1. Introduction

The word “alopecia” derives from the greek “alópex”, fox, and indicates a patchy loss of hair. In fact foxes tend to lose their hair like that during the spring. With this term we refer to a process characterised by the decrease of the quantity and of the quality of the hair. There are different types of alopecia, different in causes, manifestation, course and cures. Alopecia can affect the whole scalp or only some areas. So, there are total, spread or confined kinds of alopecia. Depending on the kind of alopecia, also the appearance of the scalp can vary: it can be red, normal, flaked of cicatricial.

Here below we will analyse specifically the different kinds of alopecia.

  1. Androgenetic alopecia

The androgenetic alopecia (AGA), also know as common baldness, is a condition caused by a genetic predisposition that sees a regression of the hair follicles and so a reduction or interruption of the growth of the hair.

In the man, at the beginning, it shows as a retreat of the hairline and a develop of an hair thinning in the vertex. The follicolar units in the occipital area of the scalp are not involved in the fall. In the women, on the contrary, the thinning is spread, especially in the central area of the scalp.

 

The condition is caused by two main reasons:

  • The action of the androgenic hormones and their relation with the estrogens.
  • In the predisposed people, the presence of enzymes particularly able to transform the androgenic hormones into stronger hormones, which attack the hair follicles. A main role is played by an enzyme called “5-alfa-reduttasi”, able to transform the testosterone into diidrotestosterone (DHT). This hormone attacks the hair follicles causing a progressive miniaturisation and the consequent hair loss.

 

What causes common baldness?

In short, the main causes of the hair loss are:

  • Genetic causes: hair follicles undergo the action of the DHT only if there is a particular genetic predisposition. The responsable genes for this characteristic have not been detected yet.
  • Hereditary causes: there seem to be a familiarity in the showing of the illness. Scientists detected the X chromosome as the key of the transmission. That is why in many cases is enough to observe the condition of the hair of the maternal grandfather to foresee which will be the course of the baldness in the gradson.
  • Stress, often wrongly indicated as the trigger, can actually contribuite to the increase of the hair loss, but will never be the reason why the organism attack the follicles.
  • A poor and not well balanced nutrition can cause a general discomfort of the organism, however does not cause baldess. When the falling is caused by this factor, in fact, it will be enough to add the necessary nutrients to one’s diet to see the hair regain its force.

 

Do successfull pharmacological therapies aganist common baldness exist?

It is not possible to defeat genetics. However, there are some drugs that can slown down the course of the condition and, in rare cases, that can reverse it. Here are the main:

  • Finasteride: a drug able to selectively inhibit the 5-alfa-reduttasi enzyme, slowing down the transformation of the testosterone into diidrotestosterone at the level of the tissue.
  • Minoxidil: a topic drug able to boost the anagen fase of the hair, allowing it to grow.
  1. Alopecia Areata

Alopecia areata is a very common pathology of the scalp that presents an hair loss that brings to the emergence of totally bald and asymptomatic areas. Those areas usually are round or oval. Only in rare cases the skin presents rushes.

The condition can be reversable, but for around 20% of the patient affected by it the falling expands to the whole scalp (alopecia totalis) and for the 1% of them to the hair of the whole body, such as eyebrows, brows, hair of the armpits, legs, arms and pubis (alopecia universalis).

The illness can incur at any age, but most frequently it appears between man and women in the prepulbescent period or bewteen people from 20 to 40 years old.

Alopecia areata does not cause any physical damage, but has a very strong impact on the psychological aspect of the patient, usually affecting his personal life and his self-esteem.

 

What causes alopecia areata?

The causes of this pathology are not fully clear to the experts yet. Here are some of the causes that, up to now, have been detected:

  • Immunological factors: it seems that a disorder in the immune system brings the organism to attack the hair follicles causing the hair loss.
  • Chemical and pharmacological factors: some antidepressants drugs have shown to have, as a side effect, the ability to cause a sudden alopecia areata.
  • Seasonality: in the cases of recidivist alopecia, the fall usually happens in winter or autumn. Nowadays there are some studies that tries to prove this hypothesis.
  • Phycological factors: stress is always considered as a cause of this pathology. Actually, a psychological disorder can contribute to a general discomfort of the organism, but a real connection between phycological factors and alopecia areata has not been found yet.

 

Does a cure againt alopecia areata exist?

The difficulties in detecting the reasons of the illness cause the impossibility to establish an efficent thetherapeutic plan against alopecia areata. Usually, topic systemic corticosteroids are used, but the experts are trying new methods in order to indentify a better cure, suitable for every sigle patient.

  1. Front-parietal male alopecia

The front-paretial male alopecia presents a retreat of the hairline in the front-paretial line of the hair, that brings to the appaerance of a “M” shape (the so called “receding hairline”). It is a physiological phenomenon that does not get worse and does not affect the mid-scalp and the vertex.

It is very common to confuse this kind of alopecia with the androgenetic alopecia, since the firsts phases of the last one sees the retreat of the hairline. Also in this case the causes are due to the genetics, but the genes that bring to the front-parietal alopecia are different from those of the androgenetic alopecia.

  1. Traction alopecia

With this term we refer to a kind of alopecia caused by a mechanical and extended tension or by a repetitive tension on the follicles. It occurs with the appareance of areas in which the hair is broken or missing. It usually affects the front-temporal area, but may occur in any area of the scalp.

The manifestation will depend on the severity of the illness. In the first moment there is an inflammation around the hair follicle. Then, the follicle will miniaturize always more. Itching is possible too. If the mechanical action continues, a real thinning or the appaerance of alopecic patches car occur.

This condition is more frequent in women, especially those from Africa, that comb their hair in constrictive hairstyles, such as braids or extensions. Women who tie their hair in chignons or ponytales risk traction alopecia too. Other causes of this kind of alopecia can be to excessivelt brush the hair always in the same direction or to wear helmet and glasses for a long time.

 

How can the traction alopecia be treated?

In order to treat the traction alopecia, it is necessary to focus on the trigger. If the trigger is a particular hairstyle that damages the follicle, it is appropriate to stop tying the hair that way. If we take action when the illness is just at its beginning, it will be possible to reverse the miniaturization process. On the contrary, if the damage is already severe, it will not be possible to favor a new growth. Anyway, the use of drugs, like minoxidil of finasteride, can help.

  1. Tricotillomania alopecia

The tricotillomania alopecia is a kind of artifical alopecia, that occurs as an obsessive compulsive disorder, accompanied by the necessity to pull the hair until ripped. It is a very common condition that affects many people since they were children. It brings to the appaerance of one or more alopecic areas with an irregular shape, where the hair has different lenghts but is not miniaturised. If affects both man and women also at a very young age.

It has to be considered a pshycological disorder, associated with anxiety, depression, psychosis etc. Our advice, in these cases, is to contact a specialist to solve the disorder.

  1. Seborrheic alopecia

With the term seborrheic alopecia we refer to a kind of early alopecia that usually occurs in men when they are around 20 years old. It can occur in women too, but much less frequently.

The seborrheic alopecia in men mainly affects the front-temporal area and the vertex. The hair falling is caused by an excessive production of sebum. The major symptoms are: scalp pain, itching, scaling and greasy dandruff.

The too much sebum is caused by an uncontrolled activity of the sebaceous glands. The reason of this anomaly is an hormone imbalance. The diidrotestosterone hormone, derived from the transformation of testosterone carried out by the 5-alfa-reduttasi enzyme, influences the quantitly of producted sebum.

The  elements that make up the sebum, such as cholesterol, free fat acids,triglyceride etc. cause an acidification of the PH. This brings to a change in the metabolism and in the cellular turn-over of the skin. Another cause for this pathology may be the presence of the Malassezia mushrooms. It seems that in the areas affected by seborrheic alopecia there is a big quantity of this mushroom. The mushroom causes a cellular multiplication that make the sebum changes its composition, making the hair very oily. However, a strict relation between this mushroom and the condition has not been proved yet.

Which are the cures for seborrheic alopecia?

Hair therapies against seborrheic alopecia have to focus on the remouval of the exceeding sebum. Generally, the experts suggest to use finasteride.

A usefull technology, that can sanitize the skin and remove bacteria, is a low frequence laser.

  1. Pshycogenic alopecia

Stress is often recognised as a cause of the alopecia. For a long time experts have tried to understand if stress can or cannot be considered a trigger for the condition. During the 19th century, Plumbe and Duhring talked about “post-emotional alopecia”. Since then, researches have continued.

For sure, exogenous, social and phsycological stress bring some changes into the organism, that tries to adapt with some defense mechanisms. When our body respond to violent emotions or to very stressful situations, the hypothalamus-hypophisis-adrenal cortical axis activates, causing an higher hormonal release. It is hypothesized that this could be the reason for the massive hair loss. There still are no sure proofs about this mechanism.

What is sure is that the wellness of the follicles and of the hair depends on the wellness of the whole body. That is way it is important to keep a good pshyco-physical condition in order to ensure that all the mechanisms of our body work correclty.

  1. Scarring alopecia

With this term we refer to an irreversible hair fall caused by a destruction of the follicles after a damage in the stem cells of the hair follicle. So, all the types of scarring alopecia are the scars of processes that caused the total destruction of the hair follicle.

Scarring alopecia sees the appaerance of patches in which the follicle is replaced by fibrosis or by an excess of collagen. The skin seems thin and shiny. A single hair may be there, or also a single tuft, because their follicles had survived.

 

Classification of scarring alopeciae

The classification of this kind of alopecia is controversial, because often the same pathology is indicated with different names and there is a lot of confusion. This happens because there is a lack of certanties at the histopathological level and about the aetiology of the different kinds of scarring alopeciae.

Here a re the main kinds of scarring aloepeciae:

  • Lichen planus
  • Decalvans folliculitis
  • Lupus erimetatoso discoide
  • Peudopelade of Brocq.
  • Graham-Little syndrome
  • Fronal fibrotic alopecia
  • Scarring alopecia in course of androgenetic pustulas erosive dermatosis
  • Pustulas erosive dermatosis
  • Alopecia parvimaculata
  • Keloidic acne of the nape
  • Dessiccative cellulitis
  1. Pityrianic alopecia

Pityrianic alopecia is caused by the dandruff that, if not treated, can bring to a scalp thickening and to the resulting damages to the hair follicle.

The dandruff usually arises between the age of 10 and 25 and tend to get better with the years, even if, in some cases, it will last for the whole life of the person. It is caused by an excessively fast turnover of the cells of the epidermis, the most superficial layer of the skin. These cells tent to come off before being fully matured and give rise to white scales, made out of cells of the corneum layer. The phenomenon can be small or can spread all over the scalp.

The causes of this phenomenon are still unknown. It is thought that the digestive system and the liver could be involved, but also that the androgenic hormones regulate the process. The oval pityrosporum mushroom is very common to be found in the scales of the dandruff, however it is not clear wheter the dandruff is a hospitable enviroment in which the mushroom flourish or, on the contrary, is a trigger for dandruff.

 

How to cure pityrianic alopecia

The market offers lots of anti-dandruff shampoos and lotions, able to fight germs and microrganisms and to eliminate dead cells from the scalp. To use this kind of products implies accepting the risk to reduce the thickness of the corneum layer, reduction that will make  the production of sebum increase.

It is important to contact a trichologist in order to understand which therapy is the best in the single case.

  1. Actinic alopecia

It is a rare kind of alopecia that occur after a long scalp exposure to radiations (ultraviolet rays and X rays). The actinic alopecia is due to the action of the bundle of radiations on the scalp. In some cases, patches will appear and the hair will become very weack, so it will fall easly.

In almost every case, it is reversible and has the tendancy to resolve spontaneously in a few months.

  1. Senile alopecia

Our hair, just like our skin and, in general, our organism, are sujected to the ageing that provokes a progressive weakening. The senile alopecia is a clear example of this concept. When we age, we lose hair, it is a physiological and natural  phenomenon, that does not have to worry anybody.

The cycle of life of an hair follicle, and the resulting growth of the hair, change depending on the age. How it works is not very clear to the experts yet. It seems that there is an imbalance between the activation signals and the stem cell of the follicle inhibition process. This imbalance causes the slowing down of the cellular regeneration. A specific protein, the follistatina, is able to modify the metabolic processes of the cells.

  1. Iatrogenic alopecia

Iatrogenic aloepecia is caused by the assumption of some drugs that ake action of the hair follicles, stopping the growth of the hair. For sure, the best known example is the alopecia caused by chemotherapy drugs, but there are some others:

  • Anticoagulants (es: eparina)
  • ACE inhibitors
  • Antigouts
  • Antimalarials
  • Antineoplastics
  • Antirheumatics
  • Beta blockers
  • Thyroid drugs
  • Neuroactives drugs
  • Poisons
  • Oral contraceptives, testosterone and anabolic steroids (hormonal medicines)
  • Penicillin

The fall may occur in anagen or in telogen. In anagen, it occurs 10 days after the intake of the frug, in telogen after 90-100 days.