HAIR LOSS; Myths and truths; When is it normal and when is alopecia

Partial or total hair loss is called alopecia. It can affect the scalp or other skin areas where
there is hair, including the eyelashes, eyebrows, armpits, genital region and beard.

Each hair consists of a visible and external part at the scalp level - the shaft - and an internal
part, the hair follicle. The greater follicles number, the denser the hair mane will be. In each
hair follicle and throughout life, moments of growth and rest are repeated; these are the hair
cycle phases.

This cycle is made up of three stages:

Growth or anagen phase: the length of the hair is determined by this phase, which is the
longest and lasts between 2 and 7 years.
Transition or catagen phase: lasts about 3 weeks, the follicle cells activity stops causing
growth to stop.
Resting or telogen phase: functional activities stop completely, the hair root remains in the
hair follicle and falls out especially when cleaning and combing. It lasts 3 months and when
this stage ends, the hair cycle begins again with the growth phase.

Hair in the anagen phase is well anchored and can only be removed by exerting strong
tension and causing slight pain. In the telogen phase, the anchoring system weakens and a
less strong tension is enough for it to fall, for example massaging during shampooing or
combing.

Although the hair falls out, the hair follicle does not disappear since the germinative matrix of
the bulb is ready to start a new cycle, provided that unbalanced factors do not act. Each
follicle follows its own cycle, which is not the same as the others, and that is why the hairs do
not all fall out together. This asynchrony allows us to always have a constant mane without
reducing its density.

CAUSES OF ALOPECIA

In people, as it happens in animals, a physiological form of hair loss called seasonal

defluvium, typical of the spring and autumn period, can be observed. It presents with an
abundant hair loss (100-300 hairs per day) and can last for 1 or 2 months. This seasonal
drop is usually self-resolving, but it could also last abnormally.

There are also conditions in which the hair can fall out abundantly: for example if you are
going through times of stress, in case of extreme diets or due to excessive alcohol
consumption. Also if you are breastfeeding or menopausal, or if you take medications for
long periods, for conditions such as thyroid disease, anemia or post-surgery. Also, UVA rays
and tobacco smoke can represent other possible causes of alopecia.

If you are a woman and have hair loss associated with acne and the appearance of hair on
your face or breasts, it will be your dermatologist who will request blood tests to evaluate
hormonal levels. Another frequent cause of hair loss in women is postpartum, hair loss can
also be observed if you take certain birth control pills or a couple of months after stopping
them. On the other hand, there are certain autoimmune or infectious diseases that can also
cause alopecia, so it is extremely important that you consult your dermatologist who is
trained to identify and treat all the possible causes of it.

To sum up, the causes that produce alopecias are multiple, which is why they are divided
into two large groups: scarring alopecias (these are those where there is destruction of the
hair follicle, this hair does not grow back) and non-scarring alopecias (they are the most
frequent and the hair follicle recovers after treatment).

SIGNS OF HAIR LOSS

You may notice a gradual loss of hair. It can happen in patches or generalized (diffuse).
Normally, approximately 100 hairs are lost from the head per day. The scalp contains
between 100,000 and 150,000 hairs. 100 hairs per day corresponds to the percentage of
hair that is in the final phase of its life cycle.

DIAGNOSIS: WHAT TO EXPECT AT CONSULTATION

The diagnosis will be obtained through a clinical examination carried out by your
dermatologist who will inquire about your hair loss and its amounts, your hygienic and
dietary habits, if you have a family history of alopecia, or about your emotional well-being
and if you are going through stress, if you have current illnesses or about your surgical
history.
In a second instance, your doctor may carry out different tests to evaluate what type of
alopecia you have, among them he or she may indicate: blood tests, microscopic tests or
scalp biopsies.

TREATMENT

Treatment varies according to the type of alopecia, so it is advisable to consult your

dermatologist. There are medical treatments for hair loss in women that are different from
those performed for men, your dermatologist may indicate lotions, certain oral medications,
amino acids, capillary mesotherapy or platelet-rich plasma, as well as treatments with laser
devices or micro-surgery.
Capillary mesotherapy consists of the application of medications in low doses through
microneedling directly on the scalp, thus obtaining a good local effect, minimizing systemic
reactions.
Platelet-rich plasma treatment is a new autologous medical procedure performed with the
patient's own substance. This treatment improves hair quality and helps stop active hair loss.
Depending on the hair fall degree, your dermatologist will indicate the most appropriate
therapy for your case. This may be one treatment or a combination of several.

Below, we will answer the most frequently asked questions about alopecia, to clarify some
misunderstood concepts:
How do I know if my hair loss is normal?

We generally lose about 100 hairs per day, in some cases up to 150. Up to this point, it is
considered normal. Beyond this amount it can mean that we are facing some pathological
condition.

When can there be an increase in hair loss?

There are different situations that can lead to an increase in hair loss. We can generally
identify them according to the distribution, evolution and reversibility of the process. From
this point of view we can differentiate two processes within hair loss:

Effluvium (generally diffuse hair loss); where sudden hair loss occurs. Some effluvia
appears shortly after the process is established and becomes evident after one or two
months. They are cases secondary to chemotherapy treatments for cancer, hormonal
alterations, protein or vitamin deficiencies. In other cases, the diffuse hair fall manifests itself
after 2 or 3 months, as a result of different factors such as emotional or physical stress
secondary to major surgery, after childbirth, a febrile episode, other infectious processes or
even as a consequence of iron deficiency.

Alopecias; This is due to a process that directly affects the scalp. They can adopt a certain
distribution such as androgenetic alopecia, which is one of the most frequent (Also called
common baldness). Other forms manifest as circumscribed areas without specific
distribution, such as those due to direct infection of the hair by fungi, by autoimmune
processes in alopecia areata, or other diseases that can affect the skin. There are cases of
alopecia that are irreversible and for which you should consult your dermatologist as soon as
possible.

I went through a situation of great emotional stress and began to notice hair loss. Is
this possible?

Yes, there are studies that show that men and women who experience stressful situations
are 11 times more likely to experience hair loss when compared to people who do not
experience high levels of stress.

Is baldness hereditary?

Yes. It is the most associated genetic factor in men.

Does shampoo type influence on hair loss?

No. The importance of shampoo type is quite indirect, especially due to the short time it
remains in contact with the hair and sculp.
Can chemical products for hair straightening cause hair loss?

All straightening products damage the hair fiber and the repeated use progressively
weakens the hair shaft, which can lead to hair loss. When we subject our hair to a
straightening process, the hair Keratin weakens.

Why does hair fall out after childbirth?

After childbirth, the hormones are rebalanced and the hair that had been stopped in the
growth phase during pregnancy begins to fall out quite suddenly and abruptly.

My child always wears his hair tied, is it possible that this causes alopecia?

Hair styles influence hair fall because some exert too much traction on the hair and sculp,
such as braids, updos and tight hairstyles, especially if non-fabric covered rubber bands and
non-plastic coated hair pins are used; in this case, the hair is pulled out when these
accessories are removed.

What hair care should be taken?

The hair should be washed as many times as necessary for each person. Not because you
wash it less, it will fall less. Shampoos with a neutral pH are recommended. Frequent dryer
use, hair dyes or perms should be avoided, as they weaken the hair and favor its breakage.
Regular hairstyles with extremely tight updos should be avoided as well, because pulling can
be a cause of alopecia, with regression of the hairline.

If I am vegan, do I need to take supplements to prevent hair loss?

One of the reasons why hair may fall out more on vegetarian diets would be because of the
increased soy consumption. Soy is used in part as a substitute for protein and calcium,
however, its high consumption can alter the thyroid hormone's function. Thyroid problems
affect the hair life cycle, generating diffuse alopecia, in which hair falls off very quickly,
leaving depopulated areas on the scalp. Moderating soy consumption and complementing it
with other foods will be more than enough to prevent this problem.
Another condition that can arise is iron malabsorption. Vegetarians and vegans usually take
a lot of iron, however, it is not absorbed in the same way as in an omnivorous diet. Iron is
essential to transport oxygen through the blood and thus stimulate the tissues development.
An iron deficiency will cause a blockage of nutrients in the hair follicles (hair root) causing
the hair to interrupt its growth phase. If there is poor iron absorption, it is enough that the diet
is increased with other nutrients that stimulate its absorption and complement its effect.

Does hair grow normally after receiving chemotherapy?

Hair begins to grow back about 1 to 3 months after chemotherapy ends. In general, it takes 6
to 12 months for hair to fully grow back. When new hair grows back, the texture may be
different from the old texture.
Is hair loss common in childhood?

Although childhood is a time when many changes take place in the body, heavy hair loss is
not normal and should be treated by a dermatologist if it occurs.

Does hair loss happen in a particular season?

Yes, when summer ends and autumn begins, at this time there is more hair loss. During the
summer we spend more time outdoors and the hair accelerates its cycle. The end of the
summer season coincides with the end of the hair cycle, which translates into greater hair
fall.

If you notice excessive hair loss or thinning, do not hesitate to make an appointment
with your dermatologist. He or she will make the correct diagnosis of the causes and
will indicate an appropriate treatment for your particular situation to improve your hair
mane, its quality and appearance.