ANDROGENETIC ALOPECIA - MALE/FEMALE BALDNESS

(Greek: Andro = male, Genetica = genetically determined, Alopecia = loss of hair)

Male pattern baldness or Androgenetic alopecia is the most frequently occurring form of permanent loss of hair. For men, this form of baldness is largely determined genetically. Around one third of all men between the ages of 25 and 40 years have to deal with hair loss.
Male hair loss is categorized by the degree of baldness according to the index of Norwood Hamilton. Through this classification it is possible to decide in which stage the baldness is. Male baldness usually starts at the hairline at the height of the temples and at the crown. Often, it progresses so much that eventually, only a small "crown" is left.
Partially responsible for male baldness is the so-called Dihydrotestosterone, in short DHT. This is formed with the help of an enzyme (the 5-alpha-reductase) from the male hormone testosterone. Especially the hair on the crown of males appears to be extra sensitive for this hormone. The anagen growth phase is influenced and shortened by the oversensitivity to Dihydrotestosterone of the hair sacs. Moreover, the afflicted hair roots will mortify during the balding process and slowly, the healthy hairs will be replaced with the so-called fuzz.


Example of androgenetic alopecia or male baldness

Although the term Androgenetic alopecia usually denotes male pattern baldness, women can also be afflicted with this kind of baldness. Female baldness is classified according to the index of Ludwig. Female pattern Androgenetic alopecia is characterized by the thinning of the head of hair, often exclusively concentrated on the top side of the head. Only in very few cases is female baldness an indication of an underlying disease process, and it usually only occurs during menopause. If female pattern Androgenetic alopecia occurs before menopause, it could be a matter of hormonal deregulation. In this situation -especially in the case of exaggerated body hair or acne - it is wise to have an endocrinological examination in order to discover the reason for the hair loss.
Other than is the case with different forms of female baldness, Androgenetic alopecia is an irreversible process. Once a hair has fallen out, it will never grow back again.

Usually, when people are afflicted by Alopecia Areata, their hair falls out place by place, and it grows back on its own within 1 to 2 years. This concerns an irregular pattern of hair loss, which leads to bald round spots with a diameter of between 2.5cm to 5cm, spread around the whole surface of the skull. At times, hairs grow back in one spot, but fall out in another. In the case of Alopecia Areata Totalis - and this only occurs in a minor percentage of the afflicted patients - all hairs on the head are lost. In most cases, the hair loss is limited to the hairs on the head, but in some cases there is a matter of Alopecia Areata Universalis. In this form, even all body hairs are lost (such as eyebrows, beard and pubic hair). Presumably, Alopecia Areata is a condition of the autoimmune system, in which the body affects the hairs in a destructive and sometimes even definitive manner. The body considers the hairs as not belonging to the body and rejects them. In many cases, Alopecia Areata is an irreversible process, of which no cure is possible. This is especially the case when Alopecia Areata occurs in childhood years or when the patient has also been afflicted with other diseases of the defense system (afflictions of the thyroid, vitiligo, and allergies).

Alopecia cicatricialis is a form of baldness caused by scar tissue on the scalp or skin. These scars can be caused by a variety of reasons, for example an accident, radiotherapy, burning, various infections (among which fungal infection) or a congenital abnormality. Alopecia cicatricialis can be recognized easily because the scar tissue is smoother and often has a different color than the non-affected skin.

Brocq's Pseudopélade is a special form of alopecia cicatricialis and it is possibly the result of an inflammation process of the scalp, often with an unknown cause. It is suspected that a disorder of the autoimmune system. Brocq's Pseudolépade can be recognized by the scalp, which is usually whiter and smoother than normally, and by the follicle openings which are no longer present and the scars which can be found by spots. In order to minimalize damage, it is vital to consult a dermatologist when the disease is in an early, active stage.

Most people experience a period of time of unexpected excessive hair loss. In such case it is a matter of alopecia diffusa or effluvium. The hair loss takes place over the entire scalp and not, as is the case with alopecia areata, in spots.
The number of hairs that are in the resting phase is larger than usually. The scalp usually does not show any signs of redness, flaking or reactions to inflammation.
The cause of alopecia diffusa is not necessarily in the skin, but it can also be a matter of a metabolism disorder. Alopecia diffusa can be caused by a disorder of the thyroid, the use of high doses of sources such as Vitamin A and retinoids (a medication derived from Vitamin A which is used for the treatment of leukemia), iron deprivation (strict weight loss program), stress, a large vitamin deprivation, the use of certain medication and even a pregnancy. The hair loss can last for up to three or four months after the disease or other condition. Alopecia diffusa needs to be treated by dealing with the cause, for instance by adjusting the medication, improving nutrition or by avoiding contact with certain substances.
The growth of hair will convalesce after curing the cause. It is possible, however, - especially in the case of extreme hair loss - that the growth of hair never fully recovers.

Traumatic alopecia is often the result of external factors, such as hair straightening, perms, dying, tying up the hair too tightly or pull back the hairs too tightly.
When perming the hairs, the elastics of the roller may be placed too close to the skin. When the chemicals settle, the hair will swell and it can break off, after which the hair will continue to grow normally. This happens sooner with thin hair. If the fluid is used inadeptly, the hair and/or skin may damage.
Wrongful use of these fairly strong chemical substances can break off hairs.
Dryness, especially in thin hair, can lead to breakage when dying the hairs.
Hair becomes more vulnerable as you age, and because of that, one should anticipate a possible traumatic alopecia when treating the hair.
Hairs that have broken off can also fall out, which leads to an imbalance in which more hairs are lost than grow back. The effect is that the hair will be even thinner.
Everyone has a different type of hair, and depending on the type, it is more or less susceptible to external factors. Traumatic Alopecia is easy to recognize, because many broken hairs will be visible. The scalp looks normal, but there is a distortion in the number of hairs on the scalp and the way they are attached to the scalp.
As a matter of principle, there is no treatment for traumatic alopecia. However, it can be attempted to stabilize the situation by no longer tying up the hairs to tightly or by not perming or dying the hair anymore.

Trichotillomania (Greek; thrix: hair, tillein: pulling and mania: disturbed) is in fact no hair disease. It is caused by an impuls control disorder, a kind of compulsion that expresses itself by pulling out ones own hair compulsively. Eventually, this can lead to bald spots. Usually, this is rooted in a psychiatric condition. Trichotillomania occurs both in adults and children and is not bound to age. Seventy to ninety percent of the patients are female. The age at which Trichotillomania manifests itself varies: there are cases of children of two years old or even younger, but there are also cases of 60-year-olds or older. The pattern of hair loss of trichotillomania can closely resemble the pattern of alopecia areata. In the case of Trichotillomania, however, many broken hairs can be seen. Alopecia areata does not show this. This condition cannot be cured with medication; the patient is often directed to a psychologist or a psychiatrist. Ceasing to pull one's own hair is the only solution to this problem. It is possible, however, that by then the hair follicles have been permanently damaged, in which case the hair growth may never fully recover again.