Recent events in Hollywood have sparked many conversations about alopecia. The name alopecia may not be familiar to everyone at first, but you have certainly met people who suffer from hair loss, i.e. alopecia. Although the event that sparked the sudden interest in alopecia does not have the best reputation, it certainly had a positive outcome, and that is raising awareness about this condition.
What is alopecia?
In the most simple possible sense, alopecia is hair loss. To understand the disease, it is important to know what hair or pilosebaceal unit is. These are small anatomical bag-shaped formations. The pilosebaceous unit consists of the hair with its sheaths, the hair-lifting muscle, and the sebaceous gland. In addition, we have a hair follicle that contains the hair root.
Alopecia can be divided into focal and diffuse, and according to the presence or absence of scarring. Common forms of “scarring” alopecia are lymphocytic (such as discoid lupus erythematosus), neutrophilic and mixed folliculitis. On the other hand, non-scarring alopecia are androgenic alopecia, telogen effluvium, alopecia areata, trichotillomania and traction alopecia. The key difference between these two forms is that in “scarring” alopecia there is active destruction of the hair follicle, while in non-scarring alopecia there is a reduction or slowing down of hair growth without irreparable damage to the follicles. Other common causes of hair loss can be medications (including cytostatics), infections, and certain systemic diseases (especially those that cause high fever, systemic lupus, endocrine disorders, and nutrient deficiencies due to malnutrition). Unfortunately, hair loss is usually a major concern for patients for aesthetic and psychological reasons. Some patients experience depression, anxiety, and sometimes extremely low self-esteem due to aesthetic reasons for the disease.
Androgenic alopecia, commonly known as male pattern baldness, is the most common type of progressive hair loss disorder in men. The occurrence and development of androgenic alopecia depends on the interaction of endocrine factors and genetic predisposition. It is characterized by progressive reduction of hair follicles. Androgen hormones affect several functions of human skin, including the growth and differentiation of sebaceous glands, hair growth, the epidermal barrier, and wound healing. Although human hair growth is also affected by thyroid hormones and glucocorticoids, androgenic hormones are the most important regulators. They can increase hair follicles in androgen-dependent areas (chin, armpit and pubic hair), but, paradoxically, in the scalp follicles of affected men, suppress hair growth and promote hair loss in the anagen phase (hair growth phase), leading to baldness . Although the exact pathogenesis of androgenic alopecia has yet to be explained, research has shown that it is a polygenetic condition.
However, women are no exception to this alopecia. Female androgenic alopecia (FAGA) is a common cause of scarring alopecia in women. The role of androgens is not clearly defined and only a third of women with FAGA show abnormal androgen levels. FAGA-associated endocrine diseases with hyperandrogenism include polycystic ovary syndrome (PCOS), hyperprolactinaemia, adrenal hyperplasia, and rarely ovarian and adrenal tumors. The disease manifests as diffuse thinning of the hair above the central part of the scalp, while the frontal line of the hair is usually retained.
As for the therapy itself, the first step is a lotion with minoxidil. Minoxidil was primarily developed as a drug to treat high blood pressure, however, one particular side effect was observed, and that was an increase in hair regrowth. After topical application, minoxidil is converted to minoxidil sulfate, a potassium channel opener, which relaxes vascular smooth muscle and increases blood flow. The treatment results in an increase in hair weight, but not such an increase in the number of hairs, which suggests that its therapeutic effect is primarily due to an increase in the diameter of existing hair. In addition to minoxidil topically (in a strength of 2% or 5%), it can also be used orally. Other therapies include 5a-reductase inhibitors, and cyproterone acetate and spironolactone in women.
Alopecia areata is an autoimmune disorder characterized by temporary hair loss without scarring and preservation of hair follicles. Hair loss can take many forms, from loss in well-defined spots to diffuse or complete hair loss, which can affect all places where there is hair. Biopsies of the affected skin show lymphocytic infiltration in and around the bulb or lower part of the hair follicles in the anagen phase (hair growth). Genetic studies in patients and models of mice have shown that alopecia areata is a complex, polygenic disease. It is usually diagnosed based on clinical manifestations, but dermoscopy and histopathology may be helpful. As it is an autoimmune disease, it is not surprising that the therapy consists of local corticosteroids, systemic corticosteroids, immunosuppressants and, in severe cases, biological therapy.
In the end
Although we are bombarded with thousands of information every day, both from the digital and the real world, some events infiltrate important lessons. Alopecia is a condition that causes psychological stress in affected people so it is essential to raise awareness about the disease. By better understanding the origin and course of the disease, it is easier to gain new insights and therapeutic options. Therefore, early detection of the disease and accurate therapy can greatly improve the quality of life. Anyone can contribute to the fight against alopecia, even if it is by raising awareness about alopecia.
Translated by Filip Sakoman
2. DLAKA ILI PILOSEBACEALNA JEDINICA, https://www.eau-thermale-avene.com.hr/, accessed 29.3.2022.
3. Stefanato, Catherine M. “Histopathology of alopecia: a clinicopathological approach to diagnosis.” Histopathology 56.1 (2010): 24-38.
4. Lolli, Francesca, et al. “Androgenetic alopecia: a review.” Endocrine 57.1 (2017): 9-17.
5. Starace, Michela, et al. “Female androgenetic alopecia: an update on diagnosis and management.” American journal of clinical dermatology 21.1 (2020): 69-84
6. Pratt, C. Herbert, et al. “Alopecia areata.” Nature reviews Disease primers 3.1 (2017): 1-17.