Hair loss is a very frequent reason for consultation in the field of dermatology. However, not all hair loss is the same and its diagnosis is fundamental to establish an appropriate and effective treatment.
Alopecia can be generated by innumerable causes. When it is genetic, it is called androgenetic alopecia and can be due to both hereditary and hormonal factors. It usually starts soon, at 20-30 years old; hair becomes thinner and scarcer, hair density considerably decreases and hair loss manifests mainly in the upper part of the head.
Excess androgens can also cause alopecia. Diffuse universal alopecia may be due to several reasons but is usually due to excess male hormone and is presented following two patterns, depending on whether it affects a woman or a man.
Thus, in men, it follows the Hamilton pattern initially affecting the frontotemporal area and the crown.
In women, however, it follows the so-called Ludwig pattern: the upper scalp area gradually thins out, without affecting the implantation line (the forehead area).
Both work and emotional stress directly affect hair health. Stress can cause telogen effluvium, which is a break in the usual hair cycle. So, during that time, hair is not regenerated as usual, and less populated areas appear.
An unbalanced or inadequate diet, such as those promoted by many poorly formulated diets in fashion, can be very harmful to health, and also cause hair loss. Lack of iron or zinc are two of the most common reasons for hair loss.
Disorders in the immune system and cell inflammation are also behind many cases of alopecia.
Although the main complaint referred by the patient might be hair loss, it is not always the real problem that is occurring. Other symptoms or signs may prevail, such as an itchy scalp, desquamation or loss of density and thinning of the hair shaft in a diffuse or localized manner. Detecting whether one or the other of these situations prevails can guide us towards a diagnosis.
There are two large groups of alopecia (a medical term to generally refer to these hair diseases), which cause a definite hair loss: Scarring alopecia and those that do not destroy hair completely or permanently: non-scarring alopecia. This initial classification into both groups is not always easy, so the role of an expert trichologist-dermatologist is fundamental.
In addition, not all hair problems have their root in the hair, since the skin on the scalp can also suffer from diseases or dermatosis with its potential impact on the hair shafts; and, in turn, these can be directly damaged by external aggressions.
It is important to understand each of the conditions within these groups, scarring alopecia, non-scarring alopecia, scalp disorders and hair shaft disorders. A correct diagnosis is the only way to implement an appropriate, individualized and effective treatment.
The starting point for a correct alopecia diagnosis should always be a dermatologist who is an expert in trichology. In addition to the correct guided medical record and the trichological examination, a trichoscopy must be performed; digitalized trichoscopy is the tool with the greatest diagnostic value at present. In addition to allowing a more precise diagnosis, it helps to monitor the patient. For androgenetic alopecia, it will provide a count of hair shafts per square centimetre and their average diameter, among others, which objectively demonstrates the patient's initial condition and improvement with the treatments prescribed. For scarring alopecia, it also allows us to more precisely quantify the degree of inflammation and the process' activity in each area of the scalp. Sometimes, a biopsy may also be needed to establish a definitive diagnosis.
In recent years, new therapies have been developed for hair loss, primarily for androgenetic alopecia; and some of those already employed have been rediscovered with new routes of administration.
Hair mesotherapy with dutasteride directly contributes to the effect of the drug on hair follicles and the stimulation of microinfiltration itself has also been shown to cause stimulating growth. It is a therapy
that is well tolerated and with frank effectiveness, which can be combined with conventional treatments to add effectiveness and with platelet-rich plasma that adds growth factors to the hair follicle.
Oral administration of minoxidil is also a major step forward in the treatment of androgenetic alopecia, avoiding the daily application of this lotion, which is often uncomfortable and cumbersome, and adding greater effectiveness when the drug is administered orally. The dose must be adjusted to each patient individually by the trichologist dermatologist and be modulated according to the course of the disease. Furthermore, not all patients improve with the application of minoxidil directly to the scalp, since its effectiveness through this route of administration depends on the presence on the scalp of an enzyme that processes the medication. Not all patients have this enzyme locally, but all patients have it in other internal organs of the body, so oral minoxidil will ALWAYS be effective, even in patients where it has not worked previously when applied as a lotion.