Diffuse Alopecia

Diffuse alopecia is characterized by noticeable thinning of the hair and is more common in women and less common in men.

Although a reduction in hair density can cause anxiety, lower self-confidence and affect personal, professional and social life, it is important to know that there are effective treatments available today that can restore healthy, luscious hair.

DIFFUSE ALOPECIA

Effective treatments

Autologous Growth Factors – PRP

Autologous PRP hair mesotherapy with growth factors has been tested in cases of diffuse alopecia and is currently used with excellent results together with supportive or drug treatment. The treatment can be repeated every month until the hair growth of the affected area is sufficiently restored. Each session lasts approximately 30-45 minutes and does not require local anaesthesia.

With minoxidil

Minoxidil in a 2% or 5% solution topically on the scalp twice a day can help mainly in chronic diffuse alopecia and has very good results in both male and female androgenetic alopecia.

Hair loss treatment with minoxidil is one of the few drug treatments with proven results in hair loss and hair thinning and has been used safely worldwide for the last 20 years.

RESULTS

Treatments for hair loss & Hair transplantation

Diffuse alopecia – Types

Acute with sudden loss of hair
Subacute in which the hair is lost over several months
Chronic Diffuse Alopecia in which the phase of thinning is repeated and overall lasts more than 6 months

WHAT IT IS

The life cycle of hair

The hair life cycle consists of the anagen, catagen and telogen phases. Female hair loss occurs when there is a rapid transition from the anagen phase to the catagen phase and then to the telogen phase.

In the scalp, 95% of the hair is in the anagen phase, which lasts several years, while the catagen and telogen phases last a few months. In some forms of female hair loss, the anagen phase lasts only a few months. A daily loss of 100-150 hairs is normal and does not constitute female pattern hair loss.

The loss of these catagen hairs occurs mainly during shampooing and combing and does not necessarily indicate female pattern hair loss. A woman should seek hair loss treatment if she loses more than 150 hairs per day.

1. Anagen phase
2. Catagen phase
3. Telogen phase

DIFFUSE ALOPECIA

Common causes

Telogen Effluvium

Hair prematurely and abruptly enter the telogen phase (the last stage of their life), whereas, normally, hair should remain in the anagen phase for about three months, until the new hairs have developed, and then fall out.

Anagen or Dystrophic Alopecia

Intense shedding of hair occurs (up to 90%) due to the effect of a chemical or toxic agent (e.g. chemotherapy) or radiation; the hair will grow back when the exposure to the agent is discontinued.

Mixed Alopecia

The factors that are responsible for alopecia, affect hair follicles differently. This implies that in a number of hair follicles the anagen phase ends prematurely, whereas in a number of hair follicles growth stops despite being in the anagen phase.

FAQs

Diffuse hair loss can be due to a large number of factors that cause either physical or psychological stress, or to systemic diseases or external (usually pharmaceutical) agents. More specifically, the following have been reported as causes of diffuse alopecia:

Physical stress, e.g. after major surgery, severe infection, high fever, acute bleeding. Also, many women experience diffuse alopecia after childbirth or even up to three months later, because of the abrupt changes in their hormone levels.
Intense emotional stress, causing mostly acute diffuse alopecia.
Chronic diseases such as anaemia, systemic lupus erythematosus, amyloidosis, liver failure, chronic renal failure, inflammatory bowel disease, lymphoproliferative syndrome, dermatomyositis, and other chronic infections such as HIV and secondary syphilis. Also, dermatological diseases such as psoriasis, seborrheic dermatitis and allergic contact dermatitis have been reported to cause diffuse telogen alopecia.
Endocrine disorders. Both hyperthyroidism and hypothyroidism can cause diffuse telogen alopecia, which regresses when the person returns to a euthyroid condition, but also diabetes. Hair loss can also occur during menopause, due to hormonal changes.
Eating habits. Inadequate intake of protein, iron, zinc, essential fatty acids and other nutrients, mainly due to exhaustive diets or eating disorders (e.g. anorexia) are among the most common causes, especially in women. Malabsorption syndromes and pancreatic diseases can also lead to diffuse alopecia. Equally dangerous are deficiencies of vitamin D and biotin.
Medications such as oral contraceptives, androgens, retinoids for acne treatment, antithyroid drugs, some antidepressants, anticoagulants, vitamin A, some categories of heart drugs and some NSAIDs. Also, drugs used in chemotherapy for various cancers, which are cytotoxic, act on hairs in the anagen phase causing diffuse anagen alopecia.
Radiation, which causes hair loss mainly in the affected regions. Radiation therapy, when done at low frequencies, has reversible effects on hair loss, with only a small change in the quality of the hair.

Diffuse alopecia is usually reversible and in a few months the hair thinning is being restored and hair follicles remain healthy. It is important, however, that the patient cooperates with the specialist dermatologist or plastic surgeon he/she consults, in order to identify the precipitating agent that caused hair loss, as the possibility of diffuse alopecia becoming chronic, or becoming a precursor to androgenetic alopecia still exists. In the latter case, the hair does grow back but the strands are weaker and thinner.

In the case of acute diffuse telogen alopecia, the cause must be identified; when the patient is isolated from the cause, the loss will stop instantly and the scalp will recuperate over a few months’ time. In the case of chronic diffuse telogen alopecia, things are more complicated, as its occurrence may be attributed to more than one factors. In both cases, a diet with adequate nutrients and protein must be followed. Administration of supplements, such as vitamin C which enhances the absorption of iron, vitamin B that has a suppressive effect on stress, biotin and zinc, can enhance the regrowth of hair.

If the cause is suspected to lie in some form of medication, it is recommended to change or stop the drug for at least three months, in order to confirm if this is indeed the precipitating factor. At the same time, the possible existence of an underlying disease is examined and it is controlled with proper treatment. There is no specific medication for the treatment of diffuse alopecia.

Anagen or dystrophic diffuse alopecia can be treated with monitoring and supportive treatment, especially if the cause is known from the patient’s history and cannot be avoided for a certain period of time. Especially, in cases of diffuse alopecia due to prior chemotherapy, in young men with a family history of androgenetic alopecia, it may be observed that the hair grows back after the end of chemotherapy, but only in areas that are not affected by androgenetic alopecia. In areas that are affected by the hereditary predisposition for androgenetic alopecia, the regrowth does not proceed satisfactorily, resulting in the appearance of clinically advanced androgenetic alopecia (grade V-VII on the Hamilton-Norwood scale) which normally would have only occurred several years later in the life of the individual concerned.

This advanced form of alopecia after chemotherapy can significantly burden the psychology of these patients and perhaps constitutes the only real indication for hair transplantation in situations of diffuse alopecia. In general, hair transplantation is not considered a treatment of choice in cases of recurrent diffuse alopecia. In any case, it requires examination by a specialist dermatologist or plastic surgeon, who will assess each case on an individual base.