Hair loss

Definition of hair loss

There are basically two types of hair loss:

• Effluvium describes the shedding of hair, as a result of which more than 100 hairs are lost per day.

• Alopecia is the term used for hairlessness. This manifests itself in the form of bald spots or a bald head. If the hairlessness is innate, one speaks of Hypotrichia (partially) or Atrichia (total).

Effluvia and alopecia can be diffuse or circumscribed, scarring or non-scarring.

General / Introduction

The daily Hair loss is a physiological rejection reaction of the Scalp of older hair.

A loss of around 100 hairs a day, which get caught in the brush or simply fall out, is completely normal. If the hair falls out in significantly larger numbers, there can be various causes, such as congenital Diseases, Hormonal influences or Medication, to be responsible.

Epidemiology

Sparse hair growth or hair loss is not uncommon.
Overall, however, significantly more men are affected than women. In Germany approx. 1.5 million men and 500.000 Women suffering from hair loss.
The hormonally hereditary one Hair loss (Androgenetic alopecia) is the most common form of hair loss at around 95%. Around every second man suffers from this type of hair loss.

The circular hair loss (Alopecia areata) is much rarer. Approx. 1-2% of all people will develop circular hair loss in the course of their lives. As a rule, however, this begins in childhood or adolescence.

The hair cycle

The physiological hair cycle consists of 3 phases:

1. In the growth phase (Anagen phase) a new hair root is formed and hair production begins. Depending on age and gender, the growth phase lasts two to six years. 85- 90% of the scalp hair is in this phase and is also known as "papillary hair".
2. In the transition phase (Catagen phase) the hair matrix stops producing cells and the hair follicle narrows in the lower area. As a result, the hair becomes detached from the papilla and atrophies. In this phase, which lasts 2 to 3 weeks, there is about 1% of all hair, which is then referred to as "Beethaare".
3. The rejection phase (Telogen phase) represents the final phase of the hair cycle. The stunted hair falls out and the hair papilla and hair follicle regenerate. The matrix re-emerges and starts cell division. This can create new hair. About 18% of all scalp hair is in this phase and it lasts about 2 to 4 months. In this phase, the hair is called "piston hair".

Symptoms of hair loss

The symptoms depend on the type of hair loss.

Anagen effluvia: The normally complete hair loss begins after approx. 14-20 days and is reversible in most cases. The hair roots of the fallen hair are noticeably thin.

Telogen effluvia: More than 100 hairs fall out per day. When combing and washing your hair, you can easily pull your hair out.

Androgen effluvias begin with puberty, in men first in the form of so-called “receding hairlines” and on the crown of the head, which gradually spread. You often feel itchy. In women, the front sections of the hair are retained, only the hair on the parting falls out.

Circular hair loss usually begins suddenly, with circular bald spots on the head or beard hair. Lashes and eyebrows can rarely fall out.

Read more on the topic: Eyelashes fall out - what to do?

Causes of Hair Loss

1. Hormonal hereditary hair loss (Androgenetic alopecia)

The cause of this form of hair loss is hereditary sensitivity to the male sex hormone testosterone. The sensitivity shortens the growth phase of the hair and the hair follicles shrink.
The shrinking follicles initially only produce short and thin hair (Vellus hair). These can remain or fail. New hair can then no longer be formed. Because of their sensitivity to the male sex hormone, men in particular are affected by this form of hair loss.
Although women also produce small amounts of testosterone, they are much less likely to experience this form of hair loss.
During the menopause, which is accompanied by strong hormonal changes, the risk of hair loss in women is significantly increased.
With this type of hair loss, the hair initially thins on the temples and forehead. This creates a receding hairline and a bald head. The hair on the back of the head then thins out, creating a tonsure. In young adult men, slow hair loss often begins between the ages of 20 and 25.

1. Circular hair loss (Alopecia areata)

To date, the exact causes of this form of hair loss are not explained in detail.
It is believed that the hair loss is caused by disorders of the immune system. This would mean that the body's own defense cells (immune cells) wrongly attack the hair roots. These are responsible for hair growth. The immune cells stop hair production and the hair falls out.

It is believed that the hair roots are not completely destroyed, but only inactivated. So it is possible that they suddenly become active again and produce new hair. The fact that many sufferers have other autoimmune diseases, such as neurodermatitis or hay fever, confirm this thesis.
A genetic predisposition is also discussed as the cause, as circular hair loss occurs in families in around 20% of patients.
In this form of hair loss, there are coin-sized, round to oval bald spots in various places. When viewed under magnification, so-called exclamation mark hairs become visible in the edge zone. This is thin, short, broken hair that thins towards the scalp. The bald spots are preferably visible on the back of the head or the sides, but can also appear on the entire head.

In addition, the hair can fall out completely even with this type of hair loss. In many cases, the hair grows back after a few months. However, relapses can occur.

3. Diffuse hair loss (Alopecia diffusa)

The general rule is that in the case of diffuse hair loss, the hair roots are damaged, causing the hair to fall out diffusely.
Damage to the hair roots can have various causes. This includes, for example, taking medication as part of a chemotherapy (Taking cystostatics). But also infectious diseases like Scarlet fever or typhus, Thyroid dysfunction, prolonged malnutrition or hormonal changes as part of a pregnancy, by taking hormone-containing drugs (e.g. "pill“) Or in the Menopause can lead to diffuse hair loss.
An inflammatory disease of the scalp (e.g. Psoriasis of the scalp) or a lot stress Trigger hair loss. In many cases it is a natural sign of old age. Due to the diffuse hair loss, there are no visible bald spots, but the entire hair thins. If a cause for the hair loss is identified and treated, the hair will usually grow back and the hair loss will go away.

4. Other causes of hair loss

A Fungal infection the scalp (Tinea capitis) can lead to hair loss in infected areas. This mostly affects children. Prolonged pressure or rubbing of the scalp can damage it and lead to hair loss in the affected areas.

Likewise, strong pulling on the hair (Traction alopecia), be a result of hair loss. The hair roots are damaged by the strong pull. Also by a mental illness, which too compulsive hair pulling, cut off or Pull leads by the hair, the hair thins out. Those affected often feel a feeling of pressure relief for a short time.

A congenital disorder of the hair (Anagen hair) leads to thin, brittle hair and is noticeable in early childhood. The hair structure is changed here by an inherited defect.

Another cause of hair loss can be one Zinc deficiency represent.

Stress-related hair loss

The connection between physical stress and hair loss has long been established. Physical stress can e.g. pregnancy, surgery, or high fever.

Read more on the subject at: Hair loss during pregnancy

The stress causes a certain number of hair follicles (not all!) To move from the growth phase to the rejection phase, which lasts 2-4 months. After this time, the hairs of the affected follicles fall out at the same time. A hair loss appears that is distributed over the entire head and only leads to a thinning (diffuse hair loss), because unaffected follicles continue to grow normally. After the loss, hair will grow normally again from the affected hair follicles.

A connection between mentally conditioned (psychogenic) stress and hair loss has long been considered a myth. However, it can now be considered proven that there are interactions. Only with male hormone-related hair loss (Androgenetic alopecia) stress doesn't seem to have any effect.
Acute or chronic psychogenic stress can cause diffuse hair loss by a mechanism similar to that of physical stress. However, this is usually a diagnosis of exclusion after all physical causes have been checked.
It should also be noted that psychogenic stress in turn can cause physical changes (physical stress), for example when in a state of grief Weight is lost. These changes can also lead to hair loss.

also psychogenic stress can cause hair loss aggravatecaused by other factors. This also includes circular hair loss (alopecia areata), in which the hair usually falls out in bursts in sharply defined, round areas. The cause is one through Nerve fibers mediated inflammation at the hair roots: each hair root is reached by a network of nerve fibers that carry various transmitter substances (Transmitter) submit through which they get in touch with Inflammatory cells stand. Psychological stress increases the number of nerve fibers and this causes an activation of inflammatory cells, the inflammation of the tissue and the Cell death the hair follicle cells. As a result, hair growth stops and hair falls out. Overall, it is also important to consider the reverse connection. Hair loss mostly triggers psychological stress, which in turn can worsen the hair loss.

If you suffer from stress and hair loss, you should still start with doctor physical causes are excluded. In addition, the sources of stress should be eliminated. It helps enough sleep, Relaxation techniques and time management in the sense of more space for leisure. In the event of mental illness or very serious emotional crises, a psychotherapy to be entitled to. In all cases, combatting stress as a trigger or cofactor for hair loss is more helpful than combating it Hair loss treat yourself as a symptom.

Diagnosis

Some forms of hair loss, such as circular hair loss and hereditary hormone-related hair loss Hair loss can often be recognized by a visual diagnosis.
If the hair loss is diffuse or the diagnosis is unclear, the hair, Scalp and the blood examined more closely. In the laboratory, a chronic inflammation, a thyroid dysfunction, can be a Anemia, Iron deficiency or hormone irregularities easily.

Accurate medical history, particularly of medication, other chronic diseases, family history, and menopause in women are also important.

Through the Pluck test (Epilation test) the doctor can determine how severe the hair loss is. To do this, the doctor gently pulls a small tuft of hair to see how easily it can be removed from the scalp.
The hair roots can be examined more closely with the help of a trichogram. Here, the different growth phases of some hair are examined microscopically.
For the creation of a trichogram the patient 20- 50 Hair pulled out in the direction of growth. The phase of the hair cycle can then be determined under the microscope. Since every hair goes through different phases, the proportion of hair in the individual phases can be estimated. For healthy hair, more than 80% of hair in the growth phase and less than 20% be in the rejection phase.

The remaining approx. 1-3% are usually in the transition phase. The plucking of the hair is essential for the examination, since hair that had previously fallen out was obviously in the rejection phase and therefore no statement can be made about the vital hair of the scalp.
With help of a TrichoScans further parameters of the hair determine.
This is a special one computer- Software, which makes a statement about the hair density per square centimeter, the hair diameter and the growth speed of the hair over time possible through digital photography.
This not only allows the current Hair loss assess its intensity, but also enables a follow-up examination to assess the success of the therapy. With this examination method, the hair does not have to be pulled out, but small areas must be shaved off on one or two places on the scalp.
The hair that grows back is colored after three days and then photographed in high magnification. Using the growth speed, special software calculates the proportion of individual hairs in the growth phases.
When the clinical picture is no longer sufficient to make a diagnosis, small tissue samples (Biopsies) can be removed. The tissue samples are taken deep enough that the entire hair follicle is visible under the microscope.

Hair loss therapy

The diagnostic procedure should be coordinated individually according to the specific anamnesis and directional findings. For this purpose, an examination of hair growth and hair loss is carried out on the entire body. To Diagnosis and analysis of the findings, an individual treatment concept should be developed.

The elimination of the causal factors such as replacing the triggering one Medication or harmful substances can be followed by spontaneous recovery.

It can also help to try measures that stimulate or accelerate hair growth.

The androgen that is decisive for the development of androgenetic hair loss is dehydrotestosterone (DHT). It is metabolized from testosterone using two enzymes. The therapeutic starting point is hormonal follicular interaction. Selective enzyme inhibitors lower DHT (5-alpha reductase inhibitors, finasteride, trade name: Propecia®).

Finasteride should not be used in women, as in the case of a pregnancy there is a risk of damage to the unborn male child!

Please also read: Medication in Pregnancy

An alternative is a local therapy one 2- or 5% minoxidil solution. The application increases the local blood circulation and stimulates hair growth.

In women, the use of oral contraceptives ("pill") Show effects.

State-of-the-art surgical techniques achieve excellent aesthetic results for permanent scalp hair reconstruction. Hair restoration can be done by a Hair transplant and plastic-surgical reconstruction options.

Homeopathic medicines can also have a positive effect on hair loss. The cause of the hair loss is taken into account. You can find more about homeopathy and hair loss in the topic: Homeopathy Hair loss.

Hair loss is a widespread problem among the population and affects primarily men.
There are basically three different types of hair loss:

Hereditary hormonal factors Hair loss (Androgenetic alopecia), circular hair loss (Alopecia areata), and more diffuse Hair loss (Alopecia diffusa).
The causes of these forms of hair loss have not yet been fully explained and this makes therapy more difficult in some cases. The diagnosis is carried out by carefully examining the pattern of hair loss, taking the anamnesis of other underlying diseases and taking medication, as well as blood tests and other specific tests.
With the help of these diagnostic possibilities, the hair cycle and hair follicle can be examined in detail and thus possibly lead to the diagnosis.

In many cases, the therapy is lifelong Taking medication. The form of hormone-related hair loss can be treated relatively well because the exact cause and thus a therapeutic starting point has been found here.
Therapy for diffuse hair loss consists in treating the underlying disease that triggers it. On the other hand, circular hair loss is relatively difficult to treat, as the exact cause has not yet been found. Basically, the therapy often takes a long time and, especially in the context of hormonal hair loss, has to be taken for life. Depending on the various causes and types of hair loss, the prognosis varies widely.

Male hair loss

Male pattern baldness (Alopecia androgenetica in men) is the reason for 95% of all hair loss in men. It is both genetically determined and influenced by age. There is an increased sensitivity to males Sex hormones (Androgens) is based. As with 60-80% in Europe over half of the men He will suffer from this more or less pronounced hair loss not as a disease viewed as such. The health insurance companies do not cover the costs of treatment. Clinically, four forms can be distinguished: In grade I, the typical ones Receding hairline to which a tonsure (hair clip) (grade II) is added on the back of the head in the further course. As a result of hair loss on the crown of the head, these areas combine (grade III) and a horseshoe-shaped ring of hair remains from the sides of the skull to the lower back of the head. Hair growth in the hairy areas is normal and sharply demarcated from the bald areas, which are caused by the intact Sebum production shine.

The operations are not yet fully clarified. However, one is probably playing Hypersensitivity of the hair follicles on the active form of the hormone testosterone (Dihydrotestosterone, DHT), which is found in the Hair follicles is formed plays an important role. This causes one Shortening the growth phase (Anagen phase). Thus, the hair that grows from the affected hair follicles becomes smaller and finer until it falls out immediately. The corresponding hair follicles wither, which is why this process is not reversible.

It will, however not all hair follicles hypersensitive at the same time for DHT, which is reflected in the time course of the failure (degrees I-IV). The hair follicles above the ears and on the back of the head usually remain largely insensitive and the hair remains. Transplanted If you push an insensitive hair follicle from the side into a bald spot on the forehead, hair will grow there again. Also the degree of sensitivity and thus the Degree of hair loss is variable. Temporal course and expression are genetically up to now unknown genes predetermined, but inherited to a variable extent. In order to estimate the probable course, a comparison of the hair density between father and son at the same age makes sense.

Environmental influencessuch as wearing a hat or combing frequently, play due to the strong genetic component not matter. Also the often assumed connection with stress does not apply. The change in diet or cosmetic articles have only a marginal effect on hair loss. Of the Testosterone levels in the blood, it is slightly increased, for example, by frequent sexual intercourse, hardly affects the hair loss. The hypersensitivity of the affected Hair follicles is already so high that the normal testosterone level is enough for hair loss. A slight increase no longer has any additional effect. The only drugs that are currently sufficiently proven to be effective in influencing hair growth are Finasteride (Tablet) and minoxidil (tincture). However, especially with finasteride, the Side effects must be observed and weighed.

Hair loss in children

As with adults, there can be many different Causes in Children to Hair loss to lead. The hair almost always grows back completely, often without treatment.

Genetic diseases can be a rare cause. With these, however, other, more serious symptoms are usually in the foreground, so that the hair loss is secondary.

More common is an infection of the scalp, the so-called Tinea capitis. The fungus causes the scalp to flake. Typically, the hair then breaks off on reddened areas. Possible causes are close contact with animals or living in rural areas. This type of hair loss is completely reversible with the use of antifungal ointments or tablets.

Another type of hair loss that usually disappears completely is circular hair loss. The most likely cause is a malfunction of the immune system, which is directed against the hair-forming cells. Most of the time, the bald spots regress within half a year. However, a recurrence is possible. Cortisone preparations that are applied to the bald areas ensure faster regression.

Stress or psychological stress also affect children's hair. The phenomenon of self-inflicted hair pulling has also been observed in children.

Hair loss and thyroid

The thyroid hormones act on many different tissues and cells in the human body.

Among other things, on the hair-forming cells. Normally, the hormones ensure that the hair on the one hand regenerates and on the other hand survives stably for a certain time. If the hormonal balance is disrupted by a disorder, this can manifest itself in hair loss. It is not crucial whether the thyroid tissue is overactive or underactive, because both too much and too little hormone can lead to hair loss.

The accompanying symptoms are crucial for a clinical distinction. With overfunction (Hyperthyroidism) the hair is rather greasy and thin, palpitations, anxiety attacks, diarrhea and many other symptoms can also occur.
In contrast, the sub-function (Hypothyroidism) characterized by dull, brittle hair, freezing, fatigue, depression and constipation.

The family doctor can make a reliable distinction by checking the thyroid hormones in the blood. When the hormonal balance is restored, the symptoms, which include hair loss, slowly and usually completely recede.

Read more on this topic at:

• Hair loss from the thyroid gland
• Hair loss from a thyroid disorder

Hair loss during pregnancy

Hair loss during pregnancy is less common than after pregnancy.

The high levels of estrogens usually make hair longer and more beautiful. However, some women experience hair loss, especially in the first trimester of pregnancy. However, this is reversible, the hair will grow back completely. One reason for hair loss can be an iron deficiency, which can be improved with iron tablets after consulting a doctor and after determining the amount of iron in the blood.

In addition to iron deficiency, stress or fears can trigger or worsen hair loss.

Please also read our article on this

• Consequences of iron deficiency.
• Iron Deficiency During Pregnancy

Hair loss while breastfeeding

Breastfeeding itself has no definite influence on increased hair loss.

Therefore, you should never stop breastfeeding just to minimize hair loss!
Many women suffer from hair loss after pregnancy because the body's hormonal balance has to be reorganized.
For example, if you don't have enough iron or if your estrogen level drops, your hair will fall out earlier than usual. Even if that seems frightening, you can rest assured that your hair will grow back again.
The duration varies greatly from woman to woman, but the hair loss usually subsides within a few months.

Abstract topic of hair loss

Of the Hair loss is a fairly common disorder with a variety of causes. Various diseases have to be taken into account. Overall, the hair loss therapy must be individually adapted.