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Hair Fall

Causes of Hair Fall
Investigations & Diagnosis
Treatment of Hair Problems

Introduction: Each hair grows from a hair root called as hair follicle. The hair follicle goes through a cycle of growth (anagen phase), shrinkage (catagen phase) and rest (telogen phase). The length to which hair will grow depends on the length of the anagen phase. The longer hair in the female is due to the longer anagen phase in women.
Hair color is essentially governed by the amount of melanin pigment in the hair which is genetically & nutritionally determined.
The main controlling influences on hair growth are complex genetic, racial factors , hormonal, nutritional & other factors.

Hair fall may be of following type:

1) Generalized Hair Fall (Telogen effluvium)
2) Patchy hair loss (alopecia areata)
3) Male pattern baldness (Androgenetic alopecia also called: Common baldness )
4) Cicatricial Alopecia

Generalized Hair Fall

Causes of Generalized Hair Fall

(1) Hormonal cause of hair fall: excess hair fall may occur due to any of the below mentioned hormone disorders.

Adrenal

Ovarian

Other

Cushing syndrome, disease , androgen producting) Tumor (adenoma, carcinoma), adrenal, Late-onset genetic defects in steroidogenesis, 21-Hydroxylase deficiency, 11ß-Hydroxylase deficiency

Primary polycystic ovaries , Secondary polycystic ovaries, Androgen-producing ovarian cell tumor, stromal Tumor (adenoma, carcinoma), Hilar cell hyperplasia

Idiopathic Hirsutism , ingestion, injection of androgen or androgenic
substance, Ingestion of nonsteroidal drug,HypothyroidismHypopituitarism, Pituitary disorder, hyperthyroidism

2)	DRUGS:
(a)	Steroid, androgen therapy, overdose of thyroid medicines, Anticoagulants, Cancer drugs, Anti-psychotics, Hypervitaminosis ACytotoxic Agents, Cyclophosphamide, Vincristine olchicine,Methotrexate, Elements, e.g. arsenic, Actinomycin D, Doxorubicin Levodopa, Flurouracil Ionising radiation, Azathioprine and Prednisolone
2)	2) NUTRITIONAL AND METABOLIC:
	a. Protein deficiencyb. b. Iron deficiencyc. c. Zinc deficiency.
4)	Idiopathic:
	physiological process in genetically predisposed individuals. Terminal follicles are progressively transformed into "vellus" follicles i.e. a "miniaturization" process.
5)	Idiopathic Telogen Effluvium:
	Disturbances of hair cycle due to many reasons leads to shedding of normal club hairs, which follows the premature precipitation of anagen follicles into telogen Response to the follicles due to many different types of causes mentioned below.
6)	Traumatic:
	a. Resulting from cosmetic proceduresb. b. Accidental traumac. c. Deliberate in psychologically disturbed.
7)	Structural Defects Of Hair Shaft With Increased Fragility
8) 9) 10) 11) 12) 13) 14) 15) 16)	Febrile states, e.g. typhoid, malaria, alopecia universalis Iron deficiency malnutrition, malabsorption or sometimes metabolic defects chronic liver dysfunction, malignancies, debilitating diseases and collagen vascular diseases. Postpartum Alopecia, Neonatal Alopecia Chemicals In Environment Nutritional Alopecia Diffuse Nonscarring Alopecia Of Other Causes

ALOPECIA AREATA

There is loss of hair in a particular patchy area. It is one of the common problems of hair which if not treated in time may be difficult to treat later.
Factors implicated are patient’s genetic constitution the atopic state, non specific immune and organ-specific auto-immune reactions and emotional stress.

These are of following types:

1
2
3
4

Atopic type
Autoimmune type
Pre-hypertensive type
Common type

Aetiology: heredity , autoimmunity, hormone disorders type
Common type

CICATRICIAL (SCARRING) ALOPECIA

In this kind of hair loss there is destruction of hair follicles thus hair fall is associated with signs of atrophy of skin of scalp.causes of cicatricial alopecia, Follicular disease, Lichen planopilaris discoid lupus erythematosus ,keratosis follicularis spinulosa decalvans folliculitis decalvansa ,traction alopecia Dermal fibrosis, localized scleroderma Pseudopelade, Lichen planusLupus erythematosus, radiodermatitis pemphigoid , chemical or physical injuries.Physical traumaInfections - Fungal, bacterial

Androgenic alopecia (male pattern baldness)

Also called as androgenetic alopecia, Male pattern baldness, common baldness and androgen-dependent alopecia. It is one of the most common cause of hair fall in men & one of the prominent cause of hair fall in women.

Aetiology of androgenic alpecia:

1) Due to many hormone disorders as :

Adrenal	Ovarian	Other
Cushing syndrome, disease , androgen production) Tumor (adenoma, carcinoma) , Androgen-producing adrenal, Late-onset genetic defects in steroidogenesis, 21-Hydroxylase deficiency, 11ß-Hydroxylase deficiency,	Primary polycystic ovaries , Secondary polycystic ovaries Androgen-producing ovarian cell tumor, stromal Tumor (adenoma, carcinoma), Hilar cell hyperplasia.	Idiopathic Hirsutism , ingestion, injection of androgen or of androgenic substance, Ingestion of nonsteroidal drug,

2)
3)
4)
5)
6)

Hereditary:
Multifactorial
genetic factors
Dihydrotestosterone (DHT) mediated
inflammation in the hair root

Clinical Features of androgenic alopecia:

This type of hair loss in androgenic alopecia affects both men and women. The male pattern begins with recession of the fronto-temporal hairline followed by thinning of the hair in vertex & side area. It may begin at any age even as early as the late teens. The rate of hair fall & its progression is extremely variable.
Women often present with a more generalized pattern of hair loss which usually predominates on the vertex. Usually the frontal hairline does not recede as much as in men. The female pattern may accompany signs of excess male hormone action as seborrhea, acne, facial hair, excess body hair.
These patients are quiet worried about their future look.

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