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Hair Loss

Male Pattern Hair Loss

The term “common baldness” usually means male pattern or permanent pattern baldness, scientifically known as androgenetic alopecia as the role of androgens (male hormones) in its occurrence is well understood. It usually begins at the age of 30 but can occur at any age after puberty. Men who have this type of hair loss usually inherit the trait. In this type of baldness, hair loss typically results in a receding hairline and loss hair on the top of the head. It is generally recognized that men in their 20’s have a 20 percent incidence of male pattern baldness, in their 30’s a 30 percent incidence of male pattern baldness, in their 40’s a 40 percent incidence of male pattern baldness, etc. Male pattern baldness is an inherited condition and the gene can be inherited from either the mother or father’s side.

The amount of androgens present does not need to be greater than normal for male pattern baldness to occur. If androgens are present in normal amounts and the gene for hair loss is present, male pattern hair loss will occur.

How does it occur?

The hair growth cycle is affected in the growth phase (anagen) and the duration of the growth phase reduces, resulting in shorter hairs. More hairs are in the resting state (telogen) and these hairs are much more subject to loss with the daily trauma of combing and washing. The hairs in male pattern baldness become progressively small, (known as miniaturization) smaller in diameter and length, with time. Pigment (color) production is also terminated with miniaturization so the fine hair becomes lighter in color. The lighter color, miniaturized hairs cause the area to first appear thin. Involved areas in men can completely lose all follicles due to replacement by fibrotic tissue over time.

How is it managed?

Androgens are converted into the active form by an enzyme called 5 alpha- reductase. Oral and topical medications can inhibit this enzyme, thus preventing its action on the hair follicles. This checks the progress of hair thinning and brings about regrowth of hair.

The oral medication can cause transient diminution of sexual function which reverts back to normal when treatment is stopped or continued. Topical medications on the other hand, need to be used daily to keep the hair in the growing phase. After a period of about 5 years, a break in the treatment is required to prevent resistance to the medication (called as tachyphylaxis).

Female pattern hair loss

What is it?

The most common type of hair loss seen in women is androgenetic alopecia, also known as female pattern hair loss. But as in men, it does not have to be complete hair loss. There is marked thinning of hair on the top known as Christmas tree pattern, unlike in men where there is recession of the hair line.

How does it occur?

The hair growth cycle is affected in the growth phase (anagen) and the duration of the growth phase reduces, resulting in shorter hairs. More hairs are in the resting state (telogen) and these hairs are much more subject to loss with the daily trauma of combing and washing. The hairs in female pattern hair loss become progressively small, (known as miniaturization) smaller in diameter and length, with time. Pigment (color) production is also terminated with miniaturization so the fine hair becomes lighter in color. The lighter color, miniaturized hairs cause the area to appear thin and the central parting to appear wider.

How is it managed?

Female patients with hair loss need to be thoroughly investigated to rule out other causes of diffuse hair loss as female pattern baldness can mimic a condition called telogen effluvium which is usually caused as a result of some trigger like an illness or nutritional deficiency.

Treatment of this condition entails taking certain oral and topical medications that inhibit an enzyme called as 5 alpha- reductase which is involved in the conversion of androgens into their active form and preventing their action on the hair roots. This checks the progress of hair thinning and brings about regrowth of hair.

Topical medications on the other hand, need to be used daily to keep the hair in the growing phase.

How long the treatment should be continued?

Long term treatment is required with daily application of the topical medications. The hair will be maintained in the growing phase with therapy. Some people may notice minimal loss of hair in the initial phase of treatment. If treatment is discontinued, the hair loss will revert to the original numbers as before treatment. After a period of about 5 years, a break in the treatment is required to prevent resistance to the medication (called as tachyphylaxis).

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