Alopecia: all you need to know about hair loss

What is alopecia?

The alopecia is a medical term for a hair loss leaving the skin partially or completely naked. The pattern baldness , or androgenetic alopecia, is the form of alopecia the most common. It mainly affects men. Hair loss is a natural phenomenon that is strongly determined by heredity . Other forms of alopecia may indicate a health problem or be caused by taking medication, for example.

Some people choose to initiate treatments to stimulate regrowth or limit hair loss. Hair is culturally associated with the power of seduction , health and vitality , the treatment of alopecia arouses great interest. However, be aware that the result is not always satisfactory. Hair transplantation may then be the last resort.

Types of alopecia

Here are the main forms of alopecia and their causes. Although alopecia primarily affects the hair, it can occur in any hairy area of ​​the body.

Androgenetic baldness or alopecia

About a third of Caucasian men experience baldness by the age of 30, half by the age of 50, and about 80% by the age of 70. In men, baldness is characterized by the gradual decline in hair loss. edge of the hair, at the top of the forehead. Sometimes it occurs more on the top of the head. Baldness can start at the end of adolescence;

Fewer women suffer from baldness. By the age of 30, it affects 2% to 5% of women, and almost 40% by the age of 70 4 . The female pattern baldness looks different: all of the hair from the top of the skull becomes increasingly sparse. Although it is often reported that hair loss tends to increase after menopause, this has not been evident in the epidemiological studies carried out so far 4 ;

Several studies are underway to better understand the causes of baldness. Heredity seems to have a major influence. In men, baldness is influenced by male sex hormones (androgens), such as testosterone. Testosterone speeds up the life cycle of hair. Over time, these become thinner and shorter. Hair follicles shrink and then stop being active. It also seems that certain hair types are more influenced by testosterone levels. The causes of baldness in women have been much less studied. Women also produce androgens, but in very small amounts. In some women, baldness could be linked to a higher androgen level than the average but the main cause is heredity (history of baldness in the mother, a sister …).

Alopécie cicatricielle.

L’alopécie peut être causée par une lésion définitive du cuir chevelu en raison d’une maladie ou d’une infection de la peau (lupus, psoriasis, lichen plan, etc.). Les réactions inflammatoires qui se produisent dans la peau peuvent détruire les follicules pileux. La teigne, une infection à champignons du cuir chevelu, est la cause la plus fréquente d’alopécie chez les enfants. Cependant, chez eux, il y a repousse dans la plupart des cas ;

Teigne.

La teigne, une infection à champignons du cuir chevelu, est la cause la plus fréquente d’alopécie chez les enfants. Cependant, chez eux, il y a repousse dans la plupart des cas ;

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Pelade. 

La pelade, ou alopécie en plaques, est une maladie auto-immune. Elle se reconnaît par la chute complète des cheveux ou des poils sur de petites superficies de peau. Il y a parfois repousse, mais une rechute est toujours possible des mois ou des années plus tard. La pelade universelle (perte de tous les poils du corps) est très rare. Pour en savoir plus, consultez notre fiche Pelade ;

Effluvium télogène.

Il s’agit d’une chute soudaine et temporaire de cheveux, à la suite d’un choc physique ou émotif, d’une grossesse, d’une opération chirurgicale, d’une perte de poids importante, d’une forte fièvre, etc. Jusqu’à 30 % des cheveux entrent prématurément en phase de repos, puis tombent. Une fois le stress passé, les follicules pileux reviennent en phase active. Cela peut toutefois prendre quelques mois ;

Alopécie congénitale. 

Très rare, elle peut notamment être attribuable à l’absence de racines des cheveux ou à une anomalie de la tige du poil. Des mutations sur le gène P2RY5 seraient responsables de l’une de ces formes héréditaires appelée hypotrichose simplex, qui commence dès l’enfance chez les 2 sexes. Ce gène participerait à la formation d’un récepteur qui joue un rôle dans la croissance du cheveu ;

Médicaments, chimiothérapie, etc.

Différentes situations peuvent déclencher une perte de cheveux. Par exemple, des carences nutritionnelles, un déséquilibre du système hormonal, des traitements de chimiothérapie ou de radiothérapie pour traiter un cancer, des médicaments (par exemple, la warfarine, un anticoagulant, ou le lithium, utilisé dans le traitement des troubles bipolaires).

When to consult?

  • If your hair begins to fall out in handfuls or patches for no apparent reason;
  • If you want to experience a treatment in order to hide baldness.

 Our doctor’s opinion

Most of the cases of diffuse hair loss that I have seen in my practice were simply telogen effluvium cases. So, be patient and console yourself by telling yourself that in fact, the falling hair is growing back from the corresponding hair follicle.

In addition, few people are inclined, in the event of baldness, to undertake a daily treatment of indefinite duration. Most (like me!) Accept that baldness is largely inevitable. Like presbyopia, graying and the rest …

For people who really care, surgery is a reasonable option.

D r  Dominic Larose

Symptoms of alopecia

Symptoms

  • Partial or generalized loss of hair or body hair ;
  • Alopecia can set in acutely or gradually.

Warning signs that may be linked to alopecia  : dull hair, itchy scalp, painful roots, excess sebum or appearance of dandruff.

People at risk

  • Family history . The men with a family member due to baldness are more likely to make too. Researchers have found genes involved in baldness on chromosome 20 (passed on from the father or mother), as well as on the X chromosome (passed on from the mother). The X chromosome variant concerns genes involved in the functioning of male sex hormone receptors (androgens);
  • The Caucasians are at greater risk of baldness that Asians, Native Americans and Africans.
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Risk factors

The heredity is a risk factor for androgenetic alopecia and history of autoimmune disease may be associated with alopecia areata.

Prevent hair loss

Basic preventive measures

There is no magic trick to preventing alopecia , especially when it is hereditary . All the same, a few basic steps contribute to healthy hair .

Caring for your hair
– Having good hair hygiene reduces the risk of ringworm.
– Avoid sharing combs, brushes and other hair accessories.
– Do not abuse chemicals (dyes, fixatives, etc.).
– Avoid excessive hair pulling when styling or holding hair in place with accessories.

Eat well
Several trace elements play an important role in the health of the hair. In particular magnesium, but also calcium, iron, potassium and zinc.
To avoid a possible deficiency of one or the other of these trace elements, it is important to eat in a healthy and balanced way. To learn more about the basics of healthy eating, see our How to eat well?

Guarding against stress
Stress causes the secretion of androgens which, in excess, promote baldness. Find the source of your stress and find solutions to better cope with the situations that create it, if necessary. Practicing relaxation techniques can also be helpful.

Act quickly
While there are a few remedies to curb hair loss, resources are much more limited when it comes to regrowth.

In case of chemotherapy or radiotherapy
Certain chemotherapy treatments can cause hair loss or hair loss, depending on the type of chemotherapy used, the dose, the duration of the treatments and other personal factors. Radiation therapy can also cause hair loss. Usually, body hair and hair grow back within weeks or months of stopping treatment. However, according to the Canadian Cancer Society, it is possible to reduce the effect of these treatments. Here are some tips 1  :
– use a mild shampoo and a soft bristle brush;
– let your hair dry naturally or use a blow dryer at low temperature;
– avoid coloring or perming your hair;
– wear a cooling helmet during chemotherapy to reduce blood flow to the hair follicles. This method is contraindicated for certain types of cancer. Also, it is not always effective. Ask the healthcare team for more information.

What solution against hair loss?

he treatment chosen, if any, depends on the cause of the alopecia . In the event of temporary alopecia (stress, pregnancy, etc.), treatment is rarely indicated. Many people choose not to start treatment. In this case, we can opt for natural, or for camouflage makeup, a complete shave of the head, a wig or a scarf.

 Medications

Note that minoxidil and finasteride, although they help to slow hair loss and stimulate regrowth , are not able to reproduce the original hair.

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Topical solution of minoxidil (Rogaine®) . This drug slows down hair loss and stimulates hair growth. It can be suitable for both men and women with baldness . It is used in the form of a liquid (2% or 5% concentrate) or a foam in Canada (5% concentrate) to be applied twice a day to the bald parts of the scalp. Hair that grows back with minoxidil is thinner. We can judge the results after about 4 to 6 months. If the results are positive and you want to keep the gains, you should continue with the treatment. Minoxidil is generally well tolerated. It can cause local irritation. This medication is obtained over the counter.

Finasteride (Propecia®, Proscar®) . Taken as a pill orally, finasteride is intended for men with baldness . Approved in 1998 to treat baldness, finasteride was first used for the treatment of benign prostatic hyperplasia . This medication works by inhibiting the enzyme that converts testosterone into dihydrotestosterone (DHT), the form of hormone that can cause hair follicle activity to stop by over-stimulation. According to clinical studies, finasteride mainly slows down hair loss. It promotes hair regrowth in some only. The therapeutic effect ceases as soon as the treatment is stopped.

Spironolactone (Aldactone®) . For women with androgenetic alopecia in whom minoxidil is not effective, the doctor may suggest taking spironolactone as well. This molecule has an antiandrogenic effect, therefore blocks hormones that play a role in hair loss.

Contraceptive pill . Some birth control pills may have an antiandrogenic effect (Yasmin®, Diane-35®, and all pills containing desogestrel and norgestimate). This option can be interesting for a woman who, in addition to wanting an oral contraception, shows clinical signs of an excess of androgen: alopecia, acne, seborrhea , hirsutism (excess of hairiness), etc.

Antifungals . In case of ringworm , oral antifungals treat the infection. Local treatment is ineffective.

 Surgery

There are a few surgical methods that can be used for hair replacement , the most popular being the micrograft technique . This lasting treatment takes time and money. The hair is removed and transplanted one at a time, or as small clusters, which include some skin tissue, on the sides and back of the head.

 Stem cell research

Preliminary studies suggest that it will one day be possible to make baldness reversible. Indeed, according to work carried out in the United States 2 , the stem cells lodged in the hair follicles – from which new hair is formed – are intact in the bald areas of the skull. On the other hand, they are “inactive”. Researchers hope to find a way to reactivate them. We will have to wait a few more years before seeing the results of this research.

Complementary approaches to alopecia (hair loss)

arious complementary approaches for the treatment of alopecia are offered, for example homeopathy and aromatherapy products. Traditional medicines from India (Ayurveda) and the East ( Traditional Chinese medicine ) also offer their approaches to stimulate regrowth. The effectiveness of these treatments has not been tested by clinical studies.