Even people with healthy hair have 50 to 100 hair loss per day. Hair loss usually occurs in male individuals, but it is also seen in women at a high rate. According to most people, hair loss or thinning and weakening of the hair is a big problem. Since hair plays a big role in the physical appearance of people, it is an important problem that suggests that it decreases the beauty and effectiveness of the person and accordingly creates a psychological problem, decreases the self-esteem or makes the person think that he/she loses his/her self-esteem.
The hair loss problem is known as “baldness” in men. Hair falls out periodically, resulting in “regional baldness” or “total baldness”. In women, the hairline is not drawn back; but the hair strands become thinner and weaker. How long the hair loss will take depends on the reason for the hair loss. Hair loss can occur in different ways in men and women. The most important factor causing this difference is hormonal factors. Hair loss can occur due to seasonal changes, stress, iron deficiency, hormone disorders. However, long-term hair loss can be one of the symptoms of serious diseases.
What Is Hair Loss?
A healthy scalp has an average of 100,000 hairs, and an average of 100-150 hairs lost per day is considered normal due to washing and combing in adults. Hair loss can occur due to hormonal and nutritional factors, exposure to chemicals, genetic predisposition, systemic diseases, hair development disorders, drugs, psychological stress, and scalp diseases. Hair loss in a healthy person can take up to 2 months. The hair loss period, which is repeated 3 times a year, exceeds 2 months, might be a precursor of some serious diseases and may require expert help. Hair loss usually starts 3-4 months after the triggering factor and these factors can return to normal 6-12 months after treatment.
The life expectancy of each hair is roughly divided into three. The growth phase is the longest, the hair grows on average 1 cm per month. The hair that completes this phase then enters the resting phase, which lasts for several weeks. After this phase, which takes 2-3 weeks on average, it will enter the hair loss phase. The hair that enters the hair loss phase loses its connection with the hair follicle and falls out within 2-4 months. This period can be shortened even more by combing, brushing and washing operations, but cannot be extended. At the end of this period, even if nothing is done to the hair, the hair will fall out by itself. New hair is produced from the hair follicle instead of the hair that is shed.
This cycle continues for a lifetime. It cannot be understood from the external appearance of the hair. In any period of time, 85-90% of the hair will be in the growth phase, 1-2% in the resting phase, 10-15% in the hair loss phase. The logic of accepting normal hair loss up to “100” hair on days without bathing comes forward in the physiology of the hair described above. Knowing these stages is also important for understanding why treatment lasts long for hair loss.
Causes of Hair Loss
Every existing hair strand has a life cycle. Each strand lives 4-6 years, then rests and then falls out. Hair loss in this way is an extremely natural process and 50-100 hair loss per day is considered normal. This situation should be taken seriously if there is more hair loss than this number, the amount of hair that is handled while bathing, or if we pull 3-5 hairs when we pull the washed dried hair by hand. There can be many different causes of hair loss. The important thing is to determine this cause and to conduct appropriate treatment.
- Genetic factors
The reasons for hair loss in women and men are different. Hair loss in men is usually male-type hormone-sensitive hair loss, which is genetic and occurs in more than 50% of the society. This type of hair loss is chronic. As the age progresses, baldness develops and may require hair transplantation as a result. Reinforcement treatments started at an early age, mesotherapy and PRP treatment slow down the spillage rate. It prolongs the time to go baldness.
This type of spillage is also seen in women. Especially those who have individuals with baldness problems in their families face the risk of hair loss. Today, male pattern hair loss with the onset of 16-18 years old is more common in young girls. The reasons why this situation is encountered more frequently compared to previous years include excessive stress, unbalanced nutrition, long-term fasting, and hormonal problems. The success rate can be increased with the addition of hormonal therapies in addition to a treatment similar to that of men.
- Skin problems
Skin and internal diseases can also cause hair loss. Most skin rashes occur when diseases involving the skin affect the scalp. If the hair is affected in conditions such as psoriasis, eczema, acne, lichen disease, excessively oily skin, fungal diseases, hair loss may be inevitable. The treatment of these spills is possible with the treatment of the underlying skin disease.
- Improper eating habits
Hair loss due to nutritional causes is another common factor. After all, hair is a living organ and it needs to be nourished. Not eating a regular and balanced diet, long-term hunger, uniform nutrition and consuming foods with a high carbohydrate content can ultimately affect and shed hair. Its treatment is extremely practical and it is important to start a balanced diet.
- Vitamin and mineral deficiency
Although there is no nutritional problem, the deficiency of vitamins and minerals required for hair is another reason that sheds hair. If vitamins and minerals such as B12, vitamin D, folic acid, biotin, zinc, iron are low, the hair cannot be fed and shed. Even when there is no iron deficiency, the iron supplement reduces hair loss. In these cases, the supplement must be taken by consulting a specialist.
- Hormonal problems
If the person has hormonal problems, menstrual delays or irregularities, increased hairiness, excess acne, and acceleration in weight gain, hormonal hair loss can be mentioned this time. Dermatology specialist should be consulted to determine the source of these problems with a blood test to be made on the 2nd or 3rd day of menstruation. Hormonal treatments are effective in this type of spills.
- Some internal diseases and drug use
Some internal diseases, thyroid gland diseases or drugs used for these diseases, rheumatic diseases, hormones used, slimming pills, adrenal gland diseases, insulin resistance, diabetes, birth control pills, and sometimes discontinuation of these control pills are other causes of hair loss. This situation must be investigated comprehensively by examinations and examinations to be performed by specialist doctors. If a sudden hair loss has started, surgeries, febrile illnesses, drug toxicities, blood loss, and severe trauma may have been considered.
- Birth and chemotherapy process
Apart from all these, there are two specific causes of hair loss. One is a postpartum spill that starts 2-3 months after birth. It is caused by the sudden shedding of hair that should be shed during pregnancy but not shed altogether. Supplements to be made under the control of specialists contribute to the elimination of discomfort in this regard.
Another is hair loss in patients receiving chemotherapy. These spills are less common with the use of more modern medicines in recent years but are already prone to self-recovery when treatment is completed.
- Cosmetic factors
Increasing cosmetic habits are other factors that cause mechanical chemical and physical hair loss. In other words, to tie the hair tightly, internal bones, blowdry processes exposed to excessive heat, dyes used to lighten the hair, lighteners, straightening methods cause hair loss by damaging the hair from the outside. In this case, the only treatment is to prevent the hair from being exposed to these applications. Applying the necessary reinforcement and care processes for the hair provide the desired appearance.
- Stress and depression
Excessive stress is another reason for hair loss as well as any disease. Depression, anxiety, psychosis, and medications used to treat them can affect hair loss. Hair is a living organ that can be affected by many factors in a short time in daily life. In light of this information, the individual should first weigh himself and then seek help from a dermatologist if necessary, if something is wrong with the person’s life.
Because misleading and hearsay information from the environment can cause patients to lose time. If there is an important underlying cause, it may be delayed in diagnosis and treatment. Apart from this, the unconsciously applied masks and mixes with the idea of preventing hair loss and re-growing the hair can cause irreversible damage by causing more damage to the hair.
Types of Hair Loss
- Male Pattern Hair Loss
Hair loss that occurs under the influence of androgens on the genetic ground is called “Androgenetic hair loss”. It occurs in about half of men and 20-25% of women. Although patients say that hair loss is intensified from time to time, telogen is an insidious hair loss in contrast to male pattern hair loss and occurs over the years. Sometimes patients realize that their hair is thinning rather than hair loss. Basically, the hair appears thinner at the top of the head and dilution is noticed according to the back of the hair. Especially in women, it is difficult to diagnose in the early stages and can easily be confused with other hair loss causes. It should be known that the treatment will take years.
- Alopecia Type Hair Loss
Alopecia areata is a disease that occurs suddenly, characterized by one or more round, completely balding areas of different diameters. It is known by the name “ringworm” among the people; however, contrary to its name, it is not a fungal disease and it does not have an infectious property. It can be seen not only in the hair but also in the beard area. It usually regresses within a few months or years. If hair loss continues, do not underestimate this. It is very important to consult a dermatologist for continuous spills, to be examined and to take the necessary tests and to treat.
- Hair Loss Due to Thyroid Hormones
In the case of hypothyroidism, widespread hair loss or loss of body hair can be observed. After 8 weeks of thyroid hormone treatment, hair begins to return to normal. In long-term hypothyroidism, permanent root loss develops, and the hard work of the thyroid gland, i.e. hyperthyroidism, may be the cause of hair loss.
- Hair Loss Due to Vitamin Deficiency
Hair loss may start due to hormonal changes, especially after 1-4 months after delivery and usually takes less than 6 months. It is necessary to control the level of sex hormones in female patients, especially when there are problems such as thinning, acne, menstrual irregularity, and increased hair growth in the front areas of the hair. Iron deficiency is found in 70% of women suffering from diffuse hair loss that covers the entire scalp. Even the reduction of iron stores without anemia can lead to hair loss.
Zinc, biotin, vitamin B12, folic acid deficiency, and vitamin D deficiency also cause hair loss. Hair loss may occur approximately 1-6 months after starting strict diets. The reduction of protein stores in the body leads to insufficient protein production and hair loss in hair cells. Hair loss can be seen 2-5 months after high fever diseases or surgical interventions.
- Stress-Induced Hair Loss
Some blood pressure medications, cholesterol-lowering drugs, thyroid hormone lowering drugs, birth control pills, some drugs used in psychiatry, vitamin A and some derivatives can cause hair loss. Hair loss itself can increase stress levels and cause a vicious cycle. Hair loss that lasts longer than 2 months should be considered important and a specialist should be consulted considering that there may be different underlying diseases.
- Hair Loss Due To Dental Caries
The cause of sudden ringworm and hair loss may be the effect of caries on the teeth and therefore infections. The immune mechanism, which fights against bacteria entering the body with dental ailments, can also damage their own healthy body cells. In this case, the immune system affects the hair follicles and causes hair loss. For this reason, it is imperative to be examined by a dentist to treat dental caries and thus prevent hair loss.
Gender and Hair Loss
- Hair Loss in Men
Hair loss is more common in men than in women. Hair loss is higher in men compared to women, due to the fact that the 5 alpha-reductase enzyme that causes loss is less in the body structure of women. In women, the aromatase enzyme is more than this enzyme. Since men are more affected by the hair loss problem, women may be considered unlucky due to the fact that the products sold in the market are for men. Because of the aromatase enzyme, these products cannot be effective in women. However, since hair transplantation methods are quite advanced, it will be a solution for everyone who has this problem.
One of the most common hair loss type (after the androgenetic hair loss) in men is Alopecia Areata. “Alopecia Areata is most likely an organ-specific autoimmune disease. Gene association studies confirm a genetic predisposition. Environmental triggers have been postulated, but none have been confirmed.” (Alopecia Areata). [https://www.longdom.org/open-access/alopecia-areata-2167-0951.1000118.pdf]
- Hair Loss in Women
The biggest cause of hair loss in women is genetic factors. Because of these factors, the hair becomes thinner and tends to fall out. This situation can lead to problems that may go until baldness in the following stages. Anemia due to iron deficiency, hormonal imbalances, a stressful life, thyroid hormone problems, postpartum, pregnancy, breastfeeding period, menopause process, use of birth control pills is seen as periods when hair loss increases in women. Factors such as perm, shellac and blow dryer cause hair loss in women in dyeing processes that are applied frequently.
How to Prevent Hair Loss?
In the treatment of hair loss, the diagnosis must be made correctly. First of all, it is necessary to learn the causes of hair loss and the type of hair loss. With the examination of the dermatologist, the factors that cause spillage are determined and appropriate treatment is planned. People who experience hair loss should avoid hair care products that can damage hair and scalp. It is especially important to switch to a protein-rich diet. If the spillage occurred due to vitamin deficiencies, the missing vitamin must be replaced. In the case of thyroid or hair loss caused by a different disease, a path towards the treatment of the disease should be followed first.
There are many different treatment methods to prevent hair loss. These include:
FDA approved drugs that prevent hair loss and thicken existing hair can be used under physician control. Drug therapy can be useful in areas where the hair becomes thinner and weakened, to prevent mild to moderate hair loss. The effect of the drugs is to increase the number of hair, to thicken thinned hair and to prevent further loss of hair.
Drug treatment has little or no effect on complete hair loss in the anterior and upper parts of the head. With complete hair loss, hair root cells die and cannot produce new hair. At this stage, no medication is useful for new hair removal.
- Hair Mesotherapy
Hair mesotherapy is an effective treatment method that is used quite frequently in hair loss. Hair mesotherapy involves the direct injection of vitamins, antioxidants, minerals, and circulatory substances, which are necessary for the growth and development of the hair, to the scalp with a microneedle. The injection is provided at approximately 1 cm intervals. Then massage is applied to the scalp.
Hair mesotherapy, which can be easily applied to both men and women, should be done in 5-10 sessions with an interval of 5 days. No pain is felt during the application. Hair mesotherapy can be applied as a cure every year. Sometimes monthly support can also be continued in the form of supplements. In this way, hair loss is stopped and new stronger hair is removed. A difference can be felt from the first session of hair mesotherapy, and the hair can regain its lively and shiny appearance.
- PRP Hair Treatment
PRP, which is the method where people with hair loss problems get the most effective results, is performed by taking the patient’s own blood and passing it through certain procedures. Here, the part called fibroblast that will feed the roots and ensure its development is separated and injected into the spilled area. This method is very effective, especially in genetic spills. Hair mesotherapy can also be applied in combination with PRP to those with genetic loss.
- Hair Transplant
Hair transplantation can be applied especially to people with male pattern hair loss. Male pattern hair loss develops in genetically susceptible individuals under the influence of the male hormone. Cells that produce hair around the hair follicle die over time, under the influence of this hormone. Thus, the hair becomes thinner first, then begins to grow and eventually falls out completely. Hair transplantation is the most accurate and permanent treatment method in patients with this condition.
What Are the Causes of Hair Loss in Children
Although hair loss is seen in older ages, it can also be seen in children due to stress and some diseases. Hair loss in children is usually caused by ‘Alopecia Areata’. This discomfort, which can be seen in both boys and girls, may continue throughout adolescence. This type of spillage manifests itself as circular spills 1-2 cm in diameter. If the treatment is delayed, all the hair on the child’s head, even eyebrows, and eyelashes, may fall out. Hereditary hair loss can also be seen in children who have hair loss in their family. Tightly gathering, knitting tightly and combing the hair frequently seen in girls can also cause hair weakening and loss.
In addition, ‘trichotillomania’, which is known as the ‘hair plucking’ disease, can cause hair loss in children. A child with a hair loss disease can tear off their hair and eyebrows by pulling them. Hair breakout, which is a psychological disorder, can be eliminated with the help of specialists. As with adults, various vitamin deficiencies, hormonal disorders, and some diseases can cause hair loss in children. For this reason, regular checks should be made and the deficiencies that cause hair loss should be eliminated and diseases should be treated.
Considerations for a Healthy Hair
It is necessary to make some adjustments in routine habits in order to prevent hair loss, to make hair grow healthy and look alive. These can be listed as follows:
- You should stay away from unconscious diets. If you want to follow a diet, you should do this under the supervision of a doctor. You should avoid carbohydrate-weighted nutrition. You should take care of protein-based nutrition. You should integrate regular eating habits into your lifestyle.
- You should pay attention to your sleep times. Regular sleep is very important to prevent hair loss.
- You should stay away from stress. If you have a vitamin deficiency, you should take supplements. You should consume foods containing zinc, B12, copper, folic acid.
- You should not make use of smoking and alcohol. If possible, you should stay away from both.
- You should include antioxidant foods (such as vegetables and fruits) on your table. You should stay away from fast food style eating habits. You should not use the medicines recommended for your hair health outside of expert control.
- The shedding of 50-100 hair strands per day is considered within normal limits. If excessive hair loss and visible thinning of the hair occurs, you should contact a dermatologist as soon as possible.
A Scientific Approach to Hair Loss
Although it varies according to races, each person has between 100-150 thousand hairs. Most of the time, 50-100 hairs will be shed while sleeping, washing, combing our hair while walking. The shedding up to this number is actually a harbinger of the “hair cycle” rather than something bad. The hair consists of the hairs located in our head region and grows in a cycle called the growth cycle, which includes the phases of growth and rest. The growth phase in this cycle lasts 2-8 years. After a 2-4 week degradation period, the hair passes to the resting phase. This phase also takes 2-4 months. At this stage, the shrunk hair cell clings to the old until the new hair grows.
After a short growth phase parallel to the growth of new hair, the cell returns to the resting phase. If the hair is shedding, it will happen immediately after the start of the next growth cycle, and the new hair body grows, ie new ones will be replaced. But one day something happens, you realize that your hair does not look as lush and healthy as before, and you start to find the strand of hair on your pillow, in the hole of the tub, as you are not used to it at all. The name of this phenomenon, which is called “baldness” in the folk language, “ordinary baldness” or “masculine hair loss” in the technical literature, is “androgenetic alopecia” (AGA).
The causes of shedding can be very diverse: low levels of iron and zinc in the body, especially low levels of B vitamins, intense and prolonged stress, exposure to radiation, heavy metal poisoning, hormonal changes due to pregnancy and childbirth, diabetes, etc. But if you are faced with androgenetic alopecia (masculine type hair loss), which is the gift of our genes, the main reason is not one of them, it is dihydrotestosterone (DHT), a derivative of testosterone (male hormone).
An enzyme called 5-alpha-reductase is the main reason why testosterone turns into DHT. DHT, above the normal level, attacks hair follicles, causing them to shrink and gradually stop hair production. The fact that some of our hairs were lost while some other people’s hair remained as before, even when they were older, is that we have inherited the 5-alpha-reductase enzyme from our ancestors. The incidence of masculine type hair loss in blacks, yellow race, and indigenous Americans is lower than in the white race because the activity of the enzyme in question is low in these racial groups. According to the researches carried out in different societies, it is determined that there are some racial differences. For example, it is stated that all white men have a genetic tendency to hair loss and 96% of them lose their hair to different degrees. It has been observed that white men experience this problem 4 times more than black men.
AGA is very rare in Eskimo and blacks. The incidence among Asians and African Americans is between the other two groups. AGA is also associated with age. For example, 50% of 50-year-old white women have AGA. White women between the ages of 35-40 get their share of 27% of this problem. In summary, 2/3 of white men and 1/3 of women are considered to have clinically observed AGA. Another finding is that hair loss in men and women is different from each other. Although the excess of male hormones plays a role in both male and female hair loss, it is not necessary for male hormone to be more than normal for male pattern hair loss. If the hair loss gene is present in the person, their hair will fall out. So the main thing is hereditary gene transfer. Hair loss in men can start with the increase or activation of male hormones after puberty.
The structure of the hair goes through phases where the hair roots grow and do not grow throughout life. Many of the molecules that control this cycle have been understood as a result of scientific studies. These findings will determine new strategies in the treatment of hair diseases. Hair root can be examined in two parts as permanent and cyclical. The cyclical part, that is, the lower part of the follicle, consists of five parts: Dermal hair papillae, hair matrix hair (medulla, cortex, cuticle), inner root sheath (inner root sheath cuticle, Huxley and Henle layers) and outer root sheath.
The hair is made up of a type of waste called keratin, the hair is completely lifeless, except for the hair follicle. The root is inside the hair follicle, just below the scalp. This is the basic mechanism in which chemical cycles that nourish the hair are formed. Hair loss is not important when the follicle is healthy, the main thing is that the follicle can continue to produce healthy hair. Hair follicles, which are affected by DHT, shrink over time and become unable to feed the hair (for some, this process may be as short as 6 months – 1 year, for the majority 3-10 years). The hair that will fall out becomes thinner and becomes lifeless, and after a while, the follicle becomes unable to reproduce the hair that has been shed.
Normally, “sebum” (hair oil), which is one of the basic requirements of a healthy hair, is often started to be produced excessively (excessive lubrication is generally observed in Type I hair loss). The oil-producing glands (sebaceous glands) also become a home for DHT. Hair oil contains dense amounts of DHT. A masculine type of hair loss can be found in both sexes. The frequency of this in men and the onset of hair loss is significantly higher than that of women. (For measurement with the Nordwood scale in men, see http://www.regrowth.com/documents.cfm?id=10664) However, the incidence in women in the post-menopausal period increases significantly due to the decrease in the level of estrogen in the body. In women, shedding is generally seen as a decrease in hair density between the back of the front hairline just before the forehead line and the vertex area behind the head, shedding does not concentrate in an area, especially in the upper temples, as in men.
Opening in the forehead corners of women is very rare compared to men. The hairline usually retains its place. There is also a risk of hair loss on all scalp in women. There may also be a general dilution. Hair loss may become evident especially during menopause. Often, hair loss occurs at a later age than men, between the late twenties and forties. Other factors can cause hair loss in women. For example, women are at risk in terms of their hair during hormonal changes, such as the use of contraceptives, postpartum, around menopause, and post-menopausal period.
In 1977, Dr. Erich Ludwig classifies AGA in women (https://bhns.org.uk/ccs_files/web_data/Resources/Diseases%20(severity%20scoring)/Patterned%20hair%20loss/Ludwig%20FPHL.pdf). Ludwig explains his classification in three phases. In the first stage, the preservation of the frontal hairline and the loss of hair at the top are noticeable; the second stage is clear sparse hair on the top, and the third stage is the loss of hair completely in the regions mentioned in the first and second stages. There are similarities as well as differences in hair loss in men and women. For example, the severity of hair loss in both sexes is related to the level of genes and sex hormones. Again, both genders can worry about this problem.
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