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Female Alopecia

1.-Introduction
2.-Growth cycles
3.-Main Causes
4.-Secondary Causes
5.-Topical treatments
6.-Oral treatments
7.-Cosmetic treatments
8.-Conclusion

Introduction

With different colors, styles and variations, young or mature, male or female, the hair has an important role in a person’s image.

While advertising for products that “strengthen the hair” are almost always male-oriented, it may seem that women do not suffer from alopecia. The reality is that over two thirds of women face the challenges of hair-loss at some point in their lives.

Many women find this very disturbing, perhaps more than men. In addition, the female physiology is unique, and factors such as menstrual cycles, pregnancy and menopause are particularly important.

For some women, hair loss can be genetic; however, many of the causes of female hair loss are treatable.

Without a doubt, the physical appearance of women depends greatly on their hair. For many women, their hair is a sign of youth and vitality.

Hair structure:

The external portion of the hair, called the stem, is the part of the hair that we see and style. In reality it is dead tissue produced by hair follicles, small bag-shaped structures located deep in the scalp. Each hair is enclosed within a follicle.

The average head has 100,000 hairs. At the base of the follicle is the oval shaped root, which is responsible for the growth of hair. In the lower portion of this is the papilla, which contains blood capillaries that provide blood to each hair.

As hair grows, the cells move towards the surface of the skin and become a protein called keratin, being replaced by new cells. Keratin is the same protein found in the nails.

The stem is composed of 3 layers: the cuticle, the cortex and medulla. The cuticle, or outer layer, consists of small cells known as scales. The cuticle serves as a case for the cortex, the thickest portion of the stem, composed of cells arranged in the form of tobacco leaves. The cortex holds the pigment that gives hair its color. The medulla is composed of cells with the form of a case and is located in the center. The spaces between cells in the medulla influence the refraction of light in tone and hair.

Glands and muscles

The hair is lubricated by oily secretions from the sebaceous glands, located on the sides of most follicles. Surrounding these glands and the rest of the follicle, there are groups of muscles (arrector pili) that allow the hair to stand up when a person is cold or afraid.

Cycles of growth

The average head has 100,000 hairs. Hair grows and is renewed regularly. Normally, 50 to 100 hairs fall out every day. If there are no problems, this loss will most likely go un-noticed.

Hair grows about 1 cm per month, although this growth declines as we age. Every hair on your head remains there for about two to six years, and during most of this time it is growing. When the hair is older it enters a resting stage in which it remains on the head, but stops growing. At the end of this phase the hair falls out. Typically, the follicle replaces the hair in about six months, but many factors can disrupt this cycle. The result may be that the hair falls out soon or is not replaced. Normally 90% of hair is in continuous growth (anagen phase) that lasts 2 to 6 years. 10% of hair is in a resting phase, which lasts about 2-3 months. At the end of this stage it is normal for the hair to fall out (telogen phase).

As the hair falls out is replaced by a new hair from the hair follicle, located under the skin. Throughout a person’s life span no new hair follicles are formed. Blonds have the most hair (140,000 hairs) followed by dark hair (105,000) and red hair (90,000). As we age the rate of hair growth diminishes, leading to a progressive thinning of hair. Since the hair is composed of protein (keratin), and this material is also in the nails, it is essential that all people ingest or eat an abundant amount of protein to maintain the healthy hair production. Protein is found in meat, poultry, fish, eggs, milk, cheese, cereals, nuts and soy.

Main causes

Androgenetic alopecia is the most common cause of hair loss. It is mainly determined by 3 factors: aging, hormones, and heredity.

Most people experience some hair loss as they age. The result may be a partial or total baldness. Men are much more likely than women to experience baldness and hair loss when they get older, but “female baldness” can also be inherited, which can cause modest or significant hair loss in women as they age. Hair loss is apparent initially between 25 and 30 years of age. In female hair loss, hair is replaced by increasingly thinner and shorter hair. Hair may even become transparent.

Usually, hair loss in women is less obvious than in men. Also, the pattern in which the hair falls out is different. It is most noticeable in the hair part, as well as the crown of the head, additionally the frontal hair line is retained. It is inherited from both father and mother.

About 50% of women who experience hair loss have “female baldness”. In these cases there is an abundance of dihydrotestosterone (male hormone) in the hair follicle. The conversion of testosterone to DHT is regulated by the 5-alpha-reductase enzyme in the scalp. Over time, the action of DHT degrades, and shortens the growth phase of the follicle (Anagen). Although the follicle is technically alive, it grows less and less each time. Some follicles just die, but most become smaller and thinner. As the Anagenic Phase remains very short, hair gradually thins and falls out until it becomes so fine that it can no longer sustain daily hair combing. Baldness turns a long, thick pigmented hair into thin, clear and light hair. Nevertheless, the sebaceous glands attached to the follicle remain the same size and continue to produce the same amount of sebum. When a medical treatment (flutamide, cyproterone or spironolactone) is able to reduce the male hormones, the sebaceous glands become smaller, and reduce their production of this hormone in the sebum causing less damage.

There also seems to be an immune factor in baldness. Basically, the immune system begins to target hair follicles in the areas of alopecia. The rise in male hormones (DHT) during puberty starts this process.

Secondary causes

A wide variety of factors can cause hair loss, often temporary, in women:

Birth Control Pills

The pills contain two ingredients, a synthetic estrogen and progestin. Women who experience hair loss while taking oral contraceptives are predisposed to a hereditary progressive hair thinning. This can be accelerated by the effects of the male hormone possessing some progestagens. If this happens, it is advisable to change to another type of oral contraceptive. Also, when a woman stops using certain oral contraceptives, she can be notice hair loss 2-3 months later. This lasts about 6 months and usually ceases. It would be similar to hair loss experienced after giving birth.

Iron deficiency anemia

Lack of iron causes hair loss in men as well as women. However, in women the problem is more prevalent, particularly in those with long or heavy menstrual cycles. The lack of iron can be detected easily with analysis, and corrected with medical treatment.

Diet

A diet low in protein can also cause hair loss, as can low iron intake. Vegetarians, people with diets low in protein, and patients with anorexia nervosa may be a protein deficient. When this occurs the body helps to conserve protein by shifting hair growth to the resting stage. This can lead to heavy hair loss about 3 months after the hair growth enters the resting stage. When the hair is pulled, it comes out easily at the root. This process is reversible with medical treatment, which requires an adequate intake of protein.

Post-partum

Some women lose large amounts of hair 2-3 months after giving birth. When a woman gives birth, too many hairs enter the resting phase. 2-3 months after she may notice a large number of hairs in the comb or brush after combing her hair. The hair loss can last about 6 months. The problem, in most cases, is resolved after appropriate medical treatment. Not all new mothers will suffer from this experience, and not all women will notice hair loss with each pregnancy.

Stress and illness

You may start to lose hair 1-3 months after a stressful situation, such as major surgery. High fevers, infections, severe or chronic diseases can also result in hair loss.

Thyroid Disease

An underactive or hyperactive thyroid can cause hair loss. These diseases are diagnosed by clinical symptoms and laboratory tests. These cases require special handling.

Medicines

Some drugs used in cancer chemotherapy cause hair cells to stop their division, resulting in thinner more fragile hair that easily breaks as it emerges from the scalp. This phenomenon occurs 1-3 weeks after the start of anticancer treatment. The patient can lose 90% of their hair. In most patients, hair grows back when anticancer treatment ends.

Also, many popular medications can cause hair loss.

Drugs that reduce cholesterol: clofibrate (Atromis-S) and gemfibrozil (Lopid).
rugs for Parkinson’s: levodopa (Dopar, Larodopa).
Anti-ulcer drugs: cimetidine (Tagamet), ranetidina (Zantac) and famotidine (Pepcid).
Anticoagulants: Coumarina and Heparin.
Anti gotoso agents: Allopurinol (Loporin, Zyloprim, Zyloric).
Anti-arthritic: penicillamina, auranofin (Ridaura), indomethacin (Inacid), naproxen (Naprosyn), Sulindac (Clinoril) and methotrexate (Folex).
erivatives of Vitamin-A: isotretinoin (Accutane, Roacutan) and etretinato (Tegison, Tigason).
Anti-convulsants / antiepileptics: trimethadione (Tridion).
Anti-depressants: tricyclics, amphetamines.
Beta blockers for hypertension: atenolol (Tenormin), metoprolol (Lopressor), nadolol (Corgard), propranolol (Inderal) and timolol (Blocadren).
Anti-thyroid: carbimazole, iodine, thiocianato, thiouracilo.
Other anticoagulants, male hormones (anabolic steroids).

Alopecia Areata

A common disease that causes patches of hair loss on the scalp and other body parts. It affects men and women of all ages, but more commonly youth. The affected follicles significantly diminish their production of hair. They become very small and produce hair that is hardly noticeable. These follicles are in a resting state, and at any time can resume their normal activities after receiving a signal. Some people develop only a few bald spots that return to normal in about a year. Some people loose all of the hair on their head (alopecia totalis). In other people all body hair is lost (alopecia universal). It is believed that alopecia areata is an autoimmune disease in which the body mistakenly produces antibodies against the hair follicle (autoallergic). Anxiety and nervousness may trigger the disease or prevent it from healing. Treatment includes injecting cortisone, or by applying Minoxidil, cyclosporine, steroid creams or Anthralin to the affected area. In selected cases, UVA treatment, or the application of dibenciprona on the lesions is used in order to produce an allergic eczema to stimulate the resting follicle.

Tinea/ringworm

A fungal infection on the scalp. Small patches can cause flaking and some hair loss.

Inappropriate hair care

Many women use chemical treatments on their scalp, such as dyes, highlights, and perms. Chemical treatments can damage the hair if done incorrectly. The hair becomes weak and breaks when these substances are applied too often, left on too long, bleaching previously bleached hair, or when two or more procedures are performed in the same day. If the hair becomes too porous and dull by excessive exposure to chemical treatments, it is advisable to suspend these treatments until the hair has recovered. Shampoo, brushing and combing are necessary for proper care of the hair, but if done excessively or inappropriately can damage hair, causing it to break at the stalk, or produce split ends. You can use a conditioner or hair repair product after shampoo to reduce the force required to comb the hair and make it more manageable. When there are split ends, and hair that is difficult to comb, it is advisable to use hair repair products with silicone serums. Excess water should not be dried and rubbed vigorously with a towel. When the hair is wet its structure is more fragile, and vigorous combing or brushing should be avoided. Forget the old recommendation of combing or brushing in excess as well, because it damages hair. Use combs with widely spaced teeth and thin bristle brushes, preferably natural (wild boar bristle brushes for example). The hairstyles that require tension on the hair like curls and braids should be alternated with loose hair styles to avoid the constant “pull” that can produce hair loss, especially on the sides of the scalp.

Topical Treatments

1. Minoxidil. Is a vasodilator agent that has been used orally in the treatment of hypertension and is now widely used in treating various types of alopecia. In general, 1 ml of lotion is applied twice a day (every 12 hours) to dry hair, as humidity increases the penetration of the product several times. Works better in young men than in women (20 years), especially in those with mild hair loss (thinning) on the crown, or a small bald patch 3-4 cm, but also is functional for a receding hairline. The response to Minoxidil varies from individual to individual. Treatment should be 2 to 5 years. The scalp will recover beginning to grow more hair from the small thin hairs. Minoxidil causes hair becomes thicker and healthier. The outcome is better for people suffering from hair loss for less than 2 years. Most see fuzz growing in the first few months. Some experience more hair loss after the first applications. This is because the old hair should fall out in order for new hair to grow. Positive results can be seen in 4-8 months, although the maximum effects of Minoxidil are reached between 12-14 months.

2. Pyrimidine N-oxides. A generic class of hair tonics similar to Minoxidil (2.4-Diaminopyrimidine Aminexil-3-oxide). The results in more than 250 men and women include an 8% increase in hair growth after 6 weeks of treatment, compared to a decrease in the rate of hair growth with a placebo.

3. Tretinoin. Has been used for years in the treatment of acne. It is also a hair tonic in appropriate doses, particularly in combination with Minoxidil. If implemented together, first apply the Minoxidil, wait for it to dry (usually 15-30 minutes) and then apply Tretinoin. Tretinoin should be applied only at night. A slight irritation to the skin of the scalp is expected, especially at the beginning of the treatment.

4. Topical estrogen. Solutions of dienestrol or progesterone may be applied daily for 6-12 months.

5. Natural treatments. There are many treatments with vitamins, sulfur amino acids (cysteine, methionine, tiazolidín carboxylic acid), minerals (zinc) and plant extracts (Indian horse chestnut, calendula) that are useful as dietary supplements and promote healthier hair. Sulfur favours the formation of keratin, the protein that gives structure to the hair. The plant extracts act to stimulate the circulation and revitalize the hair follicle. Zinc gluconate is an astringent and reduces sebaceous secretion by inhibiting the production of DHT when applied topically. Amniotic fluid and tricosacarides hydrate and stimulate the follicle.

6. Others. Lately, lotions containing superoxide dismutase (copper peptide ligands) are being used to strengthen and activate the growth of hair. This is based on the fact that there are chemical messengers in the body that send signals to hair follicles to start the Anagen and telogen phases. In this sense, focused more towards the telogen phase (resting phase), while nitric oxide causes the hair to enter the anagen (growth) phase. Obviously, the treatments should stimulate the levels of nitric oxide and reduce the levels of superoxide radicals used in superoxide dismutase and antioxidant agents.

Oral treatments

” Dietary supplements (vitamins, sulfur amino aids). Although androgenetic alopecia is not due to lack of vitamins, it is suggested that certain sulfur amino acid supplements (arginine, cysteine), vitamins and minerals (biotin, iron, folic acid) favor capillary nutrition, reduce fat, and promote the synthesis of the protein that gives structure to the hair (keratin). Many of these compounds have an antioxidant action.

” Antiandrogens. Reduce the male hormone (DHT) that causes baldness. DHT is an androgen (male hormone) competing for a place in the hair follicle receptors. If follicle receptors are occupied by other agents, DHT cannot enter the hair follicle and therefore does not induce its aggressive action. The problem is that by blocking DHT in other parts of the body signs of feminization may show in men. In contrast, for women this block is less problematic.

” Zinc. Affects hormone levels when taken orally and inhibits the production of DHT when applied topically.

” Espirolactona. Habitually used as a diuretic. It is one of the most powerful antiandrogens. Reduces DHT, the hormone that causes hair loss. Can also be applied topically, which is not absorbed and does not produce internal effects. It is used in doses of 50 to 100 mg per day. It can alter the menstrual cycle and increase bleeding in some patients, but is generally well tolerated.

” CPA (cyproterone acetate). Is a derivative of an anti-progesterone with antiandrogenic effects. It is used for the control of androgenetic alopecia in women only. It can not be used in men. Used in combination with ethinylestradiol. The treatment must be at least 12 months and often requires 2 years for improvement. The result is more favourable if treatment is started within the first two years of the onset of alopecia. The treatment stops hair loss and improves hair quality. Treatment lasts 1-2 years.

” flutamide. Another antiandrogic indicated for women. The treatment lasts 1-2 years.

” Other antiandrogens. Ketoconazole is an antifungal agent that has antiandrogenic properties. In men the treatment can be very effective with Finasteride, a drug normally used to treat hypertrophy of the prostate.

Cosmetic treatments

Cosmetic treatments include creative hairstyles, wigs, and hair transplants. To reduce the visual effect of the thinning hair, camouflage methods can be used.

Keeping the hair short, will make it appear less patched. This will also make it easier to maintain. Longer hair produces bunches and locks of hair that are separated, showing large areas of the scalp.

A skilled hairdresser can disguise thin hair in certain areas. If the hair is thin at the hair line, the hair line and extends to the temples, ask your hairdresser to cut your hair short in front, and leave it longer at the temples.

If your hair is thinner on the crown of your head, keep hair short, about neck length. Long hair is heavier, and this pulls hair, separating it at the crown and showing more of the bald area. If you still have a reasonably thick hair on the roof of the head, leave it long and cover the bald patches.

If the hair is very thin is more difficult to cover up alopecia areas. You can try a gentile perm to increase the hairs volume.

If you have dark hair, you can try to lighten it a bit to reduce the contrast between the remaining hair and scalp, thus making the skin less noticeable.

A cosmetic trick that may work in women is to apply a bit of hair coloured eye shadow, on the scalp over the areas of thin hair. This is harmless and can make fine hair less noticeable.

Finally, do not use products that make tuffs or locks of hair stick together. This allows empty spaces on the scalp to be more easily seen.

Appropriate Shampoos

Maintaining clean hair helps preserve the health and beauty of hair. The frequency of washing and shampooing for each individual are important factors and should be recommended by a dermatologist. In the case of oily hair accompanied by thinning hair, frequent washing is advised because this reduces the fat on the surface of the scalp. It is important to have hair that is clean and non oily, as sebum contains elevated levels of dihydrotestosterone and testosterone (male hormones) that can be absorbed into the skin and affect hair follicles. In cases of dandruff and greasy hair that is washed frequently if it is best to switch to a treatment shampoo for frequent use. With these shampoos, you should wash your hair twice, and the second time leave it in for 2 -3 minutes without rubbing. The comb teeth should be wide and separated. Avoid metal brushes. If the hair has split ends (tricoptilosis) these can be repaired with a silicone polymer based repair serums, which acts as a patch on the split ends.

Conclusions

Hereditary hair loss is not curable, but it is controllable, and the sooner be treated the better. Currently there is not a perfect treatment for androgenetic alopecia, but there are drugs that stop hair loss and prolong the life of hair follicles.

We must consider the present and future hair treatments because hair needs living hair follicles. With baldness follicles are miniaturized and die after 5-10 years. With any treatment you will get better results with more follicles that remain alive. Many other hair problems are temporary and can be treated by dietary measures and other measures. In these cases, good dietary habits as well as eating supplements of vitamins, minerals and antioxidants help to stop hair loss and regain normal growth after a few months. For more information about hair loss, consult your dermatologist, because skin diseases include diseases of the hair and nails. Do not be influenced by advertisements for “hair tonic” or by hairdressing specialists.


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