Hair Loss - Causes and Treatments

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Hair loss

Like all other bodily functions, hair growth has a normal cycle. At any one time, approximately 90% of the hair on a person's scalp is growing.  Hormones are responsible for normal hair growth cycle. These hormones stimulate and maintain the hair follicles and keep the growth cycle on track and allow for consistent hair growth. Each follicle has its own life cycle that can be influenced by age, disease, and a wide variety of other factors. This life cycle is divided into three phases:

The Growing Phase (anagen phase) is responsible for producing new hair and for allowing the continued lengthening of that new hair. New hair is produced at the root and blood vessels help maintain growth by feed the hair strand its nourishment. At any given moment 90% of the existing hair follicles are engaged in this phase, which last for about 4 - 5 years. These follicles enter resting phase at the end of the growth phase.

The Resting Phase (telogen phase) takes over by maintaining the hair strand and its length. The hair follicle still receives nourishment during this time but its purpose is to prepare the hair strand for shedding. In this phase each hair follicle lasts an average of two to four months, after which time the hair strand is released so that the follicle can prepare for new hair growth. About 5% of the hair follicles in the scalp are engaged in the resting phases at any given time. When the resting phase ends the shedding phase begins.

The Shedding Phase (catagen phase) is the shortest phase of the hair growth cycle. This phase is responsible for shedding or releasing the old hair strands so that the hair follicle can begin a new hair growth; hence the cycle enters the growth phase again. During the normal process of this phase about 50 to 100 hair strands are shed daily. It is at this phase that baldness is mostly associated.
What causes excessive hair loss?
By definition, abnormal hair loss is shedding more than 150 strands of hair each day for an extended period of time. The medical term for hair loss is alopecia. Pattern baldness (androgenetic alopecia), the most common type of alopecia, affects roughly one-third of men and women. It's typically permanent. Another type of alopecia, alopecia areata, can be temporary. It can involve hair loss on your scalp or other parts of your body. Several things can cause hair loss. One of these is due to hormonal problems. Hair loss may occur if male or female hormones, otherwise known as androgens and estrogens, are not in balance. Correcting the hormone imbalance may stop hair loss.
Male hormone or testosterone paves the way for Dihydroxytestosterone  (DHT) formation that adversely affects hair follicular function and disrupts hair regeneration cycle. This in turn results in hair fall. Hyper secretion of this hormone makes your scalp incapable of keeping existing hair firm onto itself. And ultimately it adds to your misery by causing complete hair loss or baldness.

Even women fall prey experience hair loss but it most often, it is of less severe kind. Most often they experience it during pregnancy and/or menopause since this causes hormonal imbalance. This is most often short lived in women and once the hormone level returns back to normal, the hair follicles resume their task. Some medicines can also cause hair loss although this type of hair loss improves when you stop taking the medicine. Medicines that may induce hair loss include blood thinners or anticoagulants, medicines used for gout, medicines used in chemotherapy, excess intake of vitamin A, birth control pills and antidepressants.
Fungal infections of the scalp can cause hair loss. The fungi that cause this (tinea capitis) can easily spread from person to person. The fungi can live for weeks or months in a dormant state so this must be treated with antifungal medicines. Fad diets, crash diets and eating disorders, can cause poor nutrition. This in turn results in inadequate protein or iron in your diet and can cause you to experience hair loss.
Chemicals used for coloring, dying, tinting, bleaching, straightening or perming can also cause hair loss by damaging the hair strands. Excessive hairstyling or hairstyles that pull your hair too tightly can also cause hair loss to some degree.  Finally, hair loss may occur as part of an underlying disease, such as lupus, diabetes, or thyroid disorders.

Hormones involved in hair loss.
Testosterone is a hormone primary secreted in the testes of males and ovaries in females, small amounts are also secreted by the adrenal glands. Testosterone is the principal male sex hormone. An adult male produce 40 to 60 times more testosterone than an adult female but females are more sensitive it.

Although testosterone acts directly on many tissues, some of its least desirable effects do not occur until it is converted into another androgen, dihydrotestosterone (DHT). DHT acts on the skin, sometimes producing acne, and on the hair follicles, putting hair on the chest but often taking it off the scalp. Male-pattern baldness (androgenic alopecia) is one thing, prostate disease quite another — but DHT also stimulates the growth of prostate cells, producing normal growth in adolescence but contributing to benign prostatic hyperplasia (BPH) in many older men.

DHT unfortunately is the primary contributing factor in male pattern baldness. The hormonal process of testosterone converting to DHT, which then harms hair follicles, happens in both men and women. Under normal conditions, women have a minute fraction of the level of testosterone that men have, but even a lower level can cause DHT- triggered hair loss in women.
Signs and symptoms

Permanent hair loss
  • Male-pattern baldness (androgenetic alopecia). For men, pattern baldness can begin very early, even in the teens or early 20s. It's typically characterized by a receding hairline at the temples and balding at the top of the head. The end result may be partial or complete baldness.
  • Female-pattern baldness (androgenetic alopecia). Women with permanent hair loss usually have hair loss limited to thinning at the front, sides or crown. Women usually maintain their frontal hairline and rarely experience complete baldness.
  • Cicatricial (scarring) alopecia. This rare condition occurs when inflammation damages and scars the hair follicle, causing permanent hair loss. Sometimes the patchy hair loss is associated with slight itching or pain.

Temporary hair loss
  • Alopecia areata. Hair loss usually occurs in small, round, smooth patches about the size of a quarter. Usually the disease doesn't extend beyond a few bare patches on the scalp, but it can cause patchy hair loss on any area that has hair, including eyebrows, eyelashes and beard. In rare cases, it can progress to cause hair loss over the entire body. If the hair loss includes your entire scalp, the condition is called alopecia totalis. If it involves your whole body, it's called alopecia universalis. Soreness and itching may precede the hair loss.
  • Telogen effluvium. This type of temporary hair loss occurs suddenly. Handfuls of hair may come out when combing or washing your hair or may fall out after gentle tugging. This type of hair loss usually causes overall hair thinning and not bald patches.
  • Traction alopecia. Bald patches can occur if you regularly wear certain hairstyles, such as pigtails, braids or cornrows, or if you use tight rollers. Hair loss typically occurs   between the rows or at the part where hair is pulled tightly

Hair Loss Myths

As previously mentioned, there are several factors that may affect a man's chances of experiencing hair loss, but there are also a lot of myths on the subject of hair loss. The following are some popular myths about hair loss to watch out for:
  • Pattern baldness comes from your mother's side only
    Male pattern baldness is genetic and hereditary but the hair loss gene that causes this condition can be passed down from either side of the family, can come from relatives other than parents, and can even skip a generation or two before becoming apparent again. Researchers think pattern baldness is probably due to the interaction of several genes inherited from both parents.
  • Only men experience pattern baldness
    In reality, hair loss is just as common in women as it is in men, though the degree of loss tends to vary by gender. While men tend to start losing hair in the 30s and 40s, hair loss begins in the 40s or 50s in women, though it can occur as early as the 20s. And while men first lose hair in the front and at the top of the head, women's hair thins diffusely throughout the scalp.
  • Cutting your hair short helps it grow back thicker
    This myth about hair care and hair loss states that if you cut your hair it will grow back thicker. This is not true, of course, but it is easy to see how the myth started. When an individual shaves the hair of their face, legs or under arms the hair grows back in thicker and coarser. However, because this hair has different properties than the hair found on the head the same rule does not apply. Cutting the hair on your hair will only make it shorter and it will continue to grow at the same diameter and speed no matter how many times you cut it.
  • Wearing a Hat Causes Hair Loss
    Contrary to what many people believe, wearing a hat or a cap does not cause significant hair loss. There is nothing wrong with wearing a hat in the summer or a cap in the winter. However, lots of people who go bald often wear hats to hide the fact, which may account for the origin of this myth.
  • Hair Loss Can Be Reversed By Standing On Your Head
    The belief that standing upside down would stimulate hair growth by sending more blood to the head has no truth in it whatsoever.
  • Hair Loss Cannot Be Treated
    The good news is that this isn't necessarily true. While it's true that there is currently no single "cure" for all types of hair loss there are various ways of slowing down or otherwise dealing with the onset of hair loss.
Physicians are reluctant to use systemic treatment (a pill or other form of internal treatment that affects your entire system) unless they know that the hair loss is due to an excess of androgen in the system or a sensitized "over-response" to the so-called "normal" amounts of androgen in the system. That's because these systemic treatments may lower the body's androgen levels. Therefore, physicians often choose topical treatments (those that are applied directly to the scalp).

The effectiveness of medications used to treat alopecia depends on the cause of hair loss, extent of the loss and individual response. Generally, treatment is less effective for more extensive cases of hair loss.

The types of drugs for treatment of alopecia include:
  •  Minoxidil (Rogaine). Minoxidil is a liquid that you rub into your scalp twice daily to regrow hair and to prevent further loss. Some people experience some hair regrowth or a slower rate of hair loss or both. New hair resulting from minoxidil use may be thinner and shorter than previous hair. But there can be enough regrowth for some people to hide their bald spots and have it blend with existing hair. New hair stops growing soon after you discontinue the use of minoxidil. If you experience minimal results within six months, your doctor may recommend discontinuing use.The side effects of this drug include: acne on the area where it is being used, headaches and/or lightheadedness, very low blood pressure, irregular heart beat, vision problems, decreased sexual desire, numbness or tingling in the hands, feet or face, rapid weight gain, and chest pain
  • Finasteride (Propecia). This prescription medication to treat male-pattern baldness is taken daily in pill form. Many people taking finasteride experience a slowing of hair loss, and some may show some new hair growth. Positive results may take several months. As with minoxidil, the benefits of finasteride stop if you stop using it.Finasteride is not approved for use by women. In fact, it poses significant danger to women of childbearing age. If you're a pregnant woman, don't even handle crushed or broken finasteride tablets because absorption of the drug may cause serious birth defects in male fetuses.
  • Corticosteroids. Injections of cortisone into the scalp can treat alopecia areata. Treatment is usually repeated monthly. Doctors sometimes prescribe corticosteroid pills for extensive hair loss due to alopecia areata. Corticosteroid creams applied to the bald patches are popular with the average dermatologist, although this treatment approach is only successful for the very mildest cases. A more potent approach is to inject corticosteroid solutions into the bald patches. This can work well for some people, but close monitoring is required to ensure that side effects, such as skin thinning at the site of injection, do not occur. In extensive cases, systemic corticosteroids (those taken in pill or other form to affect your body) are used, though not continuously since they can cause significant side effects like bone thinning.
  • Anthralin (Drithocreme). Available as either a cream or an ointment, anthralin is a synthetic, tarry substance that you apply to your scalp and wash off daily. Anthralin may stimulate new hair growth for cases of alopecia areata.Redness or irritation may occur temporarily, as well as burning, inflammation, or swelling of the area where the medication is applied. These may be signs of an allergic reaction. This medication may temporarily discolor fingernails or discolor gray/white hair and stain skin and fabrics.
  • Nourkrin.  Nourkrin is a natural food supplement which contains a protein of marine extracts, including the cartilage of deep sea fish, with other minerals and vitamins. The key ingredient is the marine cartilage, which contains glucosamine, a naturally occurring supplement which stimulates hair growth. Nourkrin tablets contain a marine extract and should therefore not be taken by those who are allergic to shellfish. Nourkrin products are not suitable for use during pregnancy or whilst breast feeding.
  • Saw palmetto extract ( found in Nisim Biofactors ) . This is an extract of the fruit of Serenoa repens. It is rich in fatty acids and phytosterols. It is an herbal DHT inhibitor with fewer side effects than finasteride. But unlike finasteride and other herbal remedies which are taken orally, saw palmetto extract are topically applied as shampoos, conditioners and serum bottles (Nasim Tri-pack) which is absorbed through the skin and locally inhibits the binding of dihydrotestosterone(DHT) to androgen receptors, there is no side-effects even if over used and it doesn’t cause itching like minoxidil. There is a definite connection between the prostate and hair loss for men. Saw Palmetto has been found to work in fighting benign prostatic disease by lowering levels of DHT, which is a known cause of androgenetic alopecia.  Saw Palmetto extract is an effective anti-androgen and shows promise as an effective treatment for hair loss prevention.

 Treatment routes : Routes of administration can broadly be divided into:

Topical: local effect, substance is applied directly where its action is desired (application onto the skin)
  1. Enteral: desired effect is systemic (non-local), substance is given by mouth (orally) as tablets or capsules
  2. Parenteral: desired effect is systemic, substance is given by infusion or injection
Benefits of topical versus oral medications
Most drugs available today are taken by mouth (orally). These may be in the form of tablets, capsules, powders, solutions, or suspensions.  Since they are taken orally, these medications must pass through the stomach and be absorbed in the intestinal tract.

Because the oral route is the most convenient and least expensive, it is the one most often used. However, it has limitations because of the way a drug typically moves through the digestive tract. For drugs administered orally, absorption may begin in the mouth and stomach. Usually, however, most of the drug is absorbed from the small intestine. The drug passes through the intestinal wall and travels to the liver before it is transported via the bloodstream to its target site. The intestinal wall and liver chemically alter (metabolize) many drugs, decreasing the amount of drug reaching the bloodstream. When a drug is taken orally, food and other drugs in the digestive tract may affect how much of and how fast the drug is absorbed. Other drugs are absorbed poorly or erratically in the digestive tract or are destroyed by the acid and digestive enzymes in the stomach.

Drugs applied to the skin are usually used for their local effects and thus are generally safer than drugs taken orally or via injection. The topical route is probably the oldest route of administration. The drug is mixed with inactive substances and topical medications are applied directly upon the skin. Depending on the consistency of the inactive substances, the formulation may be an ointment, a cream, a lotion, a solution, a powder, or a gel. Since it is applied directly on the skin, the undesirable effects of taking drugs via the digestive system are bypassed.

Palmetto extract:
Serenoa repens, the saw palmetto, is the sole species currently classified in the genus Serenoa. It has been known by a number of synonyms, including Sabal serrulatum, under which name it still often appears in alternative medicine. Native Americans initially found the effectiveness of saw palmetto for hair loss and they started using the herb as a topical application for majority of their skin, scalp and hair problems.And over the period of time the use of saw palmetto for hair loss got evolved and the indigenous Americans started using it regularly for over many centuries.
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