Hair loss & Scalp Illnesses

Male Hair loss
The hair loss has always bothered men, especially those with familiar antecedent. Men vanity is nothing new, It was just something disguised. Today there’s no problem assuming that feature, and among the main concerns is the hair aspect. One of the reasons that contribute for this is the joviality: as it relation between age and degree of baldness exists, a bald person ends up seeming older than one that still has plenty of hair. Therefore, after the hair restoration a bald person will look much younger than before.

Another reason that makes the hair to be aesthetically important is its hole in the face harmony. The face of the man is divided in thirds: from the chin to the nasal base; from the nasal base to the eye-brow and from there to the heir line. Hair loss interfere on these proportions, messing up with the symmetry and therefore, with the facial beauty.

The hair still offers a series of possibilities: to customize it, following the fashion trends, to represent a lifestyle and a standard behavior. Therefore, it is so important in the composition of the person’s image and personality. When we think about life styles, from different ages we think about the clothes and the hair that were worn and used. It is important for artists, rebel demonstrations or to stand as a neat person, or simply to assume a relaxed "off work" aspect.

Clinical Case
The hair fall can start right after the puberty, but it uses to be more evident after 25 to 30 years of age, stimulated by hormone or genetic factors you’re your father is bald, you should watch out for the amount hair in the bathroom drain when you take a shower, hen you comb it or on the pillow. Another way to find out whether or not you are developing an initial baldness is by checking from time to time if you hair is getting thinner, clearer or taking more time to grow. The sprouting of ”hair fuzz", short and fine is another strong indication.
Differently from what occurs with women, masculine hair loss is almost always associated to hormone-genetic causes. In the case of Masculine the Androgenic Alopecia, it’s basically all about the masculine hormone acting on the genetic inheritance that conditions the baldness. That’s why the cases begin after puberty. Usually, the more severe a baldness case is, the more precociously it will begin. The classic clinical case starts with a reduction in hair growth of speed in the attack area by baldness. Hair becomes clearer, finer and even smoother. Hair fall can occur, but it is more frequent to have a gradual thinning of the hair, that finish evolving to baldness. The great villain, responsible for that is a less important masculine hormone called DHT (Di-hydro-testosterone).

Levels of baldness

Masculine androgenic alopecia, depending on the level of baldness, can demand different treatment: clinic only, sometimes surgical, or both. Generally, baldness begins in the frontal hairline in the frontal part of the head, with hair thinning to the progressive hair fall, till it gets to a very thin, soft hair (Norwood level II).
The lateral part of hair, in the frontal hairline area, is frequently affected too. Later on, the “frontal hairline” tends to fuse right behind the “forelock” leaving behind an “isle” of hair (Norwood III, IV and V). As the frontal hairline advances, a “crown” rarefaction can be seen. Finally, there’s a fusion between the frontal hairline and the crown (Norwood IV and VII).

Some patient’s baldness, though, begins in the crown (Norwood III Vertex) later on affecting the frontal hairline. Some others, instead of the classic frontal hairline, also present a total and uniform retreat of the frontline of the hair, giving the impression of a forehead progressive augmentation (Norwood IIa, IIIa, IVa and Va). Is just further on that the crown is affected. There are many types and degrees of baldness. Another one is a more diffuse start, affecting first the top of the head, saving the frontline as seen frequently in female baldness (Ludwig, I to III).

Hair Treatment
The current handling consists exactly on blocking the production of this hormone, using the medicine, finasteride. This blocking is partial (70%). The DHT hormone, the main responsible for male baldness is a less important hormone for the masculine sexual features. The main masculine hormone, responsible for the sexual features, as well as for the production of sperm and the libido, is testosterone, which is not affected with the use of this drug. The finasteride (principle active of this drug) acts by blocking the enzyme responsible for the conversion of testosterone in DHT, which is the 5-alpha-reductase. There are some drugs as the Dutasteride that are capable of blocking 99%, what would make it more effective than finasteride. However was developed for handling prostate cancer. The use of it to combat baldness would be what we call "off label", which means that we would use a medication developed for a particular illness, to treat another one, even though it’s not been approved to be used in this purpose, nor proven and even, not officially indicated, even so it’s effective. What we do not know is the possible collateral effects. We still do not prescribe it, waiting the studies that have being carried through lately. There is still, the 17-alpha-estradiol, a topical use alternative that, theoretically, would have an action similar to the previous ones, (blocking the conversion of testosterone to DHT). However, only a few serious studies support this thesis and our clinical experience has shown the same. Along with the "anti-hormonal” medications there are some others of local action still not fully understood, as the famous, Minoxidil. Medications of topical use are always more laborious and present a greater possibility of provoking skin irritation. But the advantage is that it doesn’t have systemic collateral effects, besides it. There are a few other medicine, phytotherapies medicines, lotions and shampoos of action not well established yet.

What can I do to keep the hair indefinitely?
Most important thing is to start the treatment as soon as possible! Preferably, you should search for help as soon as you notice any hair fall or a reduction in hair volume. On the other hand it is an illusion to think that clinical handling only will be able to reverse an advanced baldness. The medicine treatment is going to stabilize the fall and even reverse part of the loss, improving up to 20-30%. Even the more effective medication, Finasteride, presents better resulted preventing the hair loss than overturning baldness. Although it is possible to get an improvement in diminishing the baldness, with the continuous handling, it is, generally, discrete and unsteady. The patient will notice an improvement from six months and up to two years. After that period, the effect diminishes and occurs a slow decline, with gradual hair loss. More than the fall itself, what we verify is a hair thinning in the bald areas, what is called "miniaturization". In consequence, the realistic objective of the handling it is to try to stabilize the fall and to perhaps improve a little the baldness, knowing that this effect will be temporary. Even so, it’s worth keeping the clinical handling to delay the fall, once the alternative would be to leave it to follow the natural evolution. To believe that the hair restoration separately, will solve it all can be far from reality, unless your baldness is totally stabilized, once the transplanted hair is sufficiently steady, not needing handling whatsoever. If the baldness is still acting gradually, though the problem will be of short-term, but later, with the progressions, new bald areas will appear, demanding a new surgery. Thus, the ideal would be to associate the Hair Restoration (hair transplant) to the clinical handling.

Scalp Illnesses Know the major diseases of the scalp:

Seborrheic dermatitis

The seborrhea dermatitis, popularly known as dandruff, is characterized for an extreme oiliness (seborrhea) in the scalp, followed by inflammation and scaling off. The inflammation (irritation) produces a redness and sensitivity in the scalp, while the scaling off can vary from fine scales, to the intense one, forming crusts, that many times adhered to the scalp leaving it wounded when it’s removed. The dandruff can be associated to androgenic alopecia, speeding up the hair loss. When rinsing the hair, the ideal is to remove the conditioners completely, giving special attention to the scalp (residues can cause dandruff). Except this, stress is one of the most important unchaining factors of this case. Another factor is the increase of the number of usual scalp fungus (p. Ovale). For the handling, it’s used anti-inflammatory shampoos, anti-fungicides, scaling equalizers or all of these associated.
seborrhea dermatitis
seborrhea dermatitis

A shampoo must be used daily for an efficient removal of the oiliness and impurities of the scalp. Wash the scalp twice using the pulp of the fingers (avoid using the nails), leave it there for 2 minutes in the second time. Use cold / warm water. Water it well and after drying the hair with a towel, use the hair dryer (warm) to remove the excess of humidity. Choose the professional dryers because they produce more wind than heat. Never sleep with a wet hair or use headdress, cap or helmet with humid hair because it a hot and humid environment is up to develop funguses, which unchain the seborrheic dermatitis. You can still get LED applications (light emitted for diode), which has anti-inflammatory action, gommage (a kind of hair peeling) and application of UVA light.
Psoriases - This skin illness associated with genetic inheritance, with more frequent location in the knees and elbows, also can affect the scalp, where many times can be mistaken as seborrheic dermatitis. It takes to an intense and white scaling off which is dry and adherent exceeding the scalp limits, differently of the seborrheic dermatitis. It gets better with solar exposure and adequate handling. The armory includes shampoos with tar base and salicylic acid, that has queratolitic action (or either, they sharpen the skin), lotions of corticosteroids (anti-inflammatory) of topical application and infiltrations in the most persistent places. Other therapeutical options for the intense cases include taking compressed acitretine pills, derivative of the vitamin and the PUVA.
Areata alopecia - an auto-immune illness, which the body recognizes the proper cells as enemy, destroying them. It may provoke hair loss in bare place, loss of the hair from the beard, legs and even eyebrows and eyelashes, everything in a circle form. It can be associated to other problems of the skin, as vitiligous, or to other organic problems, as thyroid gland alterations.

Ringworm of the Scalp
Caused by different fungus that provokes located hair loss. It has the sprouting of boards that can be swollen and even infecting. The handling is simple – taking verbal antibiotic should be enough - if the problem is discovered soon. In case it’s not, it can have permanent losses of hair, mainly when the soreness is exaggerated.

Ringworm of the Scalp
Ringworm of the Scalp

Flat lichen hair
Flat lichen hair
Flat lichen hair.

manifest an illness that presents redness and scalp scaling off, followed by little purple marks. If it is not treated fast, it leads to a permanent loss of hair in the place, called cicatricial alopecia. It is more frequently seen in middle-age women.
Colloidal Folliculate of the nape – It’s a chronic infection of the pilose follicles. The most serious cases can leave fibroses or scars of the colloidal type. The acne is more frequently in men with tendency to this disturb.
Pseudopelade Brocq - It is the common final process to some types of
Alopecia: without treatment, it can cause a thinning of the scalp’s skin (atrophy), which disables any type of Hair restoration.
heck some examples of Genetic Clutters that attacks mainly the children, sometimes since the birth but it is rare, fortunately.

Trichorrhexis nodosa:

it‘s a structural hair defect that makes the hair to break easily.
Trichodystrophies: [the hair from eyelashes, eyebrows and from the head is short and easily broken. For the diagnosis, the amino acid and sulphur presence they must be analyzed].
Pili torti (trichokinesis): [structural Alteration of the hair, in which the hair is fragile and twisted.] It is symptom of some syndromes.
Trichorrhexis invaginata: [the hair has a bamboo aspect. It can be associated to genetic illnesses in which, concomitantly, problems as the extreme drying of the skin, are found. ]
Moniletrix: [the hair becomes fragile and fine and is originated from small balls with rinds in the scalp].
Uncombable hair Syndrome: [Usually seen between the infancy and the adolescence. The hair have slow growth, silver-plated coloration and
is fragile, what practically becomes impossible to get a combed aspect].

Uncombable hair Syndrome.
Uncombable hair Syndrome.
Uncombable hair Syndrome.