Hair Loss
Hair Loss
Hair loss is a hair disease that results in hair weakening, lifelessness and loss due to environmental or genetic factors....
What is Hair Loss?
Hair loss is a hair disease that results in hair weakening, lifelessness and loss due to environmental or genetic factors. Generally, in hair loss, the hairline on the forehead recedes a little, and the hair on the forehead and crown becomes thinner and shed. The hair in the nape area is relatively preserved. Losing up to 100 hairs a day is considered normal. In cases where there is more hair loss, hair loss should be considered as a disease and the cause should be investigated.
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What Causes Hair Loss?
Male and female pattern hair loss (Androgenetic Alopecia)
Male and female pattern hair loss is a hormone-sensitive, androgen-dependent disease. The frequency increases with age in men and women. It can be seen in almost 80% of men aged 70 and over. Women are relatively less effective.
Increased dihydrotestosterone (DHT) hormone is responsible for male pattern hair loss. DHT causes lifelessness and miniaturization in hair follicles. In these patients, hair follicles are genetically sensitive to androgens and cause hormonal hair loss.
It is easy to diagnose male pattern hair loss with clinical findings. The hairline on the front and sides of the forehead, which we call the frontoparietel area, is the first affected area. The line goes backwards, the hair becomes lifeless and falls out. Hair loss may progress towards the top of the skull. However, the nape area is often spared. Because the hair follicles on the nape of the neck are not sensitive to hormonal loss. The hair in the crown and forehead area has become lifeless and fallen out symmetrically. However, antiandrogenic drugs can be used in the treatment of androgenetic alopecia. Methods such as topical minoxidil 2% and 5% forms, oral finteride, and hair transplantation are used in the treatment of androgenetic alopecia.
TELOGEN EFLIVIUM (TE)
Normally, 90-95% of the hair follicles are in the anagen phase (production-proliferation) while 5-10% are in the telogen (shedding) phase. While hair loss of up to 100 strands per day is considered normal, hair loss called TE occurs when more hair follicles enter the telogen shedding phase at the same time.

It is the most common cause of physiological hair loss, which you see in some systemic diseases or in the absence of any normal disease.

TE causes:

-After pregnancy

-Chronic TE (may occur without any cause or disease)

-Post-infection

-After surgical interventions

-After a severe stress

-Endocrine diseases (Hypothyroidism, hyperparathyroidism,..)

-Some medications (Retinoids, anticoagulants, thyroid medications,…)

-Iron deficiency anemia

Clinical findings: Thinning hair on the entire scalp, increased hair loss with the hair pull test, more than 100 hair loss per day. As a result, in TE, all hair is expected to grow back completely, and no permanent baldness is observed.

Treatment: First of all, it should be evaluated whether there is a triggering event and the necessary tests should be performed. If there is an identifiable cause such as chronic infection, endocrine disorder or anemia, treatment should be arranged accordingly. If there is no underlying cause and it is considered completely physiological, there is no need for treatment. Supportive treatment can be arranged (vitamin supplements, etc.) The hair will enter the growth phase again and recover.

ALOPEIA AREATA
In alopecia areata; Round, oval, coin-shaped hair loss is observed. Apart from hair, it can also affect other body hair (eyebrows, eyelashes, beard, etc.). It occurs with a frequency of 0.1 -0.2%. Alopecia areata is thought to be an autoimmune disease and may be associated with autoimmune diseases such as hypothyroidism, hyperthyroidism, and diabetes. Patients with alopecia areata should also be evaluated for other autoimmune diseases and necessary tests should be requested. Alopecia areata can occur at any age, but it is most common between 10-20 and 30-years-old. It is seen in people in their 40s. Apart from the money-shaped shedding, there are no symptoms such as itching or redness on the skin, it is asymptomatic. After the first shedding, the course of the disease cannot be fully known. While shedding in a single area may resolve spontaneously within a few months, new shedding may also occur. Sometimes it may cause all hair loss (alopecia totalis), sometimes all body hair loss (alopecia universalis). The scalp is usually the first affected area. Sometimes eyebrows, eyelashes and beard may be the first area affected. Alopecia areata may also be accompanied by nail involvement in 10-15% of cases. It can cause various deformities in the nail. In these patients, nails should also be evaluated.

Treatment of alopecia areata:
There is a high probability of spontaneous recovery. Treatment is planned mostly to stop the activity of the disease. The main and effective treatment used in the treatment of alopecia areata is corticosteroids. In cases affecting less than 50% of the hair, intralesional/topical (applied only to the area of ​​hair loss) corticosteroid treatments are prioritized. Systemic (oral) corticosteroid treatments are used in widespread alopecia areata, totalis and universalis.

Other treatments: Minoxidil, local immunotherapies, PUVA, cyclosporin-A, tacrolimus treatments.
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