Hair loss (Alopecia)

Hair loss known as Alopecia appears in many different ways. It can be temporary or permanent. It can be due to heredity, hormonal changes, medical conditions, medications or a normal part of aging. There are a lot of myths too! We will try to explain in this blog the normal process of the hair cycle. Understanding the normal hair cycle will enable us to differentiate between the different reasons for hair loss and the various treatments available.

Normal Hair Cycle

The hair on the scalp grows about .3 to .4 mm/day or about 6 inches per year. Unlike other mammals, human hair growth and shedding is random and not seasonal or cyclical. At any given time, a random number of hairs will be in one of four stages of growth and shedding: anagen, catagen, telogen and Exogen.

  • 1. Anagen (Growing Phase)

The growing phase lasts two to seven years and determines the length of our hair.

  • 2. Catagen (Regression Phase)

This stage lasts about ten days. The hair follicle shrinks and detaches from the dermal papilla.

  • 3. Telogen (Resting Phase)

The resting phase lasts around three months. Approximately 10-15% of hairs are in this phase. Whilst the old hair is resting, a new hair begins the growth phase.

  • 4. Exogen (Shedding Phase)

The Exogen represents the period from when a resting hair reaches its terminal position in the follicle to when it finally detaches. The resting hair is gradually loosened, resulting in the shedding of the hair.

Variation in Hair Growth and Thickness

It is essential to realise that “normal” for one person may not be “normal” for another person. Hair growth is no different.

There are 3 “original” ethnic-hair profiles, each with its own characteristics: colour, texture, structure and even implantation in the scalp…

Due to these differences, hair does not grow in the same way or at the same speed in people of different ethnic origins.

Asian hair

Asian hair is usually straight and either dark brown or black. It grows perpendicularly to the scalp. This hair type has the fastest growth rate at approximately 1.4 centimetres per month. 

A strand of Asian hair has a somewhat round, even shape.      

Nonetheless, Asian hair has the lowest density of the three ethnicities.

Caucasian hair

Caucasian hair can be straight, wavy or curly. Its colour can vary from blond to dark brown. This hair type grows diagonally and at a rate of about 1.2 centimetres per month.

Caucasian hair strands are oval in shape.            

Caucasian hair density is the highest of the three ethnic categories and is, therefore, the fullest.

African hair

African hair is generally characterised by tight curls and kinks and grows almost parallel to the scalp. This hair type has the slowest growth rate, 0.9 centimetres per month, due to its spiral structure that causes it to curl upon itself during growth. An African hair strand has a flattened shape.

African hair has a much higher density than Asian hair.

Alopecia (Hair Loss)

Alopecia is classically divided into scarring and nonscarring, with scarring alopecia being further divided into primary and secondary. Primary Alopecia arises from a process that originates from the hair follicles, whereas secondary Alopecia, classically referring to secondary scarring alopecia, is due to all other causes. Secondary causes can include surgery, burns or something like that that might cause hair loss secondary to surgery, Sunburns, fungal infections, rashes leading to hair loss.

Primary Alopecia, as mentioned above, can be divided into two categories scarring and non-scarring.

Scarring Alopecia

While there are many forms of scarring alopecia, the common theme is potentially permanent and irreversible destruction of hair follicles and their replacement with scar tissue. Often, the early stages of scarring alopecia will have inflammatory cells around the hair follicles, which, many researchers believe, induces the destruction of the hair follicles and the development of scar tissue. Scarring alopecia almost always burns out. The bald patches stop expanding, and any inflammation, itching, burning, or pain goes away.

This type of Alopecia is rare and leads to permanent hair loss.

Non-Scarring Alopecia

Non-scarring hair loss is more common and consists of 3 types

  1. 1.Female/male pattern hair loss (Androgenetic Alopecia),
  2. Telogen Effluvium (stress hair loss)
  3. Alopecia Areate.

1.Female/Male pattern hair loss (androgenetic Alopecia),

Androgenetic Alopecia or male and female pattern hair loss, which is also very common. The word Androgenetic consists of 2 words, “Androgens” and “Genetic”. So this type of Alopecia is related to androgen hormones such as testosterone, and it is genetic. Often people think that hair loss genetically inherited from the mum’s side of the family, but this is not true. It is more likely to involve multiple genes, and even if both parents have hair, the child can have hair loss from a distant family member!

Unlike telogen effluvium, which characterised by shedding, Androgenetic Alopecia is characterised by gradual thinning of the hair over time and the process we call miniaturisation of the hair follicle. The hair follicle literally becomes smaller and smaller. The Androgenetic Alopecia also characterised by a decreasing duration of the antigen cycle over time. However, the thinning of the hair is also part of aging. So the thinning of the hair is not always due to Androgenetic Alopecia.

Androgenetic Alopecia starts earlier and is more extreme than hair thinning due to aging.

Testing for androgen levels may be helpful to especially men, as it is apparent that their hair is thinning very quickly at a young age.

Some women will have high levels of androgens, such as women who suffer from polycystic ovary who take the pill for birth control or other reasons.

Women should also check for signs of hormone irregularities such as increased facial or body hair growth, thick facial hair, irregular periods or spotting, post-menopausal acne and other hormonal changes peri-menopause and post-menopause. To check the effects of your hormones by symptoms, complete our questionnaire and will help you identify which hormones might be dominant:

2.Telogen effluvium (stress hair loss)

Telogen effluvium is the most common of the three types of non-scarring Alopecia. It is an acute increase in shedding. As mentioned above, there 4 phases of the hair growth cycle. The 1st phase, the growth phase (antigen), is shortened for whatever reason and prematurely converts to the telogen phase. Usually, 10% converts to the telogen (resting) phase, but during this type of hair loss, up to 30% is converted! Hence, leading to increased shedding of the hair. People may find they are losing clumps of hair each day!

What causes telogen effluvium?

Increased hair shedding in telogen effluvium occurs due to a disturbance of the normal hair cycle.

Common triggers of telogen effluvium include childbirth, severe trauma or illness, a stressful or significant life event, marked weight loss and extreme dieting, thyroid problems, anaemia, low Vitamin D, a severe skin problem to the scalp, a new medication or withdrawal of hormone treatment. No cause is found in a third of people diagnosed with telogen effluvium. 

Telogen effluvium usually resolves completely without any treatment over several months. The average duration of telogen is approximately 100 days (3 to 6 months), after which period the hair starts growing again. However, depending on the hair’s length, it may take many months for the overall hair volume to return to normal gradually. Telogen effluvium can return, especially if the underlying cause is not treated or recurs, and would be called chronic telogen effluvium if lasting more than six months.

If it does last more than six months, you need to figure out if you have an underlying cause such as thyroid disease that’s not managed or anaemia. Also, certain medications may be the cause, such as Ibuprofen, beta-blockers used for blood pressure, warfarin, lithium, retinoids used for acne and some antibiotics. These are medications you should discuss with your doctor concerning your hair loss.

Another reason for this type of hair loss lasting more than six months is that you may have two kinds of hair loss co-existing, Telogen effluvium and androgenic hair loss.

You should also consider a hair count loss to check if the number of hairs lost each day decreases or increases or stays the same.

If no underlying cause, your doctor may consider medications known as hair re-growth promoters.

3.Alopecia Areata.

The immune system attacks a portion of the hair follicle, mistakenly thinking it is a bacteria or virus. It is resulting in circular areas of complete hair loss.  Sometimes there are broad patches or even loss of all hair on the head. Treatments may include anti-inflammatory creams and injections as well as Minoxidil.

Traction Alopecia

Another form of Alopecia worth mentioning is Traction Alopecia. Traction alopecia is hair loss that’s caused by repeatedly pulling on your hair. You can develop this condition if you often wear your hair in a tight ponytail, bun, or braids, primarily if you use chemicals or heat on your hair. Traction alopecia is reversible if you can stop hair pulling. But if you don’t intervene soon enough, the hair loss may be permanent.

This type of hair loss is more common in

  • African Americans
  • Caucasians
  • Ballerinas

Scalp Health

Before starting treatment, a person should examine the health of their scalp. Similar to gardening, before seeding or planting, one should examine the soil. Scalp health is critical if you want the skin where the hairs growing from to be healthy and to be optimised. For example, itching, dandruff and oiliness can all prevent good hair growth. Hence products such as Nizoral Shampoo and Head & Shoulders are often useful.

Alopecia Treatment

The most common treatment is known as hair growth promoters. The most common is topical Minoxidil or Rogaine, and this has the best evidence. It’s been studied for many years in many people and is effective at improving hair growth.

However, it is nonspecific, and it’s not hormonal and its effects, so it can be used for just about any type of hair loss. The women’s strength is 2%, and the Men’s is 5%. If women use more than a 2% solution, they may get side effects such as more hair on their face. However, the minoxidil foam is identical for men and women.

Since Minoxidil has been around for a long time, it has many reviews and opinions. However, it is effective but needs to be used at least for six months before seeing an effect. Also, once you stop using it, it stops working!

Another treatment option is the hair max laser comb. The hair laser max laser may be an option for people who wish not to use too many chemicals.  This laser comb is used for 8 minutes, three times per week. HairMax laser combs have been clinically proven to treat hair loss and promote new hair growth in both men and women.

Vitamins and Supplements

Other vitamins and supplements that may be useful include Biotin and Zinc. Biotin has been shown to grow more hair, but it doesn’t thicken the hair, but it is very good for nails also! Zinc is most helpful if patients are low in zinc. Zinc won’t grow the hair, but hair won’t grow if a person is low on zinc.

Other vitamins that need to be normalised include Vitamin A and Vitamin D for optimal hair growth.

Prescription Medications

Oral prescription medications are also available in the Australian market. Hair growth may be marginally stimulated or stabilised (i.e. hair loss stopped or slowed) in mild-to-moderate thinning using prescription medications.

Noticeable hair growth occurs by 3–4 months with the maximal response after 12 months of continuous treatment. The benefit of treatment is lost within 6–12 months of stopping. The response is best when many thin, miniature hairs remain before starting treatment. No benefit is seen where there is no visible hair. Also, hormone therapy may be beneficial for androgenetic Alopecia.

Compounding and Alopecia

Many topical medications mentioned can also be compounded into an oral capsule. Compounding hair loss medications is becoming common in Australia, primarily by dermatologists. However, some of them need a prescription. Different combination of drugs can also be combined into one capsule to increase the effectiveness of the medication.

Topical Minoxidil compounded with the combination of other medications that increase its effect can be advantageous. For example, in combination with Vitamin A analogues, Minoxidil increases the cell turnover of scalp cells, producing more new cells, making Minoxidil more effective.