Alopecia

Puxvadee Chaikul, M.Sc.

School of Cosmetic Science
Email: puxvadee@mfu.ac.th

Objectives
Definition of alopecia
Pathology of alopecia
Types of alopecia
Diagnosis of alopecia
Treatment of alopecia

Introduction
Significant role for having hairs in the lives of people
throughout history
Impact the appearance and the inner self e.g. beauty,
strength, virility, youthfulness, and confidence

Introduction (cont.)
Lack of hair
negative character
Conceal the baldness by
K artificial braids or wig
K hair-growth preparation
K surgery

What is Alopecia?
Set of disorders which involve the state of lacking hair
where it would normally grow, especially on the head

Morphology of Hair Follicles

~ 5 million follicles on the body
(1 million follicles on the head)
Penetration the entire epidermis and
dermis of active growing hair follicles
3 types of hairs
vellus: short, fine, non-pigment
intermediate: moderate pigment
terminal: large, darkly-pigment
compositions of hair follicle
dermal papilla
hair matrix

Morphology of Hair Follicles (cont.)

dermal papilla
base of each follicle
vascularized portion (capillaries)
nerves innervation

hair matrix
contact with dermal papilla
responsible for the actual production
of hair (absorption of nutrients and
oxygen via capillaries, and form hair
by repeating cell devision)
contain melanocytes

Morphology of Hair Follicles (cont.)

Hair growth
independent hair
NOT lose all at one time
rates of hair growth depend on
 gender (different hormones)
 regions of the body
 age
3 phases of hair growth cycle
1. anagen (growing phase)
2. catagen (cessation of growth
phase, transitional phase)
3. telogen (resting phase)

Morphology of Hair Follicles (cont.)

3 phases of hair growth cycle (cont.)
anagen
catagen

telogen

5 6 years
produce hairs
large dermal papilla
active hair matrix

2 3 weeks
begin when the melanocytes
stop producing melanin
stop cell devision in hair matrix

2 3 months
dermal papilla forms
a ball close to the
tip of hair follicle

hair elongation

the base is keratinized to form

a club hair
shrink and separate from the
follicle by pushing the
club hair upward

next generation of
hair starts growing
from the base and
pushes the older
hair out

Normal anagen/telogen ratio: 9:1

Morphology of Hair Follicles (cont.)

Normal Hair Growth Cycle

Pathology of Alopecia

Average shedding hairs = 50 100 telogen hairs/d

Shedding hairs > 100 telogen hairs/d
Hair loss
Causes of hair loss
1. reduced hair follicle function due to androgens
2. reduction in metabolic functions of hair follicles
and hair bulbs
3. reduction in scalp physiological functions
4. local impairment of circulation
5. etc.

Pathology of Alopecia (cont.)

1. Reduced hair follicle function due to androgens
androgens (testosterone and dihydrotestosterone)
no change in the number of hairs, but miniature in hair
follicles

Pathology of Alopecia (cont.)

1. Reduced hair follicle function due to androgens (cont.)
miniature hair follicles
- growth cycle timing
- shorter, thinner, less-pigmented hair, and eventually
ceasing hair production completely
- spending more time in the telogen phase

Pathology of Alopecia (cont.)

2. Reduction in metabolic functions of hair follicles and
hair bulbs
D decreased blood flow in the capillaries
lack of absorption of nutrients and oxygen

Pathology of Alopecia (cont.)

3. Reduction in scalp physiological functions
block the pores of the scalp due to excessive build-up of
dandruff
- hair production at the hair root
- irritating the scalp
pityriasis
pityriasis hair loss
- secretion too much sebum
seborrheic dermatitis

Pathology of Alopecia (cont.)

4. Local impairment of circulation
tension (loss in the flexibility) in the scalp
decreased blood flow in peripheral blood vessels
in subcutaneous tissue of the scalp
hair growth

Pathology of Alopecia (cont.)

5. etc.
- Emotional stress: psychiatric illness, death of family member,
job loss, marital difficulties
- Physical stress: surgery, illness (acute or chronic), anemia,
lack of sleep
- Diet considerations: rapid weight loss or gain, unusual dieting
habits, vegetarian, protein intake failure, prolonged fasting
- Hormonal causes: postpartum, oral contraceptives,
menopause, insufficient hormone supplement, ingestion of
testosterone-containing hormone supplements

Pathology of Alopecia (cont.)

5. etc. (cont.)
- Endocrinopathy: hypothyroidism, hyperthyroidism,
hypoparathyroidism, hyperparathyroidism
- Other drug side effects: chemotherapy, retinoids,
anticoagulants, antihypertensive agents, etc.

Types of Alopecia
7 types of alopecia
1. Androgenic alopecia
J genetic predisposition
J the first common form of hair loss
J effect of androgens (testosterone and
dihydrotestosterone) on the hair follicles
J use for male and female pattern baldness, hereditary
alopecia and common baldness

Types of Alopecia (cont.)

2. Alopecia areata
autoimmune disease: body produces antibodies
against some hair follicles
cause sudden smooth, circular patches of hair loss
result from such factors as stress, genetics and the
immune system

Types of Alopecia (cont.)

3. Alopecia totalis
condition that is no hairs on the scalp
may begin as alopecia areata or some other causes

4. Alopecia universalis

condition that is no hairs on any part of the body, including

eyelashes, eyebrows, and scalp hair

may develop as alopecia areata or result

from other cause

Types of Alopecia (cont.)

5. Anagen effluvium (anagen loss)
loss of hair that is supposed to be in the anagen phase
associated with chemotherapy or radiation treatment

Types of Alopecia (cont.)

6. Telogen effluvium (telogen loss)
the second most common form of hair loss
condition that is caused an increased number of hair
follicles prematurly exiting the anagen phase or hair cycle
synchonization
occurs in response to various stresses such as emotional
trauma, post-pregnancy and illness, major surgery, certain
medications

Types of Alopecia (cont.)

7. Traction alopecia
commonly found in people with ponytails or cornrows, who
pull on their hair with excessive force
wearing a hat shouldn't generally cause this

Diagosis of Alopecia
1. Is the hair loss due to external or internal causation?
2. What is the magnitude of the hair loss?
3. - Is hair breakage occuring?
- Have patient collected 4 consecutive days of hair
loss and placed each days loss in a separate
plastic bags, noting if the hair was shampooed on
that day on the outside of the bag?
4. Is there a treatable medical cause?

Treatment of Alopecia
Medical treatment
FDA-approved medication: Finasteride, Minoxidil
effective in some types of hair loss
(mild and moderate )
Non-medical treatment
surgical treatment
use to fill in or reestablish the hairline, as well as to
increase the density of the hairs on the scalp

Medical Treatment
A. Finasteride
a steroid-like inhibitor of 5- reductase enzyme
Testosterone

5- reductase

Dihydrotestosterone

dihydrotestosterone production
positive effect on hair growth
use only in male baldness by oral (1 mg daily) taking

Medical Treatment (cont.)

A. Finasteride (cont.)
stop losing hairs in 3 6 months and regrowth in
6 - 18 months
discontinuation of the medicine
effect on gained hair
side effect: temporary
< 2% - sexual side effects (erectile dysfunction)

Medical Treatment (cont.)

B. Minoxidil
antihypertensive agent which has the side effect on
hairs (hirsutism)
use topical preparation as a stimulant to hair growth
discontinuation of drug
rapid shedding of hairs
improve the quality of growing hair in 6 12 months

Medical Treatment (cont.)

Finasteride

Minoxidil

Surgical Treatment

Hair transplantation
Micro- and mini-hair transplants
Strip grafting
Scalp reduction
Combination procedures
Rotational flap techniques

Surgical Treatment (cont.)

Procedures of surgical treatment
perform under local anesthesia
removal of a strip of permanent
(hair-bearing skin from the donor area)
dissect into micrografts and minigrafts
close the donor area and plant the tiny
graft into the recipient area
grow in 6 12 weeks and continue
grow for a lifetime

Start surgical treatment prior to

complete baldness

Surgical Treatment (cont.)

the grouping of hair graft

the transplanted hairs

Treatment of Alopecia (cont.)

Use both medical and non-medical treatment
- maintaining the existing hair
- enhancing the long-term result of hair restoration
surgery

References
Draelos ZD. Hair care: an illustrated dermatologic
handbook. Italy:Taylor&Francis;2005.
Tosti A, Piraccini BM. Diagnosis and treatment of
hair disorders: an evidence based atlas. Great
Britain:Taylor2006.
Bouillon C, Wilkinson J. The science of hair care.
2nd ed. Florida:Taylor&Francis;2005.