Alopecia is the medical term for hair loss. It is a general term used to describe any type of hair loss from a small bald patch on the head to the loss of the all the hair over the entire body. There are many different types of hair loss each with a different set of symptoms and causes. There are also many different hair disorders which can cause hair loss. Therefore it is important to know which type of hair loss or hair disorder you are suffering from so that you can be offered the best treatment. Here at the London Dermatology Centre we are lucky enough to have one of the few dermatologists in the UK that specialises in all types of hair loss.
Androgenetic alopecia (male- and female-pattern baldness) and alopecia areata (bald patches) are the two most common types of hair loss. These conditions affect both men and women. More information on these conditions can be found below. Other hair disorders include cradle cap, head lice, folliculitis, hirsutism, boils and carbuncles and seborrhoeic dermatitis. Cradle cap describes the yellow, greasy, scaly patches that can sometimes appear on the scalp of young babies. Head lice are tiny insects that live in hair that cause an itchy scalp. These are easily treated with dimeticone 4% lotion spray which is easily available to purchase over the counter at any pharmacy. Folliculitis is the inflammation or infection of hair follicles in the skin. Hirsutism describes excessive hair growth, this condition mainly affects women. A boil is a painful red lump that occurs at the site of an infected hair follicle and a carbuncle is a collection of pus filled boils. Seborrhoeic dermatitis is due to the overgrowth of a harmless yeast called Malassezia that lives on the skin. Dandruff is a form of mild seborrhoeic dermatitis but more severe forms can result in scaling of the skin in other parts of the body.
The most common type of alopecia is androgenetic alopecia, also known as male-pattern baldness and female-pattern baldness. About half of all men over the age of 50 and about half of women over the age of 65 are affected by androgenetic alopecia.
In men, the hair loss usually begins around the late twenties with most men having some degree of hair loss by their late thirties. The typical pattern of hair loss is a receding hairline where the hair at the top of the forehead is lost first. Then, the hair on the crown (the patch of hair growing in the opposite direction of the rest of the hair, usually at the top of the head) and on the temples thins leaving a characteristic horseshoe shape around the back and sides of the head. In rare cases the hair loss can progress to complete baldness. Androgenetic alopecia in males is hereditary meaning that it runs in families. It is caused by the hair follicles being overly sensitive to a hormone called dihydrotestosterone (DHT). This hormone affects the hair follicles in the scalp. DHT damages the hair follicles making them become smaller and smaller causing the new hairs to become progressively shorter, thinner and lighter in colour. Ultimately the hair follicles become too small and stop producing hair completely.
As well as affecting men, androgenetic alopecia can also affect women (female-pattern baldness). The pattern of hair loss in women is different from that in men. In female-pattern baldness the hair typically thins around the top of the head at the crown, without affecting the front hairline. The cause of female-pattern baldness is not well understood. It is not clear whether the condition is hereditary. There is some suggestion that female-pattern baldness is more noticeable in women who have gone through the menopause. The severity of hair loss in women varies. Some women experience widespread hair thinning while others progress to complete baldness.
Alopecia areata, also known as autoimmune alopecia, is a type of hair loss that causes patches of baldness. These patches are usually about the size of a coin and tend to affect the scalp but can occur anywhere on the body. Alopecia areata can occur at any age but mostly affects teenagers and young adults aged between 15 and 29. It is caused by a problem with the immune system. The immune system is the body’s own natural defence against infection from foreign invaders such as bacteria and viruses. In alopecia areata the immune system mistakenly attacks the hair follicles which results in hair loss. It is more common in people with other autoimmune conditions such as diabetes.
There are three stages of alopecia areata: the sudden loss of hair followed by enlargement of the bald patch or patches and finally the regrowth of hair. Regrowth of the lost hair is the most common outcome for patients with alopecia areata. This usually happens within a few months. To begin with the new hair will be white and fine. Over time the fine, white hair thickens and regains its original colour. Although this is the case for most people with alopecia areata, in some cases the hair loss can progress until all the hair on the scalp is lost (alopecia totalis) or even complete hair loss from the entire body (alopecia universalis).
The causes of hair loss are varied and a correct diagnosis is essential to enable successful treatment. Androgenetic alopecia (male- and female-pattern baldness), the most common form of hair loss in men and women, has a number of scientifically proven treatments that can help to slow down, stop or reverse the hair loss. Generally, the earlier the treatment is started the better the results. Unfortunately these treatments are not available on the NHS and so patients who wish to reduce their hair loss will often have to seek help privately. Here at the London Dermatology Centre we stock several of these effective medications.
Finasteride is used to treat androgenetic alopecia in men. This treatment is not available to buy over the counter and has to be prescribed by a doctor. After 6 months of treatment with finasteride, patients can expect about a 30% improvement in hair loss. The effectiveness of finasteride only continues for as long as it is taken as the balding process will resume 6 to 12 months after stopping treatment. The drug works by preventing the hormone testosterone being converted to another hormone dihydrotestosterone (DHT). This reduces the amount of DHT in the body. People with androgenetic alopecia are more sensitive to this hormone than people without the condition. The DHT hormone damages the hair follicles causing them to shrink. This makes the new hair become shorter, thinner and lighter in colour. By blocking the production of DHT it allows the hair follicles to return to their normal size.
Minoxidil is another medication used to treat hair loss in both men and women. It is the active ingredient in several over the counter products that promote hair growth such as Regaine and is usually available as a lotion or foam that you rub on your scalp every day. Minoxidil encourages hair growth and can also stabilise damaged hair follicles to prevent further hair loss. It works by causing the blood vessels that supply the hair follicles to dilate. This increases the amount of blood that goes to the follicles which increases the level of nutrients that the hair follicles receive. This increase in nutrients promotes hair growth. As many of the products that contain minoxidil are available to buy over-the-counter at local pharmacies, the concentration of minoxidil in these products is quite low at around 2%. The extra strength products can contain up to 5% minoxidil. Higher concentrations of minoxidil are only available on prescription from a doctor.
Alopecia areata affects 1% of the population at some time in their lives and usually presents as patchy hair loss. Whilst the course of this condition can be unpredictable there are effective treatments to encourage regrowth. Topical treatments (applied to the skin) such as corticosteroids and minoxidil can be used to maintain the hair regrowth. Injections of triamcinolone acetonide have been shown to speed up the regrowth of hair. Corticosteroid injections have also been shown to be effective in speeding up hair growth but are not advised for long term use due to potential side effects.
Monitoring response to treatment is vital and so at the London Dermatology Centre have a medical digital photography system which allows accurate, reproducible photographs to be taken at specified time intervals for comparison.
For more information regarding the treatment of hair loss please contact us on 020 7467 3720.
Content by Dr Sunil Chopra and Rebecca Perris
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