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The Science Of Hair

Hair Loss in Men & Women

Hair loss in men and women  is far more complex than it appears on the surface. We all know that it not only plays a vital role in the appearance of both men and women, but it also helps to transmit sensory information as well as create gender identification.

The Origins of Hair.

By week 22, a developing foetus has all of its hair follicles formed. At this stage of life there are about 5 million hair follicles on the body. There are a total of one million on the head, with one hundred thousand of those follicles residing on the scalp. This is the largest number of hair follicles a human will ever have, since we do not generate new hair follicles anytime during the course of our lives. Most people will notice that the density of scalp hair is reduced as they grow from childhood to adulthood.

Hair Follicles

The picture shows 1 hair, 2 hair and 3 hair follicle.

Hair has two distinct structures – first, the follicle itself, which resides in the skin, and second, the shaft, which is what is visible above the scalp.

The hair follicle is a tunnel-like segment of the epidermis that extends down into the dermis. The structure contains several layers that all have separate functions. At the base of the follicle is the papilla, which contains capillaries, or tiny blood vessels that nourish the cells. The living part of the hair is the very bottom part surrounding the papilla, called the bulb. The cells of the bulb divide every 23 to 72 hours, remarkably faster than any other cell in the body.

Two sheaths, an inner and outer sheath, surround the follicle. These structures protect and form the growing hair shaft. The inner sheath follows the hair shaft and ends below the opening of a sebaceous (oil) gland, and sometimes an apocrine (scent) gland. The outer sheath continues all the way up to the gland. A muscle called an erector pili muscle attaches below the gland to a fibrous layer around the outer sheath. When this muscle contracts, it causes the hair to stand up which also causes the sebaceous gland to secrete oil.

The sebaceous gland is vital because it produces sebum, which conditions the hair and skin. After puberty our body produces more sebum but as we age we begin to make less sebum. Women have far less sebum production than men do as they age.

Hair Shafts

The hair shaft is made of a hard protein called keratin and is made in three layers. This protein is actually dead, so the hair that you see is not a living structure. The inner layer is the medulla. The second layer is the cortex and the outer layer is the cuticle. The cortex makes up the majority of the hair shaft. The cuticle is a tightly formed structure made of shingle-like overlapping scales. It is both the cortex and the medulla that holds the hair’s pigment, giving it its colour.

UK Hair Transplant Clinics - Hair follicles - 1 2 3 hair
UK Hair Transplant Clinics - Hair follicles 2

Hair Growth Cycle

Hair on the scalp grows about .3 to .4 mm/day or about 6 inches per year. Unlike other mammals, human hair growth and shedding is random and not seasonal or cyclical. At any given time, a random number of hairs will be in one of three stages of growth and shedding: anagen, catagen, and telogen.

Anagen

Anagen is the active phase of the hair. The cells in the root of the hair are dividing rapidly. A new hair is formed and pushes the club hair (a hair that has stopped growing or is no longer in the anagen phase) up the follicle and eventually out.

During this phase the hair grows about 1 cm every 28 days. Scalp hair stays in this active phase of growth for two to six years.

Some people have difficulty growing their hair beyond a certain length because they have a short active phase of growth. On the other hand, people with very long hair have a long active phase of growth. The hair on the arms, legs, eyelashes, and eyebrows have a very short active growth phase of about 30 to 45 days, explaining why they are so much shorter than scalp hair.

Catagen

The Catagen phase is a transitional stage and about 3% of all hairs are in this phase at any time. This phase lasts for about two to three weeks. Growth stops and the outer root sheath shrinks and attaches to the root of the hair. This is the formation of what is known as a club hair.

Telogen

Telogen is the resting phase and usually accounts for 6% to 8% of all hairs. This phase lasts for about 100 days for hairs on the scalp and longer for hairs on the eyebrow, eyelash, arm, and leg. During this phase, the hair follicle is completely at rest and the club hair is completely formed. Pulling out a hair in this phase will reveal a solid, hard, dry, white material at the root. About 25 to 100 telogen hairs are shed normally each day

Introduction To Hair Loss In Men & Women

Hair loss is a big worry to many people, both male and female. If you have a worrying amount of hair in the basin after shampooing, you may think you are on the way to baldness. But this is not usually the case. The 50–100 hairs that everyone loses each day often become tangled with the rest of the hair, but are washed out when we shampoo. So we see what seems like a lot of hair in the basin after shampooing, but in reality these hairs have been shed earlier.

The word “alopecia” is the medical term for hair loss. Alopecia does not refer to one specific hair loss disease — any form of hair loss is an alopecia.

Hair loss can be caused by any number of conditions, reflected in a specific diagnosis. Some diagnoses have alopecia in their title, such as alopecia areata or scarring alopecia, but many do not, such as telogen effluvium.

Alopecia can be caused by many factors from genetics to the environment. While androgenetic alopecia (male or female pattern baldness, AGA for short) is by far the most common form of hair loss, dermatologists also see many people with other forms of alopecia. Several hundred diseases have hair loss as a primary symptom.

NORWOOD HAIR LOSS CLASSIFICATION

There is a lot of jargon around regarding hair loss and one of the descriptions people use to describe their hair loss if referring to the Norwood scale of hair loss which is often abbreviated to NW1 etc. The correct terms for normal hair loss (and hair loss in men is pretty normal) is androgenic alopecia.

The scale goes from Norwood 1 to Norwood 7. Norwood 7 is what we are all trying to avoid and involves a total hair loss from the top of the head with only the hair around the sides remaining.

nw1
NW1 – NO HAIR LOSS

This is where hairloss has just begun and is not really noticeable – No surgery.

nw2
NW2 – RECEDING HAIRLINE

This is just where there is a very small amount of hair receding at the hair line or at the temples.

nw3
NW3 – GENERALISED FRONTAL THINNING

This is probably the first stage where you would say to yourself that you were definitely starting to lose your hair with a much more pronounced receding at the temples.

nw3vertex
NW3 VERTEX

This is when the hair loss is from the crown of the head and with only very limited receding from the temples or hairline.

nw4
NW4 – FRONTAL AREA AND CROWN BALDING

This is when you get a bald patch on your crown plus your hairline at the front has receded. The front hair line to the bald patch however are still separated by a reasonable covering of hair. Eventually though these two bald areas grow to meet each other, which is what we are trying to avoid.

nw5
NW5 – TOP OF SCALP AND CROWN BALDING

This is a worsening of NW4 with the reasonably dense hair separating the bald patch from the receding temples becoming less, resulting in a much larger bald area and much greater recession at the temples. At this stage the amount of scalp showing is significant and the persons hair is noticeably thin.

nw6
NW6 – EXTENSIVE HAIR LOSS

The bridge of hair that separated the receding temples from the bald crown has now receded with only sparce hairs remaining. In places the bald patch has met the receding temples with much less hair remaining. Often people still have hair at the very front of their head for the rest of their lives (Quentin Wilson style).

nw7
NW7 – SEVERE HAIR LOSS

This is as far as the hair loss will go. There is now no hair to speak of on the top of the head and only the hair around the sides remaining in a sort of U shape around the head. Best to shave your head or get a No.0 haircut at this stage.

CAUSES OF HAIR LOSS

There are many causes of hair loss, but the main 4 that account for almost all types are

  • Androgenetic Alopecia – known as Male pattern Baldness (MPB) – 92% of cases
  • Telogen Effluvium – upto 3%
  • Alopecia Areata – 1% to 2%
  • Scaring Alopecia – 1% to 2%

Male Pattern Baldness (MPB)

Androgenetic alopecia or common male pattern baldness (MPB) accounts for more than 95% of hair loss in men. By the age of thirty-five two-thirds of men will experience some degree of appreciable hair loss, and by the age of fifty approximately 85% of men have significantly thinning hair. Approximately twenty five percent of men who suffer with male pattern baldness begin the painful process before they reach the age of twenty-one.

Contrary to societal belief, most men who suffer from male pattern baldness are extremely unhappy with their situation and would do anything to change it. Hair loss affects every aspect of the hair loss sufferer’s life. It affects interpersonal relationships as well as the professional lives of those suffering. It is not uncommon for men to change their career paths because of their hair loss.

receeding

MPB , is caused by the effect of the male hormones, called androgens, on genetically predisposed hair follicles (passed down the family tree). For those who are prone to hair loss, within these genetically programmed hair follicles the male hormone ‘testosterone’ is converted into the androgen ‘Dihydrotestosterone’, or ‘DHT’, by an enzyme called 5-alpha reductase. It is the effect of this DHT that inhibits the growth of new hair cells, which in turn leads to male hair loss and in many cases, eventual baldness.

Telogen Effluvium

Some hair loss conditions go by the name “effluvium,” which means an outflow. Effluviums characteristically affect different phases of the hair growth cycle.

Hair follicles on the scalp do not continuously produce hair. They cycle through a growth stage that can last two or more years, then regress to a resting stage for up to two months before starting to grow a new hair fiber again. At any time on a healthy human scalp, about 80% to 90% of the hair follicles are growing hair. These active follicles are in what is called the anagen phase. That leaves up to 10% to 20% percent of scalp hair follicles in a resting state called telogen, when they don’t produce any hair fiber.

Telogen effluvium (TE) is probably the second most common form of hair loss dermatologists see. In essence though, TE happens when there is a change in the number of hair follicles growing hair. If the number of hair follicles producing hair drops significantly for any reason during the resting, or telogen phase, there will be a significant increase in dormant, telogen stage hair follicles. The result is shedding, or TE hair loss.

TE appears as a diffuse thinning of hair on the scalp, which may not be even all over. It can be a bit more severe in some areas of the scalp than others. Most often, the hair on top of the scalp thins more than it does at the sides and back of the scalp. There is usually no hair line recession, except in a few rare chronic cases.

The shed hairs are typically telogen hairs, which can be recognized by a small bulb of keratin on the root end. Whether the keratinized lump is pigmented or unpigmented makes no difference; the hair fibers are still typical telogen hairs.

People with TE never completely lose all their scalp hair, but the hair can be noticeably thin in severe cases. While TE is often limited to the scalp, in more serious cases TE can affect other areas, like the eyebrows or pubic region.

Whatever form of hair loss TE takes, it is fully reversible. The hair follicles are not permanently or irreversibly affected; there are just more hair follicles in a resting state than there should normally be.

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hair loss in men

Causes of Telogen Effluvium: Stress and Diet

What are the trigger factors for TE? The short answer is many and varied. Classic short-term TE often happens to women soon after giving birth. Called postpartum alopecia, the sudden change in hormone levels at birth is such a shock to the hair follicles that they shut down for a while. There may be some significant hair shedding, but most women regrow their hair quickly.
Similarly, vaccinations, crash dieting, physical trauma such as being in a car crash, and having surgery can sometimes be a shock to the system and a proportion of scalp hair follicles go into hibernation. As the environmental insult passes and the body recovers, the TE subsides and there is new hair growth.

Some drugs may also induce TE, especially antidepressants. Often a switch to a different drug resolves the issue.

More persistent insults can result in more persistent TE. For example, a chronic illness may lead to TE. Arguably, the two most common problems are chronic stress and diet deficiency.
TE can also be a symptom of other conditions, such as inflammatory conditions like alopecia areata. Hair follicles are particularly sensitive to thyroid hormones and about one third of individuals with a thyroid disorder have TE. Exposure to toxins can also cause TE as one of many symptoms.

Treatments for Telogen Effluvium

How TE is treated depends on what has activated it. For short-term TE that can be linked to a trigger like surgery, the best response is to sit tight and wait for the follicles to recover of their own accord.

For persistent TE, if the causal factor can be isolated, then the best method is to remove it. For example, if stress is the problem, stress reduction is the long-term answer. If a dietary deficiency appears on a blood test, then supplements can work. A deficiency in thyroid hormones can be treated with hormone supplements.

However, often a specific causal factor cannot be identified. If this is the case, there are few treatment options. Most dermatologists resort to prescribing minoxidil or follifuel, a direct hair growth stimulator. Minoxidil or Follifuel can work well for some individuals with TE, but if the underlying cause is still present, then usemust be continued to block redevelopment of TE. With removal of the trigger, use can be stopped.

Alopecia Areata

Alopecia areata (AA) is probably the third most common form of hair loss dermatologists see, after androgenetic alopecia and telogen effluvium. The lifetime risk for AA is nearly 2%, or two in every 100 people will get AA at some point in their lives. It is not contagious; you can’t catch AA from someone who has it.

UK Hair Transplant Clinics - Alopecia Areata 1
hair loss in men
Researchers believe AA is an autoimmune disease such as rheumatoid arthritis, but in this case the individual’s own immune system attacks hair follicles instead of bone joints. Just why or how AA develops is not clear. For whatever reason, the immune system is inappropriately activated and attacks hair follicles. Research using several disease models shows certain types of lymphocytes play a primary role in the hair loss. They seem to attack the hair follicles, mistakenly thinking that somehow they are a threat to the rest of the body.

AA can affect men, women, and children. It often appears as well-defined circular bald patches on the scalp. Many people will get just one or two patches, but for some the hair loss can be extensive. Unfortunately, children who develop AA before puberty are most likely to develop more extensive and persistent hair loss.

The inflammation involved in AA focuses on the roots of hair follicles deep in the skin. As a result there is very little visible at the skin surface. There is no redness and often no pain, although a few people do find their skin itchy or painful to touch in the very early stages of AA development. Usually, though, there is no sensation — just a patchy shedding of hair.

The hair loss can be quite sudden, developing in a matter of a few days and it may happen anywhere on the scalp. The patch is usually smooth bald skin with nothing obvious to see beyond the absence of hair. Unlike other autoimmune diseases, the target of the inflammatory response in AA, the hair follicles, are not completely destroyed and can re-grow if the inflammation subsides.

People with just one or two patches of AA often have a full and spontaneous recovery within two years whether or not they receive treatment. However, about 30% of individuals find the condition persists and becomes more extensive, or they have repeated cycles of hair loss and re-growth.
Traditionally, AA has been regarded as a stress-induced disease. Unfortunately that view persists today, even among some dermatologists, even though very little scientific evidence supports the view.

AA is much more complicated. Extreme stress might trigger AA in some people, but recent research shows that genes can also be involved. There are probably several genes that can make an individual more susceptible to developing AA. The more of these genes a person has, the more likely they will develop AA.

Some researchers believe there are a wide range of contributing factors that make someone more susceptible to developing AA. Hormones, allergies, viruses, and even toxins might contribute. Probably several factors combined are involved in the activation of AA in any one individual.

Treatments for Alopecia

There are a range of treatments for AA, but none are effective for everyone and some people with AA don’t respond to any treatment. Because some of the available treatments have a high risk of side effects, they are often not used for children.

The most common AA treatment involves the use of corticosteroids. 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.

Scarring Alopecia

Scarring alopecia (Cicatricial alopecia)

Scarring alopecia, also known as cicatricial alopecia, refers to a collection of hair loss disorders that may be diagnosed in up to 3% of hair loss patients. It occurs worldwide in otherwise healthy men and women of all ages.

While there are many forms of scarring alopecia, the common theme is a potentially permanent and irreversible destruction of hair follicles and their replacement with scar tissue.

Scarring Alopecia 1
UK Hair Transplant Clinics - Scarring Alopceia 4
UK Hair Transplant Clinics - Scarring Alopecia Head 3
While there are many forms of scarring alopecia, the common theme is a potentially permanent and irreversible destruction of hair follicles and their replacement with scar tissue.

Most forms of scarring alopecia first occur as small patches of hair loss in men or women that may expand with time. In some cases the hair loss is gradual, without noticeable symptoms, and may go unnoticed for a long time. In other instances, the hair loss is associated with severe itching, burning, and pain, and is rapidly progressive.

The scarring alopecia patches usually look a little different from alopecia areata in that the edges of the bald patches look more “ragged.” The destruction of the hair follicle occurs below the skin surface so there may not be much to actually see on the scalp skin surface other than patchy hair loss. Affected areas may be smooth and clean, or may have redness, scaling, increased or decreased pigmentation, or may have raised blisters with fluids or pus coming from the affected area.

Scarring alopecia almost always burns out. The bald patches stop expanding and any inflammation, itching, burning, or pain goes away. Sometimes, though, hair follicles, at least those at the periphery of a bald patch, are not completely destroyed and they can regrow, but often all that is left are just a few longitudinal scars deep in the skin to show where the hair follicles once were.

Treatment Options

Scarring alopecia can involve a lot of damage and permanent hair loss. For this reason treatment of scarring alopecia should be quite aggressive. The nature of treatment varies depending on the particular diagnosis. Scarring alopecias that involve mostly lymphocyte inflammation of hair follicles, such as lichen planopilaris and pseudopelade, are generally treated with corticosteroids in topical creams and by injection into the affected skin. In addition, antimalarial and isotretinoin drugs may be used.

For scarring alopecias with inflammation of mostly neutrophils or a mixture of cells, the typical Effective Hair Loss Treatment involves antibiotics and isotretinoin. More experimentally, drugs like methotrexate, tacrolimus, cyclosporin, and even thalidomide have been used to treat some forms.

Once a scarring alopecia has reached the burnt-out stage and there has been no more hair loss for a few years, bald areas can be either surgically removed if they are not too big or the bald patches can be transplanted with hair follicles taken from unaffected areas

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