Diffuse alopecia – Classification
Diffuse alopecia is a manifestation that, depending on the picture of the trichogram, may be due to:
Also, depending on the length of time over which the hair is lost, it can be classified into:
Diffuse alopecia – Causes
Diffuse alopecia arises as a result of a disruption of the normal life cycle of hair. It is often hard to diagnose, because the thinning is observed several (usually 3-4) months after the effect of the possible cause, which in most cases is no longer present in the patient at that time.
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:
Diffuse alopecia – Treatment
Diffuse alopecia is usually reversible and in a few months the thinning of the scalp has been restored and the 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 try and identify the precipitating agent for the hair loss, as still exists a possibility that the diffuse alopecia will persist and become chronic, or become a precursor to androgenetic alopecia. In the latter case, the hair does grow back but the strands are weaker and thinner than before the strike of alopecia.
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, vitamins B that have 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 whether 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 can not 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.