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Types of Hair Loss


There are more than 40 different types of hair loss known till date – some of them very common, others quite rare. It is not at all mandatory to know about each of these; however, knowing your type can help you to understand how well your hair loss can respond to treatment. Few of the common varieties of hair loss are discussed here:


Androgenetic alopecia (AGA) – This type of hair loss can affect both men and women and is caused by the hormone DHT (Dihydrotestosterone) which is a male hormone. It accounts for almost 95% of the cases of hair loss. Androgenetic alopecia             is genetically determined and can be classified as:

            • Male Pattern Baldness (MPB) - This is typically characterized by a receding hairline at the temples and balding at the top             of the head.

          • Female Pattern Baldness (FPB) - Also known as Alopecia Diffusa, this is characterized by thinning of hair at the front,             sides and crown of the scalp


Involution alopecia – With advancing age, more and more hair follicles go into the resting phase. This leads to gradual thinning of hair and is called involution alopecia.


Telogen effluvium - Severe stress may lead to noticeable shedding of hair – a large number of hair strands prematurely enter into the resting (telogen) phase and are thereafter shed. This may sometimes occur even 3 to 6 months after the initial           stressor. The stressor could be anything like a heart attack, severe illness, high fever, sudden weight change, major surgical           procedure, childbirth, termination of pregnancy, etc.


Anagen effluvium – This is the pathologic loss of hair in the anagen (growth) phase, classically caused by radiation therapy to the head and systemic chemotherapy. It tends to be sudden in nature.


Drug induced – Some of the drugs that can lead to loss of hair are Allopurinol (used for the treatment of Gout); Heparin, Coumarin (blood thinners); Clofibrate, Gemfibrozil (Cholesterol lowering drugs) and most of the chemotherapy medications


Alopecia Areata – Patchy loss of hair, especially from the scalp


Traumatic :

 •Traction alopecia - Regularly wear pigtails, braids or tight hairstyles causes loss of hair from the part where hair is            pulled tightly leading to traction alopecia.

          •Trichotillomania - This is a psychological disorder seen more frequently in children where they tend to pull out one's own           hair leading to hair loss.


Other types of Hair loss

Due to presence of Infections: Syphilitic Alopecia (caused by systemic syphilis), Tinea Capitis (a localized fungal infection           of the scalp)

          • Generalised atrichia – Caused by the presence of a recessive hairless gene, this is an extremely rare form of hair loss.


Male Pattern Baldness


Male pattern baldness is the most common cause of baldness seen in men. Triggered primarily due to the male hormone DHT (dihydrotestosterone), this can begin in some males as early as in their teens or twenties.


The condition is characterized by a typical pattern of receding hairline at the temples and hair thinning on the crown. It can progress to partial or complete baldness in some cases. This is the cause of hair loss in about 90% of men and more than one third of men are in their thirties. The percentage of men affected by MPB increases with advancing age.


How to identify MPB?


Excessive loss of hair


Hairline recedes from the front, temples


Thinning of hair on the crown


Bald patch on the top of the scalp


Partial baldness


Complete baldness at a later stage



How does it happen?


The male hormone DHT (dihydrotestosterone) is important for the normal male sexual development. However, in some cases, the hair follicles are genetically sensitive to this hormone and exposure to it results in shrinkage of the follicles. This shortens the lifespan of the follicles and prevents them from producing hair normally. Hair follicles in the temples and crown of the scalp are more sensitive to this hormone and hence hair loss affects these areas more prominently.


Genetic cause is a strong factor for developing male pattern baldness and almost 80% of balding men have a history of baldness in their father or grandfathers.


This image shows the Hamilton-Norwood scale which grades Male pattern baldness from stages 1 to 7:



Stages of male pattern baldness according to the Norwood Hamilton Scale:


Stage 1:

No hair loss. The head is full of hair.


Stage 2:

Minor recession at the front of hairline and some temporal recession. This stage may not even be called as balding.


Stage 2A:

Recession progresses across the entire frontal hairline.


Stage 3:

Temporal recession deepens.


Stage 3A:

Frontal recession keeps progressing backwards.


Stage 3V:

Besides the loss of hair in the frontal and temporal regions, there is early hair loss from the crown (vertex).


Stage 4:

Frontal and temporal hair loss progresses and there is enlargement of the bald patch at the crown.


Stage 4A:

Hair loss progresses past the mid-crown.


Stage 5:

Bald area in the front enlarges and starts joining the bald area at the crown.


Stage 5A:

Bald patches in the front and at the crown fuse and keep enlarging. The back part of the bald area is narrower are compared to stage 6.


Stage 5V:

The bald patch at the crown enlarges although it has still not fused with the bald area at the front.


Stage 6:

Frontal bald area and the one at the crown are fused and continue to enlarge. The back part of the bald area is wider than in stage 5.


Stage 7:

Extensive baldness where only a strip of hair remains at the back and sides of the head.


Female Pattern Baldness


Female pattern baldness, also known as alopecia diffusa, is a common cause of hair loss in women. It is characterized by diffuse loss of hair from the scalp.



The mechanism of female pattern baldness is believed to be very similar to that of male pattern baldness, with the bulk of the damage being done due to hormonal changes in the body. Genetic disposition combined with sensitivity to the male sex hormone DHT (dihydrotestosterone) are the primary triggers for this condition.


Besides the aforementioned, following can also lead to hair loss in the characteristic FPB pattern:


Hormonal changes


Menarche


Delivery (Child birth)


Menopause


Nutritional deficiency


Oral contraceptive pills


Crash dieting



How to identify Female Pattern Baldness?


Hair thinning all over the head - even if there is no visible loss of hair while washing or combing hair


The frontal hairline is generally maintained


Moderate loss of hair from the crown


In rare cases this may progress to total or near baldness


Facial hair may get coarse in some women (due to the effects of the male hormone)

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