Hair loss (androgenetic alopecia) | Disease Lexicon

Hair loss or alopecia is a condition in which 60 percent of the hair falls out in one place or a certain body area. It can have different causes and forms. About 95% of all hair loss cases are caused by androgenetic alopecia in both men and women. This form of hair loss is due to an over-sensitivity of the hair roots to androgens (male sex hormones) and can affect both men and women.

Hair loss (androgenetic alopecia) | Disease Lexicon

Basics

There are different types of hair loss. It can have genetic causes, extend over a longer period of time, or occur acutely. From the receding hairline to the bald head – the “normal” hair loss is genetic. Androgenetic alopecia is the most common. This is a genetically determined hair loss that is caused by aging. It is dependent on racial and family predispositions. Hormones control these changes.

In men, the hormones cause increased growth in the beard area on the one hand and the increase in sebum glands on the head on the other. The proliferation of the sebum glands is associated with the loss of hair. Usually, this change begins between the ages of 30 and 40. It starts in the area of ​​the frontal cusps and the vertex region. It comes to the well-known “receding hairline”. In the further course, the hair-free zones combine, so that gradually a bald head appears.

Hormonal hair loss is less common in women than in men. Hormone-related hair loss in women is rare, but it can happen. It is less pronounced than in men. It is based on a disruption of female estrogen production. The hair loss can then appear accompanying tumors of the ovaries or after menopause. Androgenetic alopecia in women is often associated with a masculine hair type. Affected women have hair on their lower legs, toes, and face. Treatment options are limited.

Androgenetic alopecia

Women can be treated with hormone preparations such as hormonal contraceptives or topically applied estrogen-containing agents. In men, the genetic predisposition to hair loss is difficult to treat. Estrogens contained in hair lotions can have a relatively successful effect. The medicinal inhibition of the proliferation of the sebum glands is also effective. Most of the time, the effect is limited to the duration of use.

Alopecia areata

Circular hair loss is a common disease. Alopecia areata is local hair loss in which the hair is lost in a limited, usually circular area. That is why it is often referred to as circular hair loss. This condition is quite common. Around one million people in Germany suffer from it. In particular, the psychological stress that this disease often brings with it leads to considerable suffering. Another form of alopecia areata is the loss of all pigmented hair. 

All that remains is hair without pigment. As a result, people suddenly only have gray hair on their heads. This form often sets in acutely and suddenly. Mental factors are neither the trigger for this phenomenon nor do they accelerate the process.

The body’s defenses “nibble” on the hair follicles. The cause of this condition is not known. However, immunological factors are suspected, because the T-lymphocytes, which play a role in the body’s defenses, attack the hair follicles. A genetic component is also suspected because alopecia areata occurs more frequently in some families. 

Alopecia areata is accompanied by inflammation. Most of the time, the hair, especially on the head, falls out suddenly. Children and young men are often affected. But women can also be affected by alopecia areata. The development of alopecia areata is difficult to predict.

The prognosis of alopecia areata is difficult. Spontaneous hair regrowth can occur after months. That is quite often the case. However, the risk of renewed hair loss is great. A total loss of all body hair is also possible – this is called alopecia Universalis.

If the hair can be easily pulled out at the edges of the hairless areas and if you find piston hair (exclamation mark-shaped hair) there, the failure is likely to progress. If alopecia is found in the neck area, it can be expected to spread over the entire head. 

A diversionary maneuver tries to bring the immune system back into balance. Treatment is extremely difficult because the cause is unknown. Anti-inflammatory therapy can be helpful. In topical immunotherapy, localized eczema is created by applying chemical solutions. This artificially induced inflammation “distracts” the immune system from the hair roots. This allows the hair roots to recover. The disadvantage of this treatment is that it only works during use.

Because of the often years of use, it can also lead to strong allergic reactions all over the body. Topical immunotherapy is successful in half of the cases. The treatment of the special form of alopecia areata atrophicans in women has so far been unsuccessful.

A special form of alopecia areata is alopecia areata atrophicans, also called Brocq pseudopods. It occurs particularly in women between the ages of 30 and 55. Alopecia areata atrophicans usually begins insidiously with small hairless spots and with reddened, shiny, and tight skin. Hair loss is slow and progressive. The cause of this disease is also unknown. Treatment attempts have so far remained unsuccessful.

causes: hair loss (androgenetic alopecia)

Medication can cause temporary hair loss. In addition to genetic predisposition and immunological factors, hair loss can also have many other causes. Some drug therapies, e.g. B. the therapy with cytostatics for malignant tumor diseases, can lead to the loss of hair. This hair loss is mostly reversed when the medication is no longer taken. Some infections are accompanied by hair loss.

Infections can also lead to temporary hair loss. These include: impetigo contaginosa, carbuncle, wound rose or shingles.

Continuous pressure and tension on the hair can destroy the hair roots. Prolonged pressure e.g. B. by wearing jewelry, work clothing or associations, or train z. B. ponytail hairstyles, hair braids or curlers, can cause hair loss. This form of hair loss also decreases or disappears completely when the damage is reduced or stopped.

The prognosis is only bad if the mechanical damage has already led to the destruction of the hair root. Diseases that cause scarring or scarred changes in the skin can lead to hair loss that does not go away. 

Hair loss that does not regress often results from scarring changes in the skin due to: bruises, chemical burns, burns, x-ray damage, diseases such as tuberculosis, leprosy, or syphilis, fungal infections in severe chronic diseases such as leukemia, severe liver disorders, tumors, diabetes mellitus, Lupus erythematosus, collagenosis or congenital skin diseases such. B. in ichthyosis or dyskeratosis Darier. The underlying disease needs treatment.

In these forms of alopecia, the therapy for hair loss consists in stopping or at least slowing down the hair loss by treating the underlying disease.

Therapy

Overall, the correct diagnostic assessment of hair loss causes is crucial in choosing the right therapy. In addition to drug treatment, hair loss surgery has also recently made a name for itself. Above all, free autologous hair transplantation is enjoying increasing popularity as it is the least invasive one and is therefore used far more frequently than reduction plastic or scalp plastic.

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