#AskID : Prof Niki Ralph about hair thinning

We asked Prof Niki Ralph:
Hair loss (Alopecia) affects men and women of all ages and often significantly affects social and psychological well-being. Alopecia has several causes, however Androgenetic alopecia is one of the most common forms of hair loss, and usually has a specific pattern of temporal-frontal loss in men and central thinning in women.

Each day the scalp hair grows approximately 0.35 mm (6 inches per year), while the scalp sheds approximately 50-100 hairs per day, and more with shampooing.

Often alopecia requires medical, prescribed therapies, therefore if you are concerned about hairloss you should make an appointment with your GP or your Dermatologist.

A careful, directed medical history and physical examination is required to uncover the potential cause of hair loss and therefore direct treatment. It is important to know whether it was gradual hair thinning or involved “handfuls” of hair being shed, and if any physical, mental, or emotional stressors occurred within the previous three to six months. Determining whether a person is reporting hair thinning (i.e., gradually more scalp appears) or hair shedding (i.e., large quantities of hair falling out) may clarify the cause of their hair loss.

Medication exposure (especially chemotherapy) or serious illness (surgery, infection, pregnancy) within previous three to four months may result in sudden hair shedding called Telogen effluvium. This can cause significant distress for the person suffering from this type of hairloss but for most people it recovers fully.

Androgenetic alopecia is classified by “central” thinning in women (front of the scalp and also central hair parting may appear more obvious) and the “M” shape in men – temples and crown. Patients with androgenetic alopecia report gradual thinning of the hair rather than shedding of their hair and notice their scalp is more visible over time.

Female pattern hairloss (FPHL) has a strong genetic predisposition and many genes are involved. Therefore, one could inherit these genes from either parent or from both.
Blood tests may be performed in women who report FPHL and have other symptoms of hyperandrogenism, however for most women their androgen levels are normal.
Around 40% of women by age 50 show signs of hair loss and less than 45% of women reach the age of 80 with a full head of hair.
Hair on the scalp grows in tufts of 3-4 hairs unlike other areas of the body, however in androgenetic alopecia the tufts progressively lose hair resulting in baldness of the affected scalp

Treatments are mainly prescribed therapies which require some occasional blood monitoring and discussion with your doctor. They include:

• Topical Minoxidil (Regaine) 2% or 5% solution
• Oral therapies (hormonal therapies) which block the effect of androgens such as Spironolactone for pre-menopausal women, or Finasteride for postmenopausal women
• Combination with Oral minoxidil may also improve hair growth, reduce shedding and improve hair density
• Cosmetic camouflage with hair sprays, hair fibers or hair pieces
• Hair transplantation is becoming more popular with women, however not every patient is suitable for this procedure.