Hair Loss - Hair Loss

Hair loss: what are we talking about

It is a source of anxiety and discomfort, so much so that it has a strong impact on the quality of life of the people who suffer from it. We are talking about alopecia, a very common disease that involves a progressive and sometimes unstoppable hair loss up to baldness in some cases. It is precisely this change in physical appearance that has a strong psychological impact in men but especially in women, since hair has always been considered the symbol of femininity.

If you notice abundant or sudden hair loss, it is essential to rely on the consultation of a specialist, who will be able to advise you on the most appropriate therapy based on the origin and, in most cases, solve the problem .

First of all, it is good to point out immediately that hair loss is a normal physiological process and therefore we must not be afraid of it a priori.

As mentioned, hair loss is a natural phenomenon and should not cause concern. If we find hair on the comb or brush, in the morning on the pillow or between the sheets, in the tub or in the shower, especially in the transitional seasons (in autumn and less in spring) we need not worry, as long as their number is proportionate. to the hair we have on our heads and in any case always no more than 100 a day. So let’s talk about a physiological fall.

Conversely, when there are many more hairs in the involution phase and close to falling than those of growth or regrowth we must be alarmed, as it is possible that there is a pathological or abnormal hair loss. In this case it will be necessary to understand, through specific tests such as the trichogram or blood analysis if it is a temporary phenomenon due to food, emotional, environmental, health factors or if there are more marked and lasting problems over time.

In fact, all the hair in our body grows regulated by cyclical phases and even the hair does not escape this rule.

Put simply, the functioning of the hair bulb has the following 3 phases:

active phase (Anagen): in which it produces and makes hair grow and can last 4 years for men and up to 6 years for women and children;
stasis phase (Catagen): in which the hair progressively ceases its vital functions. It usually lasts up to 3 weeks:
fall phase (Telogen): in which the hair is in effect dead and ready to fall out due to the new regrowth that literally “pushes” it. It lasts from 2 to 4 months.

In a healthy person, therefore, the life cycle of the hair can last up to 6 years and therefore the hair is reciprocated several times over the course of life.

Causes of hair loss

If no factor (pathological or not) intervenes to vary or block the phases of the cycle, there is no problem when you see hair falling out because it is normal to have on average 15% of hair in the telogen phase and therefore to be ready to fall. It is not possible to know precisely how much hair is lost per day , but a loss of up to 100 hairs per day is considered physiological.

In practice, the hair falls out but then grows back healthy and strong as before, so the problem does not arise.

When there is an abnormal hair loss it is necessary to understand first of all if it is a temporary phenomenon or if there are underlying pathologies.

Unfortunately, it is not easy to identify the causes of hair loss on your own, so I recommend that you always contact a dermatologist who specializes in trichology . This will, in most cases, save you time and pinpoint the exact problem . Most of the time the savings are also in economic terms since you will avoid wasting money unnecessarily on DIY treatments that very often turn out to be wrong.

Below I will make an overview of the numerous types of hair loss that exist, dividing them according to their pathological nature or not:

Pathological causes

A very basic method to understand if you are a victim of pathological hair loss is given by the presence of itchy head and pain in the scalp. These factors, together with a greater production of sebum , are almost always present in the cases that we will examine.

Androgenetic alopecia

Well, we have talked extensively about this type of hair loss since androgenetic alopecia is the main theme of our site. Here I will just say that it is the common male pattern baldness that affects 3 out of 4 men over the course of their lifetime.

Also known by the name of Telogen Defluvium or Androgenetic Defluvium , it manifests itself with a progressive miniaturization of the bulbs which leads to a thinning of the hair that advances according to a typical path starting from the classic receding hairline up to the cleric.

The measure of progress is known as the Norwood scale. It is a disease of genetic origin and, although to a lesser extent, it can also affect women, especially if they are in menopause. If you want to know more, I invite you to click on the link at the beginning of the paragraph that will take you to our guide.

Tricotillomania

Although it is not due to a real “disease” that directly involves the hair, I have included trichotillomania among the pathologies as at the base there is a real obsessive-compulsive disorder that leads affected subjects to literally pull their hair from the head. At the base of this pathology there are undoubtedly inner and deep motivations that must be treated through adequate therapies and psychiatric paths . However, it is reversible and therefore eliminating the cause that leads to hair pulling, they will return to grow regularly.

Seborrheic dermatitis

The seborrheic dermatitis affects most often the scalp but can also occur in other parts of the body where there are many sebaceous glands . It manifests itself in the form of inflamed and red patches where the skin forms greasy and yellowish flakes that tend to peel off. It generally causes discomfort and itching but in severe cases it can cause real pain.

Telogen effluvium

It is a type of hair loss which, as the name suggests, is linked to abnormal telogen hair loss . It can be in acute form caused by a strong traumatic or stressful event that brings up to 85% of the hair in telogen with consequent abundant fall in the following 3 months even of hundreds of hairs a day.

There is also a chronic form in which the triggering event has a less traumatic nature and is more linked to states of anxiety and inner discomfort that last over time. The hair loss is less than the acute form but continues over time . It has no miniaturization and therefore the hair can grow back.

Hair Loss and Stress

it is a series that is difficult to interpret even by expert doctors and differs from the telogen effluvium that we have just seen because it presents typical symptoms of androgenetic alopecia with the presence of thinning and miniaturized hair. However, stress and the psychological situation can emphasize the problem. Find out more in our article on stress alopecia.

Alopecia areata

Alopecia areata results from an immune system problem that attacks the hair follicles as it does not recognize them as its own, leading to patchy hair loss in the affected areas. In the most advanced forms it can involve the entire face (alopecia totalis) to arrive, in the most severe form, all the hair of the body (alopecia universalis).

It does not cause miniaturization of the bulbs which can therefore return to producing perfectly healthy hair in the periods in which the disease is latent. So it is reversible

Cicatricial alopecia

Very rare disease in which following an inflammatory process there is a real destruction of the hair bulb which is replaced by scar tissue. Obviously this is a type of irreversible hair loss as the follicle is destroyed.

Thyroid problems

The variations both in excess and in defect of thyroxine , the main hormone produced by the thyroid gland, have consequences on the hair and all skin appendages (nails and hair). This is because thyroxine plays an essential role in the active Anagen phase that regulates hair and hair growth and which we talked about at the beginning of the article. In addition to increased hair loss, people with thyroid problems often have brittle hair that looks dull and dull.

Anagen effluvium

It is observed in conjunction with the intake of chemotherapy drugs in which cellular metabolism is inhibited, especially of the follicular cells. There are also other treatments that can have the same effects. It occurs as a loss of hair and patchy hair in the first phase, and then spreads in an all-encompassing way. Hair regrowth resumes once the treatment has ceased its action.

Physiological causes

Now we will deal with the main types of hair loss that do not have to do with diseases of any kind, but mainly depend on physiological factors :

Seasonal hair loss

Although it is the most common and perfectly normal type of hair loss , it is one of the most worrying as it affects all individuals.Seasonal hair loss occurs in late spring and early summer and then recurs in autumn .

There are various theories that attempt to explain it by involving the variations in the light / dark ratio between the various periods of the year and their influence on hormonal levels which in turn contribute to regulating the hair cycle. Still there are those who see in the stressful life of modern times, incorrect nutrition, pollution … and so on and so forth. With this I do not mean to belittle the various hypotheses but, much more simply, in my opinion the school of thought is more concrete which leans towards a seasonal change . A legacy of the past, still written in our genes, which, in fact, has to do with the shedding of the hair that many animals have as a result of the temperature variations characteristic of seasonal changes.

In practice, we too “change the hair” albeit obviously to a lesser extent

Traumatic events

This category includes all those events that we ourselves inflict on our hair… voluntarily or not. I don’t mean psychological trauma, but physical trauma. An example is sunburn caused by too much summer sun that can cause damage to the scalp resulting in excess free radicals and fall in the following weeks or months.

Among the traumas that can cause damage to the scalp, and therefore affect hair loss , we can include all those treatments with aggressive substances such as colorings or of poor quality shampoo that can literally ruin the hair shaft. Even very frequent exposure to more common substances such as pool chlorine or sea salt can damage the hair structure.

Of course these are minor problems that can at best make the hair dull and dry or make it fragile and therefore easily breakable. However, in principle it is only the hair shaft that is damaged and with regrowth everything tends to settle down (as long as you eliminate the event or substance that causes the problem)

Obviously, intolerances or allergies caused by these substances must be excluded, which in this case can lead to irritation and dermatitis of the scalp with consequent alteration of the life cycle.

Hormonal fluctuations and hair loss

We have already seen that hormones such as DHT or thyroid ones can be the basis of real pathologies that lead to abnormal hair loss. In this section, however, I include changes in hormone levels that are not due to diseases in the strict sense but to particular physiological states.

Post Partum Hair Loss

For example, this type of effluvium affects women at the end of pregnancy and in fact many during breastfeeding experience a strong increase in the fall.This is due to estrogens (female hormones) which rise in early pregnancy and, among others, have the ability to lengthen the anagen phase .

Here then explains why pregnant women often have much more beautiful hair. After gestation, however, estrogens return to standard levels and therefore many hairs pass into telogen and fall out within the next 3 months or so. cases.

Excess of cortisol and hair

Known as the stress hormone , cortisol, if at high levels and for too long, can negatively affect the activity of the cyclic AMP hormone. The latter is a kind of messenger that transmits the signal to the bulb matrix to start the production of keratocytes (the material the hair is made of) and melanocytes (the pigment that gives color to the hair).

This signal interruption causes the hair to go into the telogen phase and consequently fall out within 2-3 months.

And nowadays, having altered cortisol is relatively simple unfortunately since stressful events are enough to raise its level.

Melatonin

You have probably already heard that melatonin is the sleep hormone and is involved in the regulation of the sleep and wake cycle, however some studies carried out on animals have shown its influence on hair growth.

There are not many data on humans, but I managed to find this collection ¹⁾ which examines 5 studies carried out to evaluate the effects of melatonin in men and women suffering from androgenetic alopecia.

The first pharmacodynamic study on the topical application of melatonin through a 0.1% solution carried out on 40 women suffering from androgenetic alopecia where, at the end of the 6 months of testing, an increase in anagen hair was noted compared to the group that used placebo.

Also with regard to melatonin it is not difficult to alter its levels since it is produced only between midnight and 3 in the morning.

Therefore, for melatonin and cortisol, it is enough to have an unregulated rhythm of life and the hair can be affected.

WARNING: I’m not saying that if you miss a night’s sleep, or if the boss makes you angry at work… you will lose tons of hair. It is not the one-off episodes that create problems, but the conditions of stress and recklessness over time . Certainly they will not be the direct cause of diseases such as androgenetic or areata alopecia … but it is a fact that abnormal and prolonged values over time can affect the life cycle of the hair.

Diet and food shortages

Following an unregulated diet or one that neglects, in whole or in part, certain macronutrients is among those factors that, indirectly, can cause abnormal hair loss. Not so much because what you eat in a single meal can directly affect the hair bulbs, but for any food shortages that can occur as a result of drastic diets or significant weight loss in a short time.

Among the elements that have primary importance for the health of the hair, it is worth mentioning Iron and B vitamins . It is also very important to monitor the levels of vitamin D which I have extensively covered in this site.

Smoke and hair

It is well known that smoking is bad for you, and among the many effects, all negative, that smoking brings … hair problems should not be excluded.Basically, everything is due to nicotine which, being a vasoconstrictor , reduces blood circulation in the skin scalp resulting in less oxygenation and supply of nutrients to the hair bulbs.

To this must be added the inflammatory effect of this substance in the body with a consequent greater release of free radicals and therefore cell damage . From here we can understand why the hair of many smokers often appears brittle and dull.

In short, quitting smoking will also be good for your hair.

Traction alopecia

Here too we are in the presence of hair loss not due to diseases or to our genetics, but to our behavior. Traction alopecia is in fact caused by hairstyles that cause continuous traction of the hair . In the initial phase, or in any case in milder cases, it manifests itself with inflammatory phenomena such as folliculitis , itching, etc …

However, if the traction phenomenon persists, there is a real hair loss with the formation of alopecic patches without hair. Fortunately, it is a reversible problem as it is sufficient to eliminate the traction by changing your hairstyle.

Hair loss remedies

When looking for information on the main hair loss remedies, you are literally inundated with a multitude of information and products. As you can imagine after having seen the way in which I have structured this article, I first of all consider it necessary to distinguish between drug therapies and natural remedies.

Pharmacological remedies

Obviously, the topic is vast and it is not possible to deal with everything here. However, below I will substantially explain the drugs used to treat cases of hair loss due to the diseases that we have at the beginning of this page.

For many of these you can find in-depth guides with dedicated pages on this site.

Minoxidil: drug approved for the treatment of androgenetic alopecia but has properties of hair growth stimulator that make it suitable for other hair problems as well. It works by increasing blood circulation and synchronizing the hair cycle in the anagen phase.
Finasteride: it is also officially approved for common baldness and, in my opinion, represents the main pillar in the treatment as it reduces the conversion of testosterone to DHT which is the triggering cause in predisposed people. Being an antiandrogen drug, by its nature it is only useful for treating androgenetic alopecia.
Dutasteride: is part of the antiandrogens and therefore acts in a similar way to finasteride. On the contrary, it is also more powerful and consequently can give greater side effects. To date, it is not approved in America and Europe for the treatment of androgenetic alopecia. For this purpose it is prescribed off label by some dermatologists but to date there are no official protocols for AGA
Ketoconazole : thanks to its anti-fungal and anti-inflammatory properties, it is used in lotions and shampoos to treat seborrheic dermatitis and generally states of irritation and trichodynia of the scalp.
Cortisones : used in the form of intramuscular injections to block phases of acute telogen effluvium. They also give good results in less severe cases of alopecia areata. While for chronic telogen effluvium or mild forms, topical applications are used. Hydrocortisone butyrate is widely used in the lotions to calm the mild inflammatory state characteristic of most forms of fall. In fact, in my personal therapy it is present.
Immunosuppressants : in the most severe cases of alopecia areata, cyclosporins are used which reduce the activity of the immune system by blocking the attack against its own follicles and thus allowing their activity to resume.

It should be remembered that ALL the drugs mentioned above can be used on medical prescription issued by a specialized doctor.

Low Level Laser LLLT : Laser hair therapy technically does not fall into any of the 3 categories of remedies I have identified (pharmaceuticals, natural and aesthetic). I prefer to insert it here because, in my view, it has more affinity with drug therapies. Low-level laser therapy (LLLT) is already used successfully in many areas and also for hair it can be useful in certain cases thanks to its proven ability to intervene on circulation and accelerate cell metabolism. It is not decisive, but it can be an excellent adjuvant to strengthen the effectiveness of drugs.

Natural Hair Loss Remedies

Here a world opens up as there are so many supplements and foods with allegedly beneficial properties for the hair. On this site we have already treated some with greater interest in those effective against androgenetic alopecia, some other forms of hair loss and finally those with recognized ability to keep the scalp healthy. Here are the main ones.

Vitamins : as already mentioned, all the B vitamins useful for skin health and hair shine have great importance. Then follow those with strong antioxidant properties such as A, C and E. An excellent remedy against seborrheic dermatitis is represented by the vitamin H better known as biotin. If you want to learn more, I invite you to read our guide on the most important vitamins for hair. A separate case is represented by vitamin D3 which due to its characteristics and functions performed not only for the hair but for the whole organism can be almost assimilated to a hormone. Given its importance, I invite you to read our in-depth analysis on vitamin D where its influence on hair loss is also treated.

ATTENTION: the integration of vitamins must be carried out after the deficiency has been ascertained with specific tests prescribed by the doctor. Of course they are not drugs, but taking them without being necessary is useless and in some cases harmful.

Serenoa Repens: has antiandrogenic properties as it manages to reduce the conversion of testosterone into dihydrotestosterone. It is useful in prostate and urinary tract disorders, while for the hair it is a valid help in cases of mild androgenetic alopecia. In my opinion, and also according to the numerous studies carried out that you can see in the specific guide, serenoa repens is currently the only valid natural alternative to finasteride and dutasteride albeit with obviously lower results than drugs.
Horsetail : in general, horsetail is known for its diuretic and purifying properties, but in the trichological field it is used for its high content in minerals including potassium and especially silicon, which are very useful for remineralizing and strengthening the skin appendages, i.e. hair and nails when they appear dull and weakened.
Zinc : this mineral is very important for the functions it performs in the body, especially the male. In fact, it optimizes testosterone levels but at the same time has a mild anti-aromatase function so it keeps the level of estrogens (female hormones) under control. Regulates cell regeneration by promoting protein synthesis and therefore also the keratocytes of which hair and nails are made. Its effects are enhanced by the combined use with vitamin A. A deficiency can lead to hair loss and in fact it is one of the values that trichologists ask to be monitored in analyzes for check-ups.
Magnesium : magnesium is also an important mineral for the general health of the body that performs fundamental functions at the muscular and skeletal level. At a trichological level it is useful as it maintains cellular metabolic activity at optimal levels and allows the absorption of vitamins C, E and group B which, as we have seen, are very important for the hair. It also seems to intervene positively in avoiding the appearance of white hair (study). This is also one of the values that dermatologists monitor with analyzes for their trichological patients.
Mela Annurca : in chronological order it is probably the most recently released family of hair supplements. The first product was Applemets Hair, which we covered extensively on our site. In short, I can say that this type of product was developed in Italy on the basis of university studies that have shown an effective acceleration of hair and nail growth (test)
Neem oil : very interesting product for its antibacterial and antifungal properties, it manages to keep the scalp healthy and hydrated and is a good natural alternative to keep itchy head and seborrheic dermatitis at bay. There will be an in-depth study soon.

Antioxidants

This type of substance carries out a protective action on a general level, reducing damage from cellular oxidation throughout the body. However they are also very important for hair health and below we will see some of the most used for this purpose:

NAC (n-acetyl cysteine): it is known above all for its protective properties of the liver and detoxifying the whole organism. In practice it is able to counteract the oxidative processes and cellular aging and therefore it is also useful for hair health.
Green tea : thanks to the antioxidant action of the polyphenols and the anticarcinogenic action of the catechins it contains, it counteracts the action of harmful free radicals. In addition, its intake has been associated with an increase in the SHBG protein that keeps a part of testosterone bound. Therefore its use could have a rationale in the context of a therapy against androgenetic alopecia.
MSM (methylsulfonylmethane): is a compound that can be found in nature and derives from sulfur. The sulfur amino acids of which it is rich, are very important to keep the protein structures strong and therefore, since the hair is made up of proteins, it increases the speed of growth and quality.

Only aesthetic hair loss remedies

In this category I will include what in my opinion are currently the main hair loss remedies that do not act to cure or reduce the loss, but “circumvent” the problem by trying to artificially recreate the coverage of the scalp.

Concealers

These are cosmetics that, placed in the residual hair, are able to camouflage the contrast and visibility of the scalp, optically reducing thinning.The best known are in the form of powders based on keratin microfibers, which we have extensively covered on helphairless and I have been using them myself for a few years.

Among the ADVANTAGES there are:

In the most suitable situations, a clear change of image is obtained in a few seconds with noteworthy results
Extreme reversibility because if you don’t like it, just a shampoo and everything goes back to the way it was before

Among the LIMITS there are:

However, the need to have a minimum of hair in the area to be treated (it does not matter if thin and thinned)
Limited water resistance and therefore impossible to swim in the sea or in the pool, but also to stay under heavy rain

There are also spray or foundation-type formats that solve the problem of water resistance but, in my opinion, make it less aesthetic.

Hair Prosthesis

They are the evolution of the classic wig and consist of a customized system that will be applied using specific glues to cover the bald or thinned area. Obviously the scalp must be prepared with shaving and there are weekly maintenance phases. Of course it requires sacrifice, but the results that can be obtained with the latest generation hair implants can be truly amazing even for the most experienced eye.

Tricopigmentation

It is a specific method of tattooing done on the scalp with which the typical dots of those who wear a shaved look are recreated, restoring the coverage even if only aesthetically.If you want to learn more, you can find a lot of information in our article on tricopigmentation.

In short, I can say that it is a good solution for those who love to have their hair shaved and require not very frequent maintenance (usually once a year).

Hair transplant

It is the most extreme remedy to combat hair loss and is generally used by those suffering from androgenetic alopecia. It is not a topic that is currently dealt with in depth on this site, but it is correct to give even minimal information. In practice it consists of a real surgery with which hair bulbs are taken from areas not subject to androgenetics (usually from the nape of the neck) and then replanted them in the bald or thinned areas.

The results that can be obtained can be really good, however the following limitations must be taken into account:

starting situation of the subject because if the thinned area is very large, many follicular units are needed
limited quantity of available bulbs (follicular units). Unfortunately you take them off on one side and put them on the other …
it is still a surgical procedure and as such can lead to problems and complications.

Conclusion

With this long article I hope I have shed some light on the fact that baldness is just one of the many ways we can lose hair . It is certainly among the most serious as, if not taken in time, it has irreversible effects. However, as you have seen, the hair loss theme is an extremely vast topic with many facets. It can affect both men and women and, in some cases, even children.