The life cycle of hair comprises of:
Hair loss occurs when the duration of the anagen phase becomes shorter and the hairs quickly pass into the telogen phase (telogen hair loss or telogen effluvium). In this case, the hairloss is diffuse, i.e. not located in a particular area, but spread over the entire scalp, causing reduction of the hair density and thinning of the hair strands. This form of hairloss can occur after childbirth, due to chronic infections or after administration of certain medications.
Hair loss – Causes
The most common cause of hairloss in males is inheritance which, in combination with the action of the derivatives of the male hormone testosterone and age, cause the so-called androgenetic alopecia or male pattern hairloss. The genes that cause androgenetic alopecia can be transmitted by both parents. Women have the same hereditary predisposition for androgenetic alopecia as men, but in women of reproductive age, because of the effect of the female hormone oestrogen, the clinical onset of androgenetic alopecia with intense hair loss and apparent hair thinning is not very noticeable until the age of menopause. Only a small proportion of women, about 10 to 15%, shows clinically visible hair loss.
In men, hairloss of this type usually starts from the forehead, the temples and the crown, while it is absent from the occipital region (back of the head). The occipital region and the sides of the head remain constant throughout life and show no significant hair loss, even in old age, as the male hormones have no effect here. This region is called the ‛constant hair growth zone’ and serves as the main donor site of follicles for hair transplantation. Androgenetic alopecia in women usually occurs as diffuse hairloss; complete loss of hair from one area is rarely observed. Hair thinning in case of women with androgenetic alopecia becomes more profound after menopause.
Complete loss of hair at specific locations can be seen in alopecia areata (spot baldness) and in scars (cicatricial alopecia), such as scalp injuries or burns. Hairloss and creation of cicatricial patches is also seen in follicular lichen planus and lupus erythematosus. Characteristic feature of these pathological forms of hair loss is that they can affect any area of the scalp, even the constant hair growth zone, and evolve in an erratic and unforeseeable manner. These conditions may be localised, small-scale and relatively stable, but in rare cases can take a global form; in some cases of alopecia areata, complete hair loss may occur not only from the scalp, but also the face, eyelashes or even the entire body. Pathological cases of hair loss are much more rare than androgenetic alopecia and constitute less than 10% of all cases of alopecia.
Other cases of hair loss are due to diseases of the scalp, such as fungal infections, folliculitis and other inflammations. Hair thinning can also be caused by malfunction of the thyroid gland (hypothyroidism, hyperthyroidism) and in hyperparathyroidism and other chronic diseases. Hairloss also occurs after chemotherapy, radiation therapy and certain medications, and in a number of chronic diseases. In these situations, hairloss subsides after identifying and eliminating the cause. Especially in women, major hormonal changes such as pregnancy, lactation, menstrual disorders, polycystic ovarian syndrome, menopause, etc., can lead to severe hair loss which is reversible in most cases. Especially in women, major hormonal changes such as pregnancy, lactation, menstrual disorders, polycystic ovarian syndrome, menopause, etc., can lead to severe hair loss which is reversible in most cases.
Other important causes of hair loss in today’s era are:
Traction hairloss is caused by the excessive pulling of the hair due to various hairdressing and styling processes (e.g. ponytails, extensions, etc). Localised hair loss of a usually permanent nature may occur in cases of traumatic alopecia, caused by injuries or burns to the scalp, face or body.
Hair loss – Diagnosis
The diagnosis of hair loss should always be performed by a qualified dermatologist. Key elements in the diagnosis of androgenetic alopecia are the history of the occurrence after puberty, the gradual thinning in specific areas, and the family history regarding hair loss and alopecia. At Advanced Hair Clinics, hairloss is diagnosed or confirmed with a trichogram, using a special microcamera and software. The special diagnostic photographic imaging and digital analysis tool “Follysis” that is used in our clinic, is one of the most comprehensive and accurate tools for the diagnosis of hair loss and the monitoring of response to treatment, allowing accurate measurements of hair density and hair strand diameter in each area. Certain cases of hair loss, such as alopecia areata or cicatricial alopecia, may require special blood tests (hormonologic tests, iron, vitamins, minerals, etc.) or a skin biopsy (punch biopsy) for the purpose of differential diagnosis.
Hair loss – Therapy
Advanced Hair Clinics is one of the most specialised clinics for the diagnosis and treatment of hair loss. It is staffed by a highly specialised medical team led by plastic surgeon Dr. Anastasios Vekris, who is one of the pioneer plastic surgeons who have taught and evolved the FUE technique in Greece and abroad.
Hair loss treatment can be conservative or surgical, or a combination thereof. It is performed by the medical team of the clinic and is individualised and differentiated for each case. If the hair loss is due to external reversible factors such as anaemia, hormonal disorders, etc., it suffices to eliminate these underlying factors, combined with conservative medication such as minoxidil or the application of newer methods such as the application of autologous growth factors, also known as PRP (Platelet Rich Plasma) therapy. If the hair loss is still in its early stages and has not yet caused visible thinning or if the hair loss is diffuse, treatment is conservative.
On the other hand, if the hair loss has led to visible thinning, to fully installed alopecia or baldness, and provided that there is a sufficiently large donor site, definitive treatment is achieved with hair transplantation with the new Advanced FUE technique. Depending on the case, the surgical treatment of hair loss can be combined with conservative treatment for the maintenance of the result.