Causes of hair loss, diagnosis
What is a hair transplantation good for? Why only from your own hair? What techniques are there?
2023.08.07.
What kind of alopecias are there?
Alopecia is the Latin word for baldness. Hair loss is a widespread and complex phenomenon that can occur due to disturbances in the natural hair cycle, inflammatory conditions that damage the hair follicles, or inherited or acquired disorders of the hairs. We differentiate between scarring, non-scarring alopecia, and structural hair diseases.
The most common hair and scalp diseases are briefly summarized below.
Scarring alopecia
Inflammatory diseases of the scalp that lead to permanent hair loss belong here. For a diagnosis, skin biopsy is essential in these diseases. Based on the microscopic picture, three large groups are distinguished: lymphocytic, neutrophilic, and mixed scarring alopecia. Among these, we highlight a few that occur more often in our clinic.
Lymphocytic: from this subgroup, frontal fibrosing alopecia is a frequently seen disease, where the hair typically falls out partially or completely on the front or crown of the scalp, follicular hyperkeratosis and perifollicular erythema are visible, the skin is shiny, but painful and itchy symptoms usually do not appear in the during the course of the disease. Hair loss can also be accompanied by eyebrow and eyelash hair loss. Although the success of hair transplantation is questionable in these cases, we have already performed successful transplantation in a patient suffering from frontal fibrosing alopecia at our clinic. We will report on this soon with a case study.
Neutrophilic: within this, the disease called folliculitis decalvans is worth highlighting. Here, a part of the scalp is usually affected, where pimples, inflamed skin areas and alopecia are typical. Sometimes in addition to the skin phenomenon, the patient also suffers from hormonal hair loss, in which case it is possible to transplant hair from the healthy donor areas to the also healthy recipient areas.
Mixed: it occurs less often, it is associated with inflamed acne-like, painful lesions of the skin, and in more severe cases, necrosis. Invasive treatment of the affected skin areas is not recommended under any circumstances.
Non-scarring alopecia
Signs of inflammation are usually mild or absent, and hair follicles are not damaged. The diagnosis is often helped by the pattern of hair loss.
Local: This includes alopecia areata, in which case hair loss occurs in patches in different areas of the scalp.
Postoperative alopecia may develop after surgical interventions under general anesthesia. Hair loss can also appear in patches as a symptom of syphilis. Temporal triangular alopecia is a congenital phenomenon, where hair is missing in a spot above the ear since childhood. Also, traction alopecia is common, which can develop due to regular tight hair wear. It is possible to remedy these with hair transplantation, but this is not the first-line treatment in all cases.
Patterned: Female and male patterned androgenic alopecia is classified here. This is most often treated with hair transplantation.
Diffuse: Hair loss that affects the entire scalp evenly is classified here. There can be countless reasons, from hormonal diseases to chemotherapy drugs to mineral (e.g. zinc, selenium) or vitamin (e.g. A, D) deficiency, causing this type of hair loss. Most cases are diagnosed as telogen effluvium. Non-scarring alopecia can also occur as a direct consequence of acute or chronic inflammatory skin diseases of the scalp like psoriasis, atopic dermatitis, seborrheic dermatitis and contact dermatitis. Additionally, hair loss can occur in patients with lupus or other autoimmune diseases. In these cases, hair transplantation is not a solution, but other hair regenerative therapies can be used to treat them, such as medical mesotherapy or PRP treatments.
Structural hair diseases
These include structural abnormalities of the hair, where abnormal hair formation or external injuries can lead to hair fragility or growth defects. The most common hair structural disorders usually develop during harmful hair care practices; in connection with aggressive combing of the hair, use of excessive heat or chemical substances, the outer covering of the hair shafts, the protective cuticule is broken, the hair shafts "wear out", their ends break. Of course, "split ends" can also be traced back to genetic conditions in rare cases. Structural hair diseases can be treated with a proper hair care routine, keratin treatments, and semi-invasive scalp treatments (mesotherapy, PRP).
How do we diagnose?
During a personal consultation, we examine the following in order to establish a diagnosis and create an appropriate, individualized therapy plan. We assess how long the patient has been experiencing hair loss, how fast he or she is losing hair, the pattern and extent of the hair loss. Associated symptoms and hair care habits are important to be talked about. Family anamnesis is often informative, and in case of androgenic hair loss, the hair condition of the father and maternal grandfather can predict the expected pattern of hair loss. Taking medication, eating habits and chronic diseases are also decisive in establishing a diagnosis. The thorough discussion is followed by a physical examination, during which we perform dermoscopy and trichoscopy using a digital microscope, that is, we examine the condition and structure of the scalp and hair.
In some cases, we also perform a hair pull test: while pulling 50-60 hairs in case at least 5-6 hairs remain in our hands without effort, we can talk about abnormal hair loss. Of course, if scarring alopecia is suspected, further invasive tests may be necessary. During a dermatological examination, laboratory tests and skin biopsy may be needed for differential diagnosis.
In all cases, our consultations end with the establishment of a therapy plan. If you also suffer from one of the above-mentioned diseases, have recognized the symptoms and would like a detailed hair examination and an individualized therapy plan, contact us with confidence, we look forward to welcoming you to our free medical consultation.
