation 1 or 2 times a day for application; hair transplantation should be considered individually only after careful examination.
Circular hair loss (alopecia areata): bald spots, as if punched out
Hair Loss: What Men And Women Should Know? If bald patches that appear to be punched out develop on the head, less often also on the face – eyebrows, eyelashes, beard – in a short time, it is usually an alopecia areata (circular hair loss).
In Germany, according to estimates, well over a million people suffer from it. It mainly affects children and young people, less often this alopecia occurs beyond the age of 30.
Alopecia areata is an autoimmune disease. The body’s own tissue is attacked, here hair roots on the scalp, sometimes also on other hairy parts of the body.
- Development of symptoms: On the one hand, it can lead to long-lasting, complete hair loss. On the other hand, in over 80 percent of those affected, the bald patches eventually close again. There are all possible variants in between. The clinical picture is therefore unpredictable. The nails can also be affected. Rarely, with an acute “push”, lymph nodes behind the ears can swell.
- Diagnosis: See the section “Hair loss: Diagnosis” below.
- Therapy: The chapter “Circular hair loss (alopecia areata): Symptoms, therapy” informs about this and further about the clinical picture in this article.
Attention: Women are more likely to have circular hair loss at any age than men. If hair loss suddenly occurs in a child, which is by no means “normal”, it must be thoroughly examined to find out and treat the underlying cause, for example, alopecia areata (but there are also many other ways, see the chapters “Diffuse hair loss” and “Hair loss: Special forms and Causes”).
Diffuse hair loss: hair consistently thinner
Hair Loss: What Men And Women Should Know? If more hair goes out than usual over the entire head, this indicates diffuse hair loss. After pregnancy, for example, this happens more often.
Even with hormone treatments, for example with certain anti-baby pills or hormone therapy during menopause, the hair density can noticeably decrease overall – depending on the preparation, rather at the beginning of the intake or after discontinuation.
- In addition, the important causes of diffuse hair loss include dysfunction of the thyroid gland and iron deficiency. Some medications can also make hair thinner. The influence of stress on hair growth is discussed.
- Development of symptoms: There can be weeks between the triggering event and hair loss. Not always the hair is lost immediately. Often, first of all, they stop their growth and prematurely switch to a dormant state. At the end of this resting phase, hair falls out more and more at the same time (telogen effluvium, more about this also in the chapter “Diffuse hair loss: Causes, therapy”). Only very rarely do diffuse scarring occur, see chapter “Hair loss: Special forms”).
- The therapy depends on the trigger. If possible, a known cause will of course be rectified. For example, has the doctor detected a suspected responsible drug and discontinued it (you should not do this without consulting him!), it must be observed for at least three months whether the hair improves. In other cases, too, therapy often consists of waiting a few months and observing the development. Hair transplantation is not indicated for diffuse hair loss.
Info: Diffuse hair loss (as a so-called telogenic effluvium) affects women to a greater extent than men. Depending on the cause, children can also get sick.
Hair loss – Special forms, without and with scarring
- Focal hair loss leads to individual bald spots, so-called blades. An example has already been described above: the alopecia areata, the circular hair loss. In principle, it is reversible, there are no scars.
- But there are other examples, such as hair loss due to inflammatory diseases of the skin or scalp. For example, fungal infections such as cat fungus sometimes cause hair to fall out in individual places. Early therapy is crucial here in order to avoid deeper damage with scarring and permanent hair loss.
- Due to constant pressure or tension – for the sake of the hairstyle or as a result of pathological tearing out (trichotillomania) – the main hair can lighten in tufts. In extreme cases, diffuse scarring is possible. The hair no longer grows back there.
- Pseudopelade Broq, a rare, scarring hair loss of unknown cause, mainly affects women, usually between the ages of 30 and 55. The scalp looks reddened and shiny in the initially small, gradually expanding hairless areas.
Hair loss: Diagnosis
In order to determine the cause of hair loss, one must know that there can be weeks between the triggering event and hair loss. Not always the hair is lost immediately.
Hair Loss: What Men And Women Should Know? Often, the first stop their growth and switch to the resting state (see the picture gallery “How to scalp hair grows” in the chapter “Diffuse hair loss”). At the end of this resting phase, a lot of hair falls out at once at the same time. In rare cases, hairlessness is already congenital or occurs in the first years of life, for example, as a result of metabolic defects.
The central contact person is the dermatologist (dermatologist)
The consultation is expediently carried out in consultation with the general practitioner, gynecologist or pediatrician. In conversation with the patient, the dermatologist first asks about the duration and strength of the hair loss, about other symptoms, such as itching or nail changes, about diseases, medications – even an application several weeks ago can be significant here – and life circumstances that could affect hair growth.
Whether a close relative suffers from hair loss is also of interest. Women with suspected androgenetic or actually hormonal (androgenic) alopecia will be asked by the doctor about changes in the cycle, the use of hormonal contraceptives, pregnancies, and births, depending on age, and also about the onset of menopause.
Why does the hair fall out more?
Various investigations can help to answer this question.
Dermatologist’s eye diagnosis: Often the pattern of hair loss and the appearance of bald skin already refer to the diagnosis. The doctor may also use a magnifying lamp (dermatoscopy). The device allows multiple enlarged views of the skin.
Sometimes additional examinations are necessary, for example, a blood or hair analysis, less often a scalp biopsy (see below).
Hair Loss: What Men And Women Should Know? Then the doctor will carefully look at the hair and its distribution pattern, the nails, and the scalp and assess whether there is a skin disease, whether the nails are affected and whether the hair is only thinned in certain places or diffusely distributed over the entire head.
The doctor will also check the rest of the body’s hair pattern. With an orienting physical examination, it may be possible to find other signs of the disease, such as swollen lymph nodes on the neck, as they can occur, for example, with head fungus.
Plucking test: The dermatologist may test how many hairs are already loosening by light, painless plucking (plucking, pulling, epilation, or extraction test). If the doctor keeps more than ten loose hairs in his hand when testing a patient with freshly washed hair from about 60 detected, this indicates an active hair loss.
He also examines whether pores of the hair follicles (hair follicles) are still visible on the hairless scalp. The hair loss is then not scarring. This suggests that the hair could grow back in principle.
For the details and documentation: Microscope, Photos & Computer
Microscope: If necessary, the dermatologist looks at individual hairs under the microscope and assesses their structure, for example, whether he has anagen or telogen hair (see picture gallery in the chapter “Diffuse hair loss”) or broken hair in front of him.
Hair Loss: What Men And Women Should Know? Microscopic hair root analysis is also called Trichogramma. On the one hand, it shows which proportion of the hair is currently growing, whether, for example, an unusually large number of hairs have stopped growing. Normally, 80-90 percent of the hair grows actively, and less than
Phototrichogram: No hair sample is required for this, but the hair is cut off in one or two, as inconspicuous as possible places. These areas are then tattooed and photographed with a camera. Three days later, the same places are photographed again and the pictures are compared. The examination allows an accurate determination of growing and resting or falling out hair and is more often used in studies. The hair roots can not be judged with this.
Triclosan: Further development of the phototrichogram. The area with the cut hair is stained three days later and photographed with a digital camera at microscopic magnification (incident light microscopy). A computer analyzes the images and provides information about the number and percentage of hair in the various growth and cycle phases (see picture gallery in the chapter “Diffuse hair loss”). The statutory health insurance companies generally do not pay for the examination.
10-20 percent rest. On the other hand, the doctor can more accurately assess hair roots and hair shafts.
Trichogramma can be used to prognostically estimate the proportion of hair loss and hair growth capacity. For the examination, about 50 to 100 hairs are plucked out in different areas of the scalp (for comparison). This is a bit unpleasant, but these hairs grow back again.
In order for the examination to have a good informative value, in this case, the patient should have washed his hair for the last time four to five days before.
Special examinations for hair loss
Pathogen culture: In unclear cases, a pathogen culture from smears of hair or hair stumps from a diseased area can help. It is used, for example, to detect a fungal disease of the scalp. However, it takes a few weeks for the result to be available.
Tissue sample from the scalp: In order to come to a diagnosis, it is sometimes necessary to examine a tissue sample of the scalp, a scalp biopsy, possibly also in a specialized center. Removal is carried out with local anesthesia under sterile conditions. It is mainly aimed at cicatricial alopecia or unclear non-cicatricial alopecia.
Search for traces in the blood: If the doctor suspects diseases or deficiency symptoms as the cause, further examinations may be useful. For example, a blood test can be used to detect iron, thyroid or inflammation levels and pathological immune phenomena and the results may reveal a disease.
An examination of the sex hormone levels in women is only useful if androgenic alopecia is suspected, for example, because of visibly increased masculinization signs such as male hair distribution pattern.
Therapy of hair loss: each alopecia is treated separately
Hair Loss: What Men And Women Should Know? Hair loss can have many causes. Sometimes there is a disease behind it, for example, a hormone disorder or anemia with iron deficiency – causes that are to be treated specifically. Also, one form of hair loss can be superimposed on another. Therefore, a visit to the doctor is always advisable. It often also applies: time is hair. Therefore, the sooner the correct diagnosis is made and therapy is started, the greater the chance of “saving” and preserving as many hairs as possible. A number of clinics and private doctors today offer special hair consultation hours.
In principle, the motto should be: first the diagnosis, then (if necessary) the treatment. Also, there is no one therapy for every hair loss, and not every hair loss needs to be treated. In some cases, the hair also grows back by itself.
Sometimes cosmetic measures such as hair styling, hair replacement parts, and permanent make-up can also facilitate the acceptance of the hair problem.
Even with plant-related hair loss: do not treat it without the doctor
Hair Loss: What Men And Women Should Know? Androgenetic alopecia in men is extremely widespread (see above) and does not automatically give rise to extensive medical examinations. Nevertheless, expert advice can also be helpful here if therapy is desired.
There are numerous remedies available on the market that are designed to stimulate hair growth or stop hair loss. However, only a few have been tested for their effectiveness in good clinical studies. If you want an (optional) therapy, you should inform yourself beforehand with the doctor or pharmacist exactly which effects and which possible side effects you can expect.
You can find out more about the treatment options for androgenetic alopecia, including hair transplantation, in the chapter “Plant-related hair loss”.
Tips for proper hair care
With the right care, the hair looks better right away. Here are eight basic tips:
- The shampoo is there for cleaning hair and scalp, do not use too much, shampoo only once per wash, and rinse the hair well afterward
- The hair care products should be tailored to the hair and scalp
- From time to time, the hair is happy about rinses and cures, which makes the hair easier to comb
- Do not rub your hair dry after washing, but gently “press dry” and leave it in the towel for a few minutes
- Blow dry only lukewarm, do not hold the hair dryer too close to the hair, alternatively, let the hair dry in the air
- Protect hair and scalp from UV radiation
- Do not use styling procedures such as bleaching, straightening, or perming too often – this can strain the hair and make hair more brittle. Hair loss usually does not occur.
- Use brushes with rounded bristles and combs with widely spaced tines
This article contains only general information and may not be used for self-diagnosis or self-treatment. He can not replace a visit to the doctor.
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