Hair loss & treatments

Myths & FAQs

Dr. Christopher Tzermias

Dermatologist | Contact
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Hair Loss from Neonatal Period to Adolescence

Hair loss in babies, children, adolescents and young adults is a completely different problem than adult hair loss.

The causes are numerous; there is much greater association with a genetic disorder, while both treatment and prognosis differ as compared to alopecia observed in adults.

The assessment of hair loss in a child should include a complete recording of family history, trichoscopy and microscopic examination of hair bulb and shaft.

Congenital or early-onset alopecia

This type of alopecia is distinguished in diffuse and localised. Diffuse alopecia can be distinguished into partial (hypotrichosis) or complete (alopecia totalis). It may be a separate condition, it may coexist with other pathological conditions of the skin or be part of a syndrome.

Alopecia may be present at birth or occur for the first time during the first months of life. In neonates the diagnosis of extensive alopecia may even delay for many years due to the varying number of hair on babies.

Causes of scarring alopecia in children

In this case, hair loss is caused by a certain skin disorder, such as:

  1. Developmental disorder and hereditary conditions (skin aplasia, epidermal nevi, porokeratosis of Mibelli, ichthyosis, Darier disease, etc.
  2. Defects due to natural causes: mechanical traumas, burns, x-ray dermatitis.
  3. Microbial infections: tinea/ringworm infections, bacterial infections (lupus vulgaris, leprosy, tertiary syphilis, furuncle, carbuncle, folliculitis, acne necrotising), leishmaniasis, viral infections (herpes zoster, chickenpox, smallpox).
  4. Neoplasias: basal cell carcinoma, cicatricial (scarring) basal cell carcinoma, metastatic carcinomas.
  5. Various other dermatoses/skin diseases of unknown aetiology: lichen planus, lupus erythematosus, scleroderma, lipoid necrobiosis, sarcoidosis, benign mucous membrane pemphigoid, and follicular mucinosis.

 

Hair loss immediately after adolescence

The appearance of hair loss in young men (18-24 years old) occurs very frequently.

In all cases, androgenetic alopecia is the main cause, but other factors are also likely to contribute to the onset of hair loss, such as poor eating habits leading to accumulated deficiency in proteins, vitamins, amino acids, minerals and trace elements, aggravating environmental agents, stress, some medications, various diseases, etc.

An important characteristic of hair loss in these ages is that hair thinning becomes evident when a great number of the initial hair has already been lost.

Furthermore, since hair loss is a symptom that is gradually progressing, at a young age it is quite likely that the donor area is not stable yet.

Furthermore, when hair loss starts at a young age the chances that it will soon evolve into extensive thinning are much greater.

How can male hair loss be treated at a young age

Hair loss is a condition with significant impact on young men, affecting negatively their mentality and psychology.

It influences the self image and self-esteem, since it affects the hair of the scalp, a point of reference for ourselves and of the current aesthetic perception for our image in general.

These men may feel and act in a more introvert way, as they are influenced by hair loss at social, professional and erotic level.

According to many research studies that have been conducted in the past decades, it is evident that the presence of an enzyme in the hair follicle is what determines the manifestation of androgenetic alopecia.

This enzyme is called 5-alpha reductase

This particular enzyme has the ability to transform testosterone produced by the testicles, it circulates in the blood and its levels are the same both in people with hair loss and in people who have hair.

Through the activity of the enzyme 5a-reductase testosterone is converted into a potent derivative, dihydrotestosterone (DHT), which is a more powerful hormone acting locally in the hair follicle and eventually leads to hair loss.

The quantity of the enzyme in the hair follicles and the way it is distributed on the scalp regulates the age of hair loss onset, the rate hairs are lost and the extent of the condition in its final stage.

The presence of this specific enzyme is regulated by our genes and it is inherited by both our parents.

In many cases, a person with hair loss may report that his father has hair at an older age. This phenomenon is due to a gene that we inherit from the side of our mother. The gene has been expressed to her father or her brothers while she is protected by the female hormones, at least up until menopause.

As a result, hair loss occurs at a younger age than would be normally expected, new hair are thinner and, finally only a small number of thin hair is produced, or nothing.

In most cases, hair thinning occurs in the lateral sides of the forehead towards the temples and at the top of the head. As alopecia progresses it may affect all the scalp, leaving a small intact area in the occipital area.

Today many therapeutic options exist, both for the prevention of alopecia and for its effective treatment.

A digital footprint of the scalp

Nevertheless, before making any diagnosis and choosing a therapeutic approach, trichoscopy should be conducted first. Trichoscopy is the initial and necessary step for the treatment of hair loss.

The large number and the variability among the factors causing hair loss make both the diagnosis and the selection of the appropriate treatment a challenging task, which cannot provide us with correct and scientifically proven results unless the right staging and monitoring during treatment is performed. In each trichoscopy the following data are digitally recorded:

  • Number of existing hair follicles
  • Corresponding number of hair
  • Hair thickness
  • Number of single hair follicles

 

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