Diffuse hair thinning in women: causes and therapeutic approach

Diffuse hair loss: causes and treatment

Diffuse hair loss is often called symptomatic alopecia. Daily diffuse hair loss occurs evenly in the frontoparietal, occipital, and temporal areas of the head and is normal hair loss. Normally, a follicle that has lost hair begins the hair growth stage again - anagen. The trichogram does not change, and thinning does not form. But if a significant number of hair follicles enter the resting phase ahead of time, then the anagen stage is shortened, and the percentage of telogen hair (loss) exceeds the physiological norm.

Low Level Laser Therapy (LLLT)

Low level laser therapy has the following effects:

• Anti-inflammatory: increased microcirculation, changes in prostaglandin levels, equalization of osmotic pressure, decreased swelling, activation of superoxide dismutase and catalase, decreased lipid peroxidation.
• Painkiller: activation of neuronal metabolism, increased levels of porphyrins, increased pain threshold.
• Reparative: accumulation of ATP, activation of cell metabolism, increased proliferation of fibroblasts and other cells, protein and collagen synthesis, neoangionenesis.
• Immunomodulatory: increased proliferation of immune cells, increased production of immunoglobulins.

The infrared radiation spectrum is more often used, 10-40 mW/cm2.

When does diffuse hair loss develop and how long does it last?

Severe hair loss usually develops on average after 3 months from exposure to the causative factor and can last up to 3-4 months, despite concomitant treatment. Proper hair growth begins after eliminating the trigger factor, and volume restoration occurs according to growth standards, which is about 1-1.5 cm per month. Diagnosis of hair loss is relatively complex: it is necessary to collect a detailed history, exclude possible deficient conditions, conduct a phototrichogram, and, based on the totality of the examination results, prescribe effective treatment.

Dermatological peelings

Dermatological peelings. Improved skin quality

Dermatological peelings provide a decrease in the cohesion of corneocytes in the stratum corneum, but with a further increase in concentration and inclusion of the medium, they will begin to cause a weakening of the connection of desmosomes, at very high concentrations - epidermolysis (destruction of desmosomes in the banal layer of the epidermis). The external manifestation is peeling of the skin.

In addition, peels are responsible for modulating the accelerated turnover of cellular matrix and collagen structure (via anti-inflammatory stimulation mediated by IL-1 alpha). Helps increase the content of hyalic acid in the epidermis and dermis, as well as enhance the synthesis of ceramides in keratinocytes.

Dermatological peelings. Protection and treatment

Dermatological peels improve the reactivity of the skin barrier and increase the skin's resistance to irritation caused by sulfactants.

They also inhibit the development of UVR-induced damage, including tumors (blocking the UVR-induced apostle, inhibition of the p52-p21 pathways, reducing the expression of UVR-induced regular cell cycle proteins, signaling mediators p38 kinase, mitogen-activated protein kinase.

Promotes increased penetration of related substances and also has an irritating effect, which is useful for alopecia.

Diffuse loss of cause

• One of the most common factors that cause hair loss is chronic stress, depression, and neurotic conditions. Hair has a rich nervous innervation, thus there is a direct relationship between the nervous system and the hair follicle. Therefore, the effectiveness of hair loss treatment in this case will depend on the successful correction of the patient’s psycho-emotional status.

Also, excessive diffuse alopecia is provoked by the following reasons:

• previous intoxication with fever (38 degrees or more), general anesthesia, taking certain medications (antibiotics, immunostimulants, oral contraceptives, etc.), sudden fasting or sudden loss of body weight, endocrine diseases not associated with hyperandrogenism, etc. Today More than 200 reasons for the development of diffuse alopecia are described today.
• Deficiency conditions: deficiency of proteins, essential microelements, vitamins, amino acids can lead to deterioration in the structure and quality of hair and aggravate hair loss.
• The seasonality factor is also a common cause of hair loss; the peaks of increased shedding occur in spring and, most importantly, in autumn.

The key to successful treatment of diffuse hair loss is

1. identification of the causative factor and its elimination, so-called specific etiotropic therapy. This is taking medications that compensate for identified deficiencies, such as iron supplements for anemia, amino acids for protein-calorie deficiency, etc.

2. active use of nonspecific treatment methods: external cosmetics and physiotherapeutic measures that have an effect regardless of the existing problem. These manipulations act as a kind of hair growth activators. By improving microcirculation, activating metabolism in the hair follicle, providing an anti-inflammatory, antiseborrheic effect, they contribute to faster and better restoration of hair damaged by diffuse hair loss. Among the physiotherapy procedures, the most popular are microcurrent therapy, laser therapy (low-intensity lasers), ultraphonophoresis and ultrasonic peeling, and ozone therapy. The absolute favorite is head mesotherapy with the introduction of individually selected drugs. The hair follicle is an intensively dividing mini-organ, characterized by a high speed of processes, hence it needs an uninterrupted supply of amino acids, vitamins, microelements and other components for adequate production of healthy hair. With the help of mesotherapy, the possibility of rapid targeted delivery of the substrate for high-quality hair follicle growth is realized. It should be remembered: during a trichological appointment, diffuse hair loss is one of the most common causes of complaints in women. An integrated, systematic approach to the diagnosis and treatment of symptoms is paramount, allowing for control of the disease, ensuring the most favorable prognosis.

Therapeutic methods

Therapeutic methods should be:

• pathogenetically substantiated (anti-inflammatory, trophic, defibrosing effect);
• with known effectiveness (combined high-evidence and low-evidence);
• well tolerated;
• compatible with each other;
• the therapeutic course must be of sufficient duration.

Androgenetic alopecia (stage 3 according to Ludwig or stage 4 or more according to Norwood)

sample course for 1 year

• Dermatological trichological peelings Course 5-10 times, 1 time per week (depending on scalp type) + home care
• Electropulse therapy with a professional trichological agent (mens therapy, fluctuarization) Course of 20 procedures, 2 times a week + home care
• Low-intensity laser therapy (NLT) + magnetic therapy: Local technique (scalp) or local + general technique Course of 20 procedures. 2 times a week + home care.

Then take a 1 month break and repeat the course.

Additionally:

• Dietary supplements with “plant estrogen precursors” for women (wild yam, red clover, etc.);
• Hormone replacement therapy for men and women;
• Adaptogens, metabolics, nootropic drugs, angioprotectors, antioxidants;
• Correction of metabolic syndrome;
• Avoidance of polypromasia, preference for a healthy lifestyle.
  Systemic treatment is often prescribed by an endocrinologist or therapist. Local treatment is regular, in fact, permanent.

The original article was published in the journal Vestnik Trichology

Diagnostics

Diagnosis and assessment of the severity of the disease is performed using a trichoscope. The device is a digital video camera equipped with a pair of lenses of different “calibers” (x60 and x200). The camera is connected to a PC, and the resulting materials are analyzed using special software.

Two main studies are carried out using this apparatus.

1. Trichoscopy. It allows:

• assess the condition of the scalp and hair itself;
• find out the morphometric characteristics of hair (diameter and density in different areas of the scalp);
• determine the amount of vellus (abnormally thin) hair;
• identify anisotrichosis (polymorphism) - the presence of a large number of hairs of heterogeneous diameters.

1. Phototrichogram. Allows you to conduct the same studies as trichoscopy (by clarifying and confirming the data), as well as determine the amount of hair at the stages of growth and loss.

Additionally, the quality of the mouths of the follicles, the general condition of the skin, and the activity of the sebaceous glands are assessed.

All this data is needed to make an accurate diagnosis and formulate an effective treatment plan, as well as timely course adjustments if necessary.

Trichotylomania

Trichotylomania is the most common cause of alopecia in children - and psychiatric illnesses, which occur in boys in the middle of 8 years, and in girls - in 12 years and manifests itself as hair loss. The scalp is most often affected, although any part of the body can be affected. Patients may have hair loss (trichophagia) and complications such as intestinal obstruction. Loss of hair often causes the wondrous appearance of healthy plots with excessive loss of hair (Fig. 9). The scalp may appear normal or there may be erythema or pustules. Some patients will experience a disease and a scalp biopsy may be necessary to exclude other illnesses.

Rice. 9.

Trichotylomania.

In cases of psychiatric illness, treatment is provided by verbal therapy, behavior modification and hypnosis. In some cases, selective serotonin secretion inhibitors and other drugs can be used to treat depression or obsessive-compulsive disorders. As the lesions appear to have a “eating milli” appearance, there is no sign that the patient himself is plucking the hair, after turning off syphilis.

The essence of pathology

A feature of the telogen effluvium is the biological mechanism of baldness associated with a disruption in the life cycles of hair.

The main phases of hair development look like this:

• Anagen. The stage of active growth, accompanied by the division of follicle cells, as well as the production of melanin (the pigment on which hair color depends). The duration of the stage varies from 2 to 7 years.
• Catagen. A short transitional stage, lasting only a few weeks. Melanin production stops, cells stop dividing, and follicles become smaller. The hair shaft begins to move towards the epidermis.
• Telogen. The final stage lasts about three months, ending with hair loss. They are easily removed by combing, since they are already weakly held in the skin. Subsequently, new hairs are formed, which eventually replace the lost ones.

In normal condition, about 10% of the scalp is in the last phase - approximately 10,000 hairs (with an average rate of 100,000 for the entire scalp). With a 3-month duration, the process produces about 100 lost hairs per day.

Telogen effluvium is associated with disorders of the last phase. This pathology means that the overwhelming number of follicles - up to 80% - go into the telogen state, with a serious disruption of normal cycles. At the same time, hair that has not yet fallen out suffers - due to structural disorders, it becomes more brittle.

There are several stages of development for this pathology:

• acute - extremely high activity of hair loss, a significant effect appears within several weeks;
• subacute - the active process of loss takes several months;
• chronic - loss lasts for more than six months.