Alopecia

Alopecia is the loss of hair in any part of the body for any reason. Androgenetic Alopecia (AGA) type, which is mostly due to hormones, is the most common one. Although androgenetic alopecia is called male pattern hair loss, it affects 45% of women.

Alopecia is divided into two sub-classes such as scarring alopecia and non-scarring alopecia. Alopecia, which leaves a scar on the skin, is a rare type.

What are the types of alopecia that do not leave marks on the skin?

• Androgenetic Alopecia: It is the most common type of alopecia. It occurs due to genetic predisposition and hormones. Androgenetic alopecia, which is observed in men in their twenties, is mostly observed in women in their forties. While men typically start to lose their hair from the front and sides, women are typical for a Christmas tree-like shedding.

• • Ringworm (Alopecia Areata): It is the loss of hair in any part of the body and in a specific area. It can affect the scalp as well as other areas such as arms, legs and eyebrows. Although the cause is not fully understood, it is thought to occur when the body defends against its own cells (autoimmune disease). For this reason, it is common to apply local steroids to the areas where it is observed.

• Traumatic alopecia: It occurs when the hair is pulled strongly and exposed to trauma. It is common in children and break dancers. The shedding seen in trichotillomania disease, in which people constantly pull their hair, is also considered within this type.
• Telogen effluvium: Our hair maintains their lives in a cycle. The growth phase is called as anagen, the stagnation phase is called as katagen, and the resting phase is telogen. In a normal person, 80% of the hair is in anagen phase, 2% in katagen phase and 18% in telogen phase. If the percentage of hair in the anagen phase decreases while the percentage of telogen phase increases, it is called as telogen effluvium. Thyroid dysfunction, iron-defficient diet, not taking essential vitamins and minerals, and some medications can cause telogen effluvium.
• Traction (pulling) style alopecia: It occurs when women tightly tie their hair. It is more common in African-American women. Typically manifested by thinning on the front line and sides.
• Chemotherapy induced alopecia: It is also called as anagen effluvium. In most of the cases, the hair returns to normal after the treatment is over.

What are the types of alopecia that leave scars on the skin?

• Tinea Capitis: It is most common in people with low defense systems such as children and the elderly. The most common causes are Trichophyton and Microsporum fungi. The diagnosis is made by taking culture and microscopic examination. If it is detected in an individual in the family, all family members should be examined. In the treatment, anti-fungal drugs are used.

• Mucinous alopecia (Alopecia mucinosa): The cause is not fully known. It is formed by the accumulation of a substance called mucin in the glands that feed the hair follicles.
• Neoplastic alopecia: It occurs when tumors infiltrate the scalp.

Androgenetic Alopecia

It is a form of spill due to hormones. Typically, hair follicles first become thinner and then baldness occurs. Although testosterone hormone is known as a male hormone, it should not be misunderstood as it is not observed in women. 70% of men and 45% of women are affected by this type of hair loss. Testosterone is converted into a hormone called dihydrotestosterone by the 5-alpha-reductase enzyme in hair follicles. Only a certain part of individuals with this type of hair loss are detected high in number. In a significant part, hormone levels are completely normal. The reason for this is that a large part of dihydrotestosterone is produced in the hair follicles and very little passes into the systemic circulation from there. Therefore, this factor should be taken into consideration while investigating the causes of hair loss. Dihydrotestosterone binds to receptors in hair cells and sends signals inside the cell. It increases hair loss on the scalp and increases hair growth in other parts of the body. Some studies have stated that men with this type of hair loss have an increased risk of heart disease and prostate enlargement.

Treatments of androgenetic alopecia

• 5-alpha-reductase enzyme inhibitors

Drugs containing Finasteride-active ingredient have received FDA approval for the treatment of androgenetic alopecia. They show their effects by inactivating 5-alpha-reductase enzyme type II.

Another active ingredient that should be mentioned in this group is Dutasteride. 5-alpha-reductase acts on type 1 and type II. It has been indicated to be more effective than finasteride in short term use. There is no FDA approval yet, as there are no long-term results.

The same data were detected when the both drugs were compared in terms of their side effects.

• Minoxidil

The active ingredient of Minoxidil was initially used to regulate blood pressure in patients with blood pressure disease. Although it is still not fully understood how it stimulates hair growth, it has received FDA approval for the treatment of androgenetic hair loss. It has been determined that the hair loss has stopped in around 60% of the patients using it topically. Most patients using Minoxidil experience more intense hair loss than before when they stop taking the drug. For this reason, continuous use of the drug is recommended.

• Hair Transplantation

Hair transplant has developed over the years and has become one of the most common medical aesthetic procedures in recent years. Every year, many people travel to other countries and have a hair transplant operation there. The biggest advantage is that it offers permanent solutions to people suffering from hair loss. The result to be obtained varies according to the person’s suitability for the treatment, his expectation, and the experience of the clinic and surgeon performing the procedure. Hair transplantation, which requires personal planning and is performed in experienced clinics, gives good results.