Genetic Hair loss Androgenetic alopecia (Male Pattern Baldness )
Genetic Hair loss Androgenetic alopecia (Male Pattern Baldness)
Genetic Hair loss or Hereditary-pattern baldness is the most common cause of hair loss. Genetic Hair loss is not really a disease, but a natural condition caused by some combination of genetics, hormone levels and the aging process.
Almost all men and women will notice hair loss or hair thinning as they age. However, up to 40% of men and women will experience a more obvious form of this condition. Hair loss typically begins in the 20s and 30s, although in women the changes are most noticeable after menopause. The condition is also called androgenetic alopecia and, in men, male-pattern baldness.
Researchers have begun to understand more about the cause of this type of hair loss. Under the influence of a form of the male hormone testosterone, the normal cycle of hair growth changes, resulting in shorter, thinner or “miniaturized” hair. Eventually, hair growth in certain parts of the scalp stops entirely, which causes the typical pattern of hair loss. Contrary to the folk wisdom that baldness is inherited from one’s mother’s family, the condition seems to depend on genes contributed by both parents.
Symptoms
Genetic Hair loss starts with thinning of the hair and often progresses to complete hair loss on parts of the scalp. Hairs on the pillow, in the tub or on the comb are unreliable symptoms of hair loss. The average non-balding person loses 100 hairs per day, and more hair may fall out under certain circumstances, such as after childbirth or a serious illness.
Male pattern baldness or androgenetic alopecia. “Andro” refers to the androgens (testosterone, dihydrotestosterone) necessary to produce male-pattern hair loss (MPHL). “Genetic” refers to the inherited gene necessary for MPHL to occur. In men who develop male pattern baldness the hair loss may begin any time after puberty when blood levels of androgens rise. The first change is usually recession in the temporal areas, which is seen in 96 percent of mature Caucasian males, including those men not destined to progress to further hair loss.
In men, hair loss typically begins at the temples and crown and proceeds in an M-shaped pattern. In the most advanced stage, only a rim of hair along the side and back of the scalp remains.
In women, hair loss tends to be more widespread but better hidden. The top of the head down the middle is most commonly affected, often in a “Christmas tree” pattern. In contrast to men, the hairline along the forehead and temples usually remains normal in women. Complete loss of hair in any one place on the scalp is unusual and may suggest that a different problem is the cause, such as alopecia areata (an immune system disorder that causes bald patches), a fungus infection or one of a number of other skin conditions.
Hamilton and later Norwood have classified the patterns of male pattern baldness (see illustration below). It is generally recognized that men in their 20’s have a 20 percent incidence of male pattern baldness, in their 30’s a 30 percent incidence of male pattern baldness, in their 40’s a 40 percent incidence of male pattern baldness, etc. Using these numbers one can see that a male in his 90’s has a 90 percent chance of having some degree of male pattern baldness.
Androgens (testosterone, dihydrotestosterone) are necessary for the development of male pattern baldness. The amount of androgens present does not need to be greater than normal for male pattern baldness to occur. If androgens are present in normal amounts and the gene for hair loss is present, male pattern hair loss will occur. Axillary (under arm) and pubic hair are dependent on testosterone for growth. Beard growth and male pattern hair loss are dependent on dihydrotestosterone (DHT). Testosterone is converted to DHT by the enzyme, 5α -reductase. Receptors exist on cells that bind androgens. These receptors have the greatest affinity for DHT followed by testosterone, estrogen, and progesterone. After binding to the receptor, DHT goes into the cell and interacts with the nucleus of the cell altering the production of protein by the DNA in the nucleus of the cell. Ultimately growth of the hair follicle ceases.
In summary, male pattern hair loss (Androgenetic Alopecia) is an inherited condition manifested when androgens are present in normal amounts. The gene can be inherited from the mother or father’s side. The onset, rate, and severity of hair loss are unpredictable. The severity increases with age and if the condition is present it will be progressive and relentless.
Diagnosis
Genetic Hair loss usually is diagnosed by both its pattern and a history of a similar type of hair loss affecting family members. In most people, no further tests are required.
Prevention
If you begin to lose hair in a hereditary pattern, you may be able to slow further hair loss by using minoxidil (Rogaine) or finasteride (Propecia). Minoxidil can be used by both men and women, while finasteride usually is used just for men.
Minoxidil is a solution, now available over the counter. It is applied to the scalp twice daily. It can help to slow further hair loss in some people, and within four to eight months there may be some hair regrowth. In men a higher strength (5%) works best. In women there seems to be little difference in effect of the 2% strength and the 5% strength, and there is the risk of development of facial hair with the 5% strength. One caution: If you stop using minoxidil, you probably will lose any hair that may have been retained or restored by the medication.
Finasteride is a prescription-only pill that blocks the formation of the type of testosterone that affects hair growth. Higher strengths of the same medication are used in men to stop non-cancerous (benign) growth of the prostate gland. Studies suggest that finasteride helps to prevent hair loss in up to 99% of men with hereditary-patterned baldness, and that two-thirds experience some new hair growth. As with minoxidil, any benefits from the medication are quickly lost once it is discontinued. In addition, a small number of men develop difficulty with sexual function.
Finasteride does not appear to prevent hair loss in women. It also may cause birth defects, and should not be used by any woman who could possibly get pregnant. However, other types of hormonal treatment, such as certain types of birth control pills, may help the small number of women with hair loss that have elevated levels of male hormones.
In some people, hair loss may be caused by certain hair treatments (straightening, coloring), hairstyles (tight braids) or hair pulling. These do not cause hereditary-pattern baldness, but they may contribute to hair loss and should be discontinued.
A variety of other creams, oils, lotions and herbal remedies for hair loss are regularly advertised. However, only minoxidil and finasteride have been proven useful.
Some over-the-counter scalp treatments can cause irritation or harm and worsen hair loss.
Treatment
Minoxidil and finasteride may prevent hair loss and promote new hair growth. This effect, however, is quite unpredictable from one person to the next.
Hair weaves, wigs and toupees can be used. In addition, a variety of surgical techniques also can be used, including:
- Scalp reduction – Strips of bald skin are removed surgically to decrease the size of a bald spot.
- Hair flaps – A strip of skin with good hair growth can be moved from a less cosmetically important area to a more important one.
- Hair transplants – Tiny plugs of skin containing from one to 15 hairs are moved from the back or side of the scalp to a bald area. The newer “micrografts,” which contain very few hairs, yield the best results, but are more expensive and time consuming than older types of transplants. Up to 700 individual grafts may be necessary to complete a treatment. It may take up to two years to see the full benefit of hair replacement surgery.
Other hairloss causes can be found here
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Hair loss Causes and Hair Cycle Explain
Hair loss Causes in Hair Cycle
Hair grows originate from the follicle, root,and underneath the skin. The hair is ‘fed’ by blood vessels at the base of the follicle, which give it the nourishment it needs to grow. Between starting to grow and falling out years later, each hair passes through four stages: anagen, catagen, telogen and exogen. Every hair is at a different stage of the growth cycle.
Over time, the length of the anagen stage decreases. Therefore, the hair may become weaker and thinner after each cycle. That’s why it’s important to ensure your diet is rich in specific nutrients to maintain normal, healthy hair growth.
Anagen (Growing Phase)
The growing phase lasts two to seven years and determines the length of our hair.
Catagen (Transition Phase)
This is the transitional stage that lasts about ten days. The hair follicle shrinks and detaches from the dermal papilla.
Telogen (Resting Phase)
This is the resting phase which lasts around three months. Around 10-15 percent of hairs are in this phase. Whilst the old hair is resting, a new hair begins the growth phase.
Exogen (New Hair Phase)
This is part of the resting phase where the old hair sheds and a new hair continues to grow. Approximately 50 to 150 hairs can fall out daily, this is considered to be normal hair shedding.
If hairs enter the resting phase too early, excess shedding and noticeable thinning can occur and hair loss will be noticed
Periods of growth (anagen) between two and eight years are followed by a brief period, two to four weeks, in which the follicle is almost totally degraded (catagen). The resting phase (telogen) then begins and lasts two to four months. Shedding of the hair occurs only after the next growth cycle (anagen) begins and a new hair shaft begins to emerge. On average 50-100 telogen hairs are shed every day. This is normal hair loss and accounts for the hair loss seen every day in the shower and with hair combing. These hairs will regrow. Not more than 10 percent of the follicles are in the resting phase (telogen) at any time. A variety of factors can affect the hair growth cycle and cause temporary or permanent hair loss (alopecia) including medication, radiation, chemotherapy, exposure to chemicals, hormonal and nutritional factors, thyroid disease, generalized or local skin disease, and stress.
Androgens (testosterone, dihydrotestosterone) are the most important control factors of human hair growth. Androgens must be present for the growth of beard, axillary (underarm), and pubic hair. Growth of scalp hair is NOT androgen-dependent but androgens are necessary for the development of male and female pattern hair loss.
The above figure shows miniaturization of the hair follicle in pattern hair loss. Hair grows for shorter periods of time and becomes smaller, finer, and lighter as it approaches the vellus stage.
Common Hair loss Causes
GENETICS
A common family predisposition involves natural, age-related hormonal changes that can trigger hair loss. This is caused by the conversion oftestosteroneinto the toxin Dihydrotestosterone (DHT) and can be inherited from either your mother or your father.
STRESS AND TRAUMA
Stress can produce increased levels of testosterone, which converts to DHT and interrupts the hair’s growth cycle. Stress also constricts blood supply through the capillaries, restricting oxygen and nutrient uptake and vitamins to the hair follicle.
What you eat can play a significant role in hair thinning. A high consumption of animal fats, rapid weight loss and liquidproteindiets can result in a lack of amino acids,biotin,iron,proteinandzinc— all of which are essential for healthy-looking hair.
Several underlying health issues can cause hair thinning, including a malfunctioning of the hormone-producingthyroidgland and the natural hormonal changes women experience after pregnancy and during the menopause.
Air and water pollutants,chlorine, metals and minerals may be left on the scalp and hair as we wash with water every day, contributing to thinning. Pollutants such as pseudo-estrogens and toxins from within our bodies are also a factor.
The hair follicle is incredibly sensitive to changes in the body. Any hormone therapy (including birth control) can contribute to hair thinning, as can steroids, specific chemotherapies, and medication for blood pressure, diabetes, heart disease and acne.
Other causes of hair loss
Genetics Hair loss Causes
The causes of Alopecia Areata are not fully understood. Alopecia Areata is considered to be an auto-immune condition in which the immune system of the body (which protects the body from bacteria, viruses, allergens, etc.) mistakenly attacks the hair follicles and destroys them. This leads to hair loss in the affected area. This abnormal behavior of the immune system is understood to be guided, influenced and triggered by multiple factors.
The exact hair loss causes, why hair follicles undergo this kind of destruction, is not known but a genetic component to this is suspected. Family history of Alopecia Areata or any of the other auto-immune diseases (such as hypothyroid, diabetes, cancer, ulcerative colitis, rheumatoid arthritis, etc.) is often seen in many cases, suggesting a role of genetic element. In addition to the genetic predisposition, certain triggering factors may bring on the onset of this condition. Prolonged underlying stress often predisposes some patients to develop auto-immune process leading to Alopecia Areata. However, stress may not be the cause in every case. Alopecia Areata treatment has to take into account the underlying causes.
Treatment
60% of cases in this disease are self limited. The most common treatment is with steroids (cortisone is one form) either topically or by injection. The outcome of treatment is good when the alopecia areata process is present less than one year and poor, especially in adults, if the disease has been present for longer periods of time. Minoxidil (Rogaine) can help to regrow hair. Surgical treatment of this disorder is not recommended if the disease is active.
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Scarring Alopecia
Hair loss due to scarring of the scalp is called scarring alopecia. Scarring can be due to a variety of causes. Traction alopecia over a period of time may lead to scarring and permanent hair loss. Trichotillomania (compulsive hair-plucking) can cause permanent scalp scarring over time.
Injury to the scalp caused by physical trauma or burns may leave permanent scars and permanent hair loss. Diseases that may cause permanent hair loss due to scalp scarring include (1) the autoimmune conditions lupus erythematosus and scleroderma, and (2) bacterial infections such as folliculitis, fungal infections, and viral infections such as shingles (herpes zoster).
Scarring alopecia from burn
Traction Alopecia
Traction alopecia is caused by chronic traction (pulling) on the hair follicle and is seen most commonly in African-American females associated with tight braiding or cornrow hair styles, pony tail. It is generally present along the hairline. Men who attach hairpieces to their existing hair can experience this type of permanent hair loss if the hairpiece is attached in the same location over a long period of time. Trichotillomania is a traction alopecia related to a compulsive disorder caused when patients pull on and pluck hairs, often creating bizarre patterns of hair loss.
Traction Alopecia
Trichotillomania
Trichotillomania is the name given to habitual, compulsive plucking of hair from the scalp or other hair-bearing areas of the body. Over time, continual plucking of scalp hair will result in a hairless area-a bald spot. Long-term trichotillomania can result in permanent damage to scalp skin and to scarring alopecia. It is not known whether trichotillomania should be classified as a habit or as obsessive-compulsive behavior. In its mildest form, trichotillomania is a habitual plucking of hair while a person reads or watches television. In its more severe forms, trichotillomania has a ritualistic pattern and the hair-plucking may be conducted in front of a mirror. The person with trichotillomania often has guilt feelings about his or her “odd” behavior and will attempt to conceal it.
Trichotillomania
Treatment
Consult with psychiatry, psychology, or developmental-behavioral pediatrics specialists.
Anagen Effluvium
Patients present with diffuse hair loss after an exposure to drugs or toxic chemicals. Chemotherapeutic agents are most commonly responsible for hair loss. Other medications that can cause anagen effluvium include bismuth, levodopa, colchicine, and cyclosporine. Hair loss usually begins 7-14 days after a single pulse of chemotherapy. The hair loss is clinically most apparent after 1-2 months.
Medical Care:
- Although topical minoxidil is not effective in preventing chemotherapy-induced alopecia, it shortens the period of baldness by about 50 days.
- The application of a pressure cuff around the scalp and local hypothermia retard anagen arrest, if these measures are implemented during the infusion of medication.
Prognosis:
- Anagen effluvium is entirely reversible.
- Upon the cessation of drug therapy, the follicle resumes its normal activity within a few weeks.
- In some cases, hair regrows despite continued or maintenance therapy.
- On occasion, the color and texture of the hair that regrows after chemotherapy-induced alopecia is different from those of the original hair.
Telogen Effluvium
Telogen effluvium is a form of non-scarring alopecia characterized by diffuse hair shedding, often with an acute onset. A chronic form with a more insidious onset and a longer duration also exists. Telogen effluvium is a reactive process caused by a metabolic or hormonal stress or by medications. Generally, recovery is spontaneous and occurs within 6 months.
The symptom of both acute and chronic telogen effluvium is increased hair shedding. Patients usually only complain that their hair is falling out at an increased rate. Occasionally, they note that the remaining hair feels less dense. In both forms of telogen effluvium, hair is lost diffusely from the entire scalp. Complete alopecia is not seen.
- Acute telogen effluvium is defined as hair shedding lasting less than 6 months. Patients with acute telogen effluvium usually complain of relatively sudden onset of hair loss. Careful questioning usually reveals a metabolic or physiologic stress 1-6 months before the start of the hair shedding. Physiologic stresses that can induce telogen effluvium include febrile illness, major injury, change in diet, pregnancy and delivery, and starting a new medication. Immunizations also have been reported to cause acute hair shedding. Papulosquamous diseases of the scalp, such as psoriasis and seborrheic dermatitis, can produce telogen effluvium.
- Chronic telogen effluvium is hair shedding lasting longer than 6 months. The onset is often insidious, and it can be difficult to identify an inciting event. Because of the duration of the hair shedding, patients are more likely to complain of decreased scalp hair density, or they may note that their hair appears thin and lifeless.
Hairloss Causes: Physiologic stress is the cause of telogen effluvium. These inciting factors can be organized into several categories, noted below. In humans, however, the role these effects play in hair loss has not yet been determined.
- Acute illness such as febrile illness, severe infection, major surgery and severe trauma
- Chronic illness such as malignancy, particularly lymphoproliferative malignancy; and any chronic debilitating illness, such as systemic lupus erythematosus, end-stage renal disease, or liver disease
- Hormonal changes such as pregnancy and delivery (can affect both mother and child), hypothyroidism, and discontinuation of estrogen-containing medications
- Changes in diet like crash dieting, anorexia, low protein intake, and chronic iron deficiency
- Heavy metals such as selenium, arsenic, and thallium
Medications, of which the most frequency cited are beta-blockers, anticoagulants, retinoids (including excess vitamin A), propylthiouracil (induces hypothyroidism), carbamazepine, and immunizations
- Allergic contact dermatitis of the scalp
Medical Care:
- Because acute telogen effluvium is a reactive process, which resolves spontaneously, treatment usually is limited to reassurance.
- While chronic telogen effluvium is less likely to resolve rapidly, reassurance is appropriate for these patients. Often, the knowledge that the hair loss will not progress to baldness is comforting to the patient. The patient should be encouraged to style the hair in a way, which masks any perceived defects in hair density.
- Any reversible cause of hair shedding, such as poor diet, iron deficiency, hypothyroidism, or medication use, should be corrected.
- While topical minoxidil is not proven to promote recovery of hair in telogen effluvium, this medication has a theoretical benefit and is well tolerated. Patients who are eager to play an active role in their treatment may choose to use minoxidil.
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