Cosmetics and hair loss

Cosmetic hair care products are often implicated by the user or the clinician in cases of hair loss. Yet, these products are used ad lib, in a wide variety of home conditions and on a wide variety of hair types, by millions of consumers every day with no adverse effects. Based on this extensive data set, the absence of literature reports, and a detailed understanding of the mode of action of cosmetic hair care products, we can conclude that they do not cause hair loss. Clinicians investigating cases of hair loss must fully appreciate the hair cycle, the length of time a single fibre may be present on the head, and its biological and cosmetic history in order to understand the causes of hair loss and make the correct diagnosis. With a better understanding of the cosmetic practices used by everyday consumers, the clinician will be in a strong position to help patients re-grow their hair and guide them through a high quality hair care regime.     

Hair density, hair diameter and the prevalence of female pattern hair loss

BACKGROUND: Female pattern hair loss is common but estimates of its prevalence have varied widely. The relationships between the clinical diagnosis of female pattern hair loss and objective measurements of hair density and hair diameter have not previously been evaluated. OBJECTIVES: To determine the prevalence of female pattern hair loss and to relate the clinical findings to hair density and hair diameter. METHODS: We examined 377 women, aged 18--99 years, who presented to a general dermatology clinic with complaints unrelated to hair growth (the unselected sample). A second group of 47 women referred with typical female pattern hair loss was included in analyses of the relationships between hair density, hair diameter and the clinical diagnosis. Hair density was measured using a photographic method. In each subject the major and minor axis diameters were measured in a random sample of 50 hairs. RESULTS: Six per cent of women aged under 50 years were diagnosed as having female pattern hair loss, increasing to 38% in subjects aged 70 years and over. The mean +/- SEM hair density was 293 +/- 61.3 hairs cm(-2) at age 35 years, falling to 211 +/- 55.1 hairs cm(-2) at age 70 years. Hair density showed a normal distribution in the unselected sample. Most women classified as having female pattern hair loss had hair densities within the lower half of the normal distribution. The perception of hair loss was determined mainly by low hair density (ANOVA P < 0.001), but there was overlap in hair density between women classified as having Ludwig I hair loss and the no hair loss group, which was partly accounted for by differences in mean hair diameter (ANOVA P < 0.001). Low hair density was associated with fewer hairs of all diameters. CONCLUSIONS: Hair density in women is distributed as a normal variable, indicating that it is determined as a multifactorial trait. Women with female pattern hair loss have a hair density which falls below the mean but lies within the spectrum of the normal distribution, although other factors, including hair diameter, may affect the subjective impression of hair loss. The hair diameter data suggest that low hair density is not due to progressive diminution in hair follicle size and that follicular miniaturization may occur within the space of a single hair cycle.     

Nutritional factors and hair loss

Summary The literature reveals what little is known about nutritional factors and hair loss. What we do know emanates from studies in protein‐energy malnutrition, starvation, and eating disorders. In otherwise healthy individuals, nutritional factors appear to play a role in subjects with persistent increased hair shedding. Hård, 40 years ago, demonstrated the importance of iron supplements in nonanaemic, iron‐deficient women with hair loss. Serum ferritin concentrations provide a good assessment of an individual's iron status. Rushton et al. first published data showing that serum ferritin concentrations were a factor in female hair loss and, 10 years later, Kantor et al. confirmed this association. What level of serum ferritin to employ in subjects with increased hair shedding is yet to be definitively established but 70 µg/L, with a normal erythrocyte sedimentation rate (< 10 mm/h), is recommended. The role of the essential amino acid, l ‐lysine in hair loss also appears to be important. Double‐blind data confirmed the findings of an open study in women with increased hair shedding, where a significant proportion responded to l ‐lysine and iron therapy. There is no evidence to support the popular view that low serum zinc concentrations cause hair loss. Excessive intakes of nutritional supplements may actually cause hair loss and are not recommended in the absence of a proven deficiency. While nutritional factors affect the hair directly, one should not forget that they also affect the skin. In the management of subjects with hair loss, eliminating scaling problems is important as is good hair care advice and the need to explain fully the hair cycle. Many individuals reduced their shampooing frequency due to fear of losing more hair but this increases the amount seen in subsequent shampoos fuelling their fear of going bald and adversely affecting their quality of life.     

Multifocal scalp hair loss

BACKGROUND: Cutaneous metastases from internal cancer are relatively uncommon in clinical practice, but they are very important to recognize. Metastases of skin may be a herald sign in the diagnosis of internal malignancy. Scalp metastasis from breast carcinoma is reported but it is rare. We describe a 42-year-old woman who presented with three foci of alopecia on her scalp resembling alopecia areata. She was a known case of breast carcinoma 10 years prior. Radical mastectomy and total chemotherapy was done 8 years prior. An incision biopsy of an alopecic patch was done revealing metastases of breast carcinoma to the scalp. Her workup failed to find metastatic involvement of other organs. This represents a case of breast carcinoma metastatic to the scalp mimicking alopecia areata, almost 10 years after radical mastectomy, and 8 years after chemotherapy. It is important for dermatologists to be alert for atypical features of alopecia areata, such as induration, and to maintain a low threshold for biopsy in atypical cases.     

Management of hair loss

The management of patients with hair loss requires a customized plan. Diagnosis, prognosis, psychosocial impact, treatment options, and patient preference are key determinants. This article discusses current agents for the treatment of three commonly encountered nonscarring alopecias: male- and female-pattern hair loss, telogen effluvium, and alopecia areata. Algorithmic approaches to management are provided.     

Female pattern hair loss

Female pattern hair loss is a common condition characterized by a diffuse reduction in hair density over the crown and frontal scalp with retention of the frontal hairline. The prevalence increases with advancing age. It has been widely thought to be the female counterpart of male balding and is often referred to as female androgenetic alopecia. However, the role of androgens is not fully established. Scalp hair loss is undoubtedly a feature of hyperandrogenism in women but many women with female pattern hair loss have no other clinical or biochemical evidence of androgen excess. Female pattern hair loss is probably a multifactorial genetically determined trait and it is possible that both androgen-dependent and androgen-independent mechanisms contribute to the phenotype. In managing patients with female pattern hair loss the physician should be aware that the adverse effects on quality of life can be quite severe and do not necessarily correlate with the objective degree of hair loss. The treatment options are currently limited but modest improvements in hair density are achievable in some women.     

Lasers,lights, and compounds for hair loss in aesthetics

Hair loss is a common complaint that is often stressful for patients and a challenge for practitioners to treat. Fortunately, innovations in the field have contributed to growing evidence for several promising topical, oral, and light and energy-based therapies. We have reviewed the current literature about the efficacy of these treatments, including topical agents (finasteride, latanoprost, spironolactone, caffeine, and metformin), oral minoxidil, nutraceuticals, platelet-rich plasma, low-level laser therapy, fractional lasers, and laser-assisted drug delivery. In addition, several debates related to these treatments have been discussed, including post-finasteride syndrome, effects of biotin supplementation on laboratory testing, standardization of platelet-rich plasma and low-level laser therapy, and combination treatment to enhance hair transplantation.     

Significant relationship between temporal hair loss and other scalp areas in female pattern hair loss

Female pattern hair loss affects the central scalp, sparing the frontal hairline. The temporal area can also be affected by hair loss. We investigated the degree of temporal hair loss and correlation of other sites of scalp hair loss in Korean female pattern hair loss patients. A total of 109 women with female pattern hair loss were enrolled in this retrospective analysis. We measured hair density and thickness in five scalp sites including the frontal, vertex, occipital and bilateral temporal areas by phototrichogram. Frontal and vertex area hair loss were classified according to the Basic and Specific (BASP) classification, and temporal scalp and occiput areas were also assessed. Eighty-nine patients showed temporal hair loss. The mean of the hair density was lowest in the temporal area among all scalp areas. Total and thick hair densities of the frontal scalp were correlated with those of the vertex, temporal scalp and occiput in descending order, and hair thickness of the frontal scalp was more related with that of the temporal scalp than the vertex. In this study, temporal involvement is evident in female pattern hair loss. We suggest that temporal involvement should be added to pattern hair loss classification, especially BASP classification.     

Diffuse hair loss and oral contraceptives

Diffuse loss of scalp hair occurs in some women when they stop taking mixed oestrogen/progestogen oral contraceptives. Nine women had diffuse alopecia while still continuing to take the pill. The relationship between the hair thinning and oral contraceptives is discussed.     

Management of hair loss diseases

The treatment of hair loss diseases is sometimes difficult because of insufficient efficacy and limited options. However, recent advances in understanding of the pathophysiology and development of new remedies have improved the treatment of refractory hair loss conditions. In this article, an update on the management of hair loss diseases is provided, especially focusing on recently reported therapeutic approaches for alopecia areata (AA). An accurate diagnosis is indispensable to optimize treatment. Dry dermoscopy represents new diagnostic techniques, which could enable the differentiation of barely indistinguishable alopecias, e.g. AA and trichotillomania. An organized scalp biopsy adopting both vertical and transverse sectioning approaches also provides a deep insight into the pathophysiology of ongoing alopecias. Among various treatments for AA, intraregional corticosteroid and contact immunotherapy have been recognized as first-line therapies. However, some AA cases are refractory to both treatments. Recent studies have demonstrated the efficacy of pulse corticosteroid therapy or the combination of oral psoralen ultraviolet A therapy and systemic corticosteroids for severe AA. Previous clinical observations have suggested the potential role of antihistamines as supportive medications for AA. Experimental evaluation using AA model mice further supports their effectiveness in AA treatment. Finasteride opens up new possibilities for the treatment of androgenetic alopecia. For androgenetic alopecia patients refractory to finasteride, the combination of finasteride with topical minoxidil or the administration of dutasteride, another 5 alpha-reductase inhibitor, may provide better outcomes. Scarring alopecia is the most difficult form of hair loss disorder to treat. The bulge stem cell area is destroyed by unnecessary immune reactions with resultant permanent loss of hair follicle structures in scarring alopecia. Currently, treatment options for this hair loss disorder are extremely limited. The development of effective therapies for this form of intractable alopecia represents an important issue to be resolved.     

皮肤镜在脱发疾病中的应用

皮肤镜是一种无创性的诊断工具,便于携带和使用,能观察到微细的、肉眼不可见的形态学结构。它在脱发疾病诊断、鉴别诊断及疗效判断中意义重大,应用于斑秃与其他非瘢痕性脱发的鉴别诊断、瘢痕性和非瘢痕性脱发的鉴别、急性弥漫性脱发如弥漫性斑秃和急性休止期脱发的鉴别诊断、原发性瘢痕性脱发中病种确定等。常见脱发疾病的皮肤镜征象与组织病理改变有一定的关联,了解其内在联系,能够在一定程度上减少组织病理活检的概率。该文对常见脱发疾病的皮肤镜征象、皮肤镜在毛发疾病的诊断、鉴别诊断及疗效评判等方面作一综述。     

Diffuse hair loss in women

In summary, the presenting signs of diffuse hair loss was thinning of the scalp hair with associated receding of frontal and temporal hairlines. The majority of patients experienced telogen efflivium between the ages of twenty and sixty years. The hair loss could be classified according to the multiple presumptive etiologic factors; hereditary, hormonal, or systemic disorders, drugs, nutritional deficits, neoplasms, physical and chemical trauma, and psychological disorders. Of the 129 women evaluated, 30 percent had concomitant systemic disorders or precipitating causes. This report stresses the importance of a full hiar loss evaluation and an attempt to identify the etiologic factors or disease states that may precipitate or exacerbate an existing condition such as androgenic alopecia. It is hoped that the outlines for the initial history and examination presented in this report will help to direct the physician's evaluation of hair loss problems in women.