ALOPECIA

Mrs. NEERAJA RAJIV

ASST PROFESSOR
CARDIO-RESP
 The first phase, anagen is the growth phase, which
can last between two and seven years. This phase
and its length determine how long the hair becomes.
 The catagen phase, also known as the regression
phase, comes next and only lasts about 10 days.
During this time the hair follicle shrinks and
detaches from the dermal papilla.
 The third phase is telogen, which lasts about three
months.
 The fourth and final phase, exogen, is when the hair
eventually detaches and falls out.
 DEFINITION
 TYPES
 CAUSES
 PATHOLOGY
 CLINICAL FEATURES
 INVESTIGATIONS
 MANAGEMENT
 PHYSIOTHERAPY MANAGEMENT.
UVR-PARAMETERS,PHYSIOLOGY
LLLT-PARAMETERS,PHYSIOLOGY
ALOPECIA
Definition:
• Alopecia is defined as the loss of hair
from areas where hair normally grows

• Partial or complete baldness or loss of

hair.
TYPES
There are different types of alopecia.
The main types of hair loss are:
 • Alopecia Areata (AA)
 • Alopecia Totalis (AT)
 • Alopecia Universalis (AU)
 • Alopecia Barbae
 • Androgenetic Alopecia (AGA)
 • Scarring Alopecias
Alopecia Areata (AA):

 • Alopecia areata is an autoimmune

condition which causes patchy hair
loss.

 It can result in a single bald patch or

extensive patchy hair loss.
Alopecia Totalis (AT)

 • Alopecia totalis is a more

advanced form of alopecia areata
which results in total loss of all
hair on the scalp.
  Alopecia Universalis (AU)

 • Alopecia universalis is the most

advanced form of alopecia areata
which results in total loss of all hair
on the body, including eyelashes and
eyebrows.
Alopecia Barbae

 • Alopecia barbae is alopecia areata

that is localised to the beard area.

 It can be a single bald patch or more

extensive hair loss across the whole
of the beard area.
  ANDROGENETIC ALOPECIA (AGA)
 • Also known as male pattern baldness or
female pattern baldness.
 • It is a thinning of the hair to an almost
transparent state, in both men or women.
 • It is hereditary
 • In both men and women, it's linked to having
an excess of male hormones (androgens)
around the hair follicles, which can block hair
growth.

Women are more likely to develop
•
androgenic alopecia after
menopause, when they have fewer
female hormones.
 • Most cases of hair loss are due to
androgenic alopecia.
 SCARRING ALOPECIAS
 • Scarring alopecias refers to a group of
rare disorders which cause permanent
hair loss.
 • Caused by any inflammatory processes
which causes permanent damage to hair
follicles.(burns, bacterial infections,
autoimmune diseases )
CAUSES OF ALOPECIA
Causes of alopecia:
• Physical stress: surgery, illness, anemia, lack of sleep.

• Emotional stress: psychiatric illness, death of family member,

job loss, anxiety etc.

• Hormonal causes: postpartum, oral contraceptives, menopause,

ingestion of testosterone containing hormone supplements.

• Endocrinopathy: hypothyroidism, hyperthyroidism

• Exposure to allergens, irritants, toxins,burns, injuries,

• Certain medications (especially anabolic
steroids like testosterone)

• Diet considerations: rapid weight loss or gain,

unusual dieting habits, protein intake failure,
prolonged fasting.

 • Radiation and chemotherapy.

EVALUATION OF HAIR LOSS
 History& Examination
 1. Time period of hair loss(congenital,
acquired)
 2. Progression of hair loss
 3. Any positive family history
 4. H/o G.I dysfunction, thyroid gland
dysfunction , psychological disorders
 5. H/o any surgical intervention / chronic
illness
 6. All medications
 7. In females, menstrual & obstetric history
 8. Hair care routine/ hair products
 9.Examination Physical appearance of hair
and pattern of hair loss helps in diagnosis of
possible etiology.
DIAGNOSTIC TESTS
PHYSICAL EXAM
 Examine scalp to check for inflammation,
redness, sores, or scarring.
 Check the pattern of the hair loss, and
whether there is hair breakage.
TRICHOMETRIC ANALYSIS

 Use a digital assessment system called Folliscope which consists of

a small handheld device containing a high definition, microscopic
camera.

 Take pictures of the scalp and hair, and the images are displayed on
a computer monitor.

 The Folliscope can magnify these images by up to 100 times, giving

detailed look at hair, hair follicles, and the scalp.

 Also provides information about hair coverage, including the total
number of hairs on the scalp and the diameter of each strand of hair.

 Also used to monitor the progression of new hair growth after

treatment begins.
FUNGAL CULTURE
 To confirm the presence of a fungus in hair
or scalp cells.
 To determine whether a fungal infection
called tinea capitis, or scalp ringworm, is the
cause of hair loss.
 Scrape or swab the scalp or take a small
sample of skin or hair and it can take several
weeks of incubation in the laboratory for a
fungus culture to become positive.
“PUNCH” BIOPSY
 It’s called a “punch” biopsy because of the
technique used: Dermatologists use a device
the size and shape of a pencil to puncture
the scalp and remove a small tissue sample.
 Biopsies are frequently used to distinguish
between the types of alopecia.
BLOOD TESTS
 Suspect the hair loss may be due to an
underlying medical condition, a vitamin or
mineral deficiency, or a hormonal
imbalance.
 Too little iron in the bloodstream may
contribute to hair loss.
 Iron rich foods include dark, leafy greens,
red meat, whole grains, and Iron
supplements, which are used to treat
anemia, may also help to stop hair loss.
DAILY HAIR COUNTS
 Useful for quantitative assessment of the
actual number of hairs shed daily in patients
with complaints of excessive shedding.
 Collect for 14 consecutive days
 Average daily loss – 30-70 hairs /day.
 If >70 hairs – microscopic examination is
done to • detect pathology.
TREATMENT

 • There is no cure for alopecia and no

universally proven therapy to induce hair re-
growth.
 • Many cases of hair loss are temporary, for
example, due to chemotherapy, or they're a
natural part of ageing and don't need
treatment.
 • If hair loss is caused by an infection or
another condition , treating the underlying
problem may help prevent further hair loss.
FINASTERIDE:
 • It acts by preventing the hormone
testosterone being converted to the hormone
dihydrotestosterone (DHT).
 • DHT causes the hair follicles to shrink, so
blocking its production allows the hair
follicles to regain their normal size.
 • The balding process usually resumes within
six to 12 months if treatment is stopped
 MINOXIDIL:
 • Minoxidil is available as a lotion you
rub on your scalp every day
 • Minoxidil is currently the only
medicine available to treat female-
pattern baldness
CORTICOSTEROID INJECTIONS:
 • Acts by suppressing the immune system. • This is
useful in Alopecia Areata because the condition is
thought to be caused by the immune system damaging
the hair follicles.

 RETIN A / TRETINOIN:
 • Retin-A was originally used for the treatment of acne
and other skin problems.
 Retin-A, when used alone in the form of a gel, which
is rubbed onto the area of hair loss, or in combination
with topical Minoxidil can result in moderate to good
hair growth in individuals with Alopecia.
 Immunosuppressive drugs
 Ultraviolet light treatment
 Wigs -Synthetic wigs- made of acrylic -

Real hair wigs

 Surgical Treatment
• Hair transplantation
• Follicular unit transplant
   Hair transplantation is a surgical technique that
removes hair follicles from one part of the body,
called the 'donor site', to a bald or balding part
of the body known as the 'recipient site'. The
technique is primarily used to treat male pattern
baldness.

 • Follicular unit transplantation (FUT) is a hair

restoration technique, also known as the strip
procedure, where a patient's hair is transplanted
in naturally occurring groups of 1 to 4 hairs,
called follicular units.
 ALOEPECIA-PHYSIOTHERAPY
Aims:

 To improve general health

 To improve nutrition to hair follicles

UVR treatment + Theraktin are given.

 Eradicate the inflammatory cell infiltrates surrounding the
affected hair follicles,
 Sub-erythema or doses of E1 are given for 5-8
minutes daily.
 Individual patches are treated by E2 and
E3 doses of of UVR and Kromayer, twice a
week.
 Treatment should be continued for 2-3 months,
and as the hair starts growing UVR must be
stopped to that area.
 The PUVA therapy involved the application of
0.1% 8-methoxypsoralen as a thin layer with
a cotton swab over the scalp.
 Following 20 min after application, patients
received UVA irradiation;with the main
emission set at 320–410 nm and the peak
emission at 351 nm.
 Each patient received PUVA therapy twice a
week.
Precautions for Use of UV
Photosensitizing medications and dietary supplements.
 Care should be taken when applying UV radiation to patients
who are taking photosensitizing medications or supplements.
 Photosensitizing medications include sulfonamide,
tetracycline, and quinolone antibiotics; gold-based
medications used for the treatment of rheumatoid arthritis;
amiodarone hydrochloride and quinidines used for the
treatment of cardiac arrhythmias; phenothiazines used for the
treatment of anxiety and psychosis; and psoralens used for the
treatment of psoriasis.
 While patients are taking these medications or supplements,
they have increased sensitivity to UV radiation, resulting in a
decrease in the minimal erythemal dose and an increased risk
of burning if too high a dose is used.
 A patient's minimal erythemal dose must be remeasured if the
patient starts to take a photosensitizing medication or
supplement during a course of UV treatment.
LLLT
 Laser Therapy works on the principle of inducing
a biological response through energy transfer, in
that the photonic energy delivered in to the tissue
by the laser modulate the biological processes
within the tissue. So it is called
PHOTOBIOMODULATION.
LLLT
Low level laser therapy
 Increase blood flow in the scalp and
stimulate metabolism in catagen or
telogen follicles, resulting in the production of
anagen hair.  
 Stimulate anagen re-entry in telogen hair follicles
 Prolong duration of anagen phase
 Increase rates of proliferation in active anagen hair
follicles
 Prevent premature catagen development.
PHYSIOLOGY
 The photons of light act on cytochrome C oxidase
leading to the production of adenosine
triphosphate (ATP). This is converted to cyclic
AMP in the hair follicle cells, releasing energy and
stimulating metabolic processes necessary for hair
growth.
 Release of nitric oxide from cells leads to
increased vascularisation to the scalp distributing
nutrients and oxygen to the hair roots.
 Excessive build-up of DHT is prevented.
PARAMETERS
 The red wavelengths have usually been between 630 nm and
660 nm.
 These devices can be divided into four broad types,
(a) hand held combs or brushes;
(b) head bands;
(c) caps or helmets;
(d) stationary hoods .
 The total number of laser diodes incorporated into each of
the delivery devices determines the total power administered
to the head, and hence the time required to deliver the desired
dose to the affected regions of the scalp.
 Dosimetry is usually measured as an energy density (J/cm2)
with a value of 4 J/cm2 .
 The time of application is usually between 10
and 20 minutes, which can be calculated as
4 J/cm2 divided by a usual power density of
5 mW/cm2 equals 800 seconds
(13.3 minutes).
 The advantages of a comb or a band device
over a cap or a hood, are that the teeth of
the laser comb part the hair to allow the
light to penetrate better.
 Delivery of laser light to scalp, 655 nm for 20
seconds daily three times per week for a total
of 6 weeks .

 LLLT also assist hair transplant patient’s

postoperative wound healing process and
improve hair growth.
THANK YOU