1. Introduction to hair loss

Hair loss is one of the commonest defect between the males and also the females all round the world. More than the 80% of the men and around the 40% of the women are affected by hair loss, which can have different causes and origins.

To classify all the form of hair loss, baldness and alopecia is always very hard and also reductive. The world of tricology is nowadays studied by all the international experts and still there are many aspetcts to clarify.

It is important to start with an introdution to some fundamental concepts and then analyse every single condition and disease:

  • With the term “defluvio”, from the latin word defluvium, we refer to an abnormal hair loss becuase of its quantity or its quality. This hair loss can lead to baldness (irreversible hair loss) or to ipotrichia (shortage of hair from all over the body), because of the loss of the hair follicles.
  • Instead, with the term “effluvio”, or “effluvium”, we refer to those cases in which the hair loss is high and omogeneous in all the scalp and becomes in the same moment. In these cases, the prognosis is not bad.
  • With Alopecia we refer to the shortage or to the total absence of hair. This category includes baldness and ipotrichia. Alopecias can be temporary, so reversible and transitional, when there only is a momentary inibition of the hair papilla, or definitive, when the follicle totally disappears.

To fully understand the process that regulates the birth, the growth and the fall of the hair, it is importat to explain the life of an hair.

  1. The life on an hair – physiological hair loss

The hair follicle is the only structure of the human organism that carries out a cyclical activity that lasts for the whole life of the human being. The cycle of the hair begins during the gestation, around the 32nd week of pregnancy.

The first cycle ends in the womb, while the second after the birth. The first hair is called “lanugo”. It is short and thin. With the time, the hair grows much stronger and longer and follows its life cycle.

Although today the machinisms of growing and falling of the hair is deeply studied, still there is a lot to investigate about.

The cycle of the hair is divided in different fases. Usually, we remember only 3: anagen, catagen and telogen. However the experts say that there are 6 different fases, because the add teloptosi, exogen and kenogen.

  • Anagen fase: is the fase in which the hair grows. The follicle sinks into the dermis and gives life to the stem. This fase lasts around 6 years and is devided in 6 under-fases. During the firsts 4 under-fases, there is an intense mitotic activity that makes the cheratinocits multiply. Then they go down into the dermis and reach the maximum depth. During the fifth under-fase, the mitotic activity slightly wanes and during the sixth under-fase it reduces almost totally. The aim at this point is to maintain a balance between cheratinotics in the reproductive fase and cheratinotics that build the stem.
  • Catagen fase: during this fase the mitotic activity totally stops. It is the fase of the regression of the hair follicle, because all the cells are not substituted. The internal epithelial sheath of the hair starts to desappear and the external one becomes thinner. This fase lasts around 20 days.
  • Telogen fase: is the fase of the mitotic rest of the follicle.the internal epithelial sheath has fully disappeared and the bulbadhere to the follicle thank to some adhesion proteins. This fase will last around 3 months and, if there are not scalp diseases, the new hair will replace the falling one. Actually, the telogen fase is always characterised by a weak metabolic activity that implies the multiplication of the cells of the matrix.

For this reason, the telogen fases is divided into:

  • Exogen fase: the hair comes off from the follicolar sheaths. The fase ends when the stem is free from the follicle.
  • Teloptosi: during this fase, the stem comes off from the follicle. The hair falls because there is no more cohesion between the stem and the sheaths.
  • Kenogen: is the fase of the real rest of the follicle. For a short time, before a new anagen fase begins, the follicle remains empty. That is the place where the new hair will grow.

In the cases of deseases, the life cycle of the hair will be compromised. The hair will reborn always thinner and weacker, until, in the worst casesm the mitotic activity totally ends. This is called the “miniaturization process”.

  1. Androgenetic Alopecia (common baldness)

With the term “androgenetic alopecia” we refer to that kind of baldness due to the action of the 5-alfa-reduttasi enzyme type 2 on the hair follicles. The enzyme is in charge for the transformation of the testosterone into DHT, an androgenic hormone that, in the predisposed people, attacks the follicles causing their miniaturization and the following hair loss.

This kind of alopecia is also known as common baldness, since it affects both men and women, even if with different numbers. The record is that the 70% of the men and the 40% of the women are affected by this type of alopecia. It is a kind of not reversible baldness, even if some farmacological therapies exsist that can stop the action of the enzyme 5-alfa-reduttasi and temporarly prevent the falling.

  1. Telogen effluvium

The telogen effluvium, also know as TE, represents one of the main causes for tha hair loss. It is usually an ignored condition, because of its heterogeneity. Headington distingueshed between 5 different types of telogen effluvium:

  • Immediate release of the anagen
  • Delayed release of the anagen
  • Short anagen syndrome
  • Immediate release of the telogen
  • Delayed release of the telogen

All these variants are verified when an excessive hair loss and a parastesis feeling on the scalp incur. The follicle enters prematurely in the telogen fase and the number of falling hair increase, exceeding the quantity of the growing hair.

The most acute form of telogen effluvium is usually caused by the delivery or by eparinoidi treatments. Another cause can be a period of special stress, both emotional and physical.

Normally, the hair loss does not cause the appearance of totally bald areas, but a spread thinning, expecially if the condition lasts for a certain period of time. The course of the desease can be various, but usually the acute form individually disappears in around 2 months.


How is telogen effluvium diagnosed? Which is the cure?

Telogen effluvium is not hard to be diagnosed. Normally, it is sufficient to analyse the clinic history of the patient and check at which stadium is the thinning of his hair. The main difficulty is in distinguishing telogen effluvium and the firsts fases of baldness.

The pull test can be usefull in these cases. Patients that present telogen effluvium lose the terminal hair and just a little quantity of miniaturized hair. On the contrary, who suffers from baldness presents many miniaturisez follicles. To understand how to take action, it is important to analyse the causes and to work for the well being of the whole organism.

  1. Anagen effluvium

With “anagen effluvium” we refer to a kind of alopecia that shows itself with a rapid and spread hair loss and that involves the whole scalp. It affects the follicles during the anagen fase, the one of the active growth. Generally, the hair follicles during the anagen fase are around the 90% of all the follicles and are distribuited evenly on the scalp. So, anagen effluvium is a kind of hair loss that can be very acute and that can involve almost all the hair follicles. Only 10% of them will not be touched by anagen effluvium.


What causes anagen effluvium?

We remember here some of the main causes of this pathology:

  • Matrix cells’ metabolic disorders, that cause an interruption in their reproductive activity.
  • Metabolic changes of the cells of the hair follicle bring to an interruption in the production of capillary fiber. The stem of the hair changes its shape and presents a thinner zone in which its structure is weacker. That is why hair easly breaks.
  • Drugs or substances that modify the metabolic activity of the cells in the hair follicle.
  • Chemotheray drugs that inhibit the metabolic activity of the cells.
  • Radiations, such as X rays and gamma rays.
  • In rare cases, a strong anemia or copper, zinc or biotin shortage can slow down the metabolic activity of the cells.

Autoimmune forms due to a genetic predisposition.

  1. Alopecia Areata

Due to a genetic predisposition this special kind of alopecia can occur. The experts still do not know which are the causes of this pathology. It can show at any time in the life of a person, in fact many children between 0 and 5 years are temporarily affected by it. Alopecia areata always changes, but in some cases can stabilise or, in some others, extend to the whole scalp (in these cases it is called totalis alopecia) or to the whole body (universalis alopecia).

  1. Hair loss camouflage systems

Some of the most popular products that can camouflage the hair loss:

  • Toppik: cheratin microfibers that, after being electrostatically charged, stick to the hair. The hair will look thicker and the skin will no more be visible through it.
  • Couvré: a coloured fluid cream that is applyed directly on the skin with a little sponge. It is available in different colores, such as blak, dark brown, medium brown, light brown, blond and grey.
  • DermMatch: it is an aesthetic product similar to foundation. It sticks to the hair and makes the scalp thicker.