Hair today, gone tomorrow? This may have been the case for most patients in the past but today there are many treatments for preventing hair fallout and even restoring fuller head of hair. Hair is an important part of who we are, how we project ourselves to others and how we are perceived by others. Too much hair in some body locations is treated with temporary or even permanent methods. (Learn more on www.UnwantedFacialHair.ca .) Too little hair, particularly scalp hair, is also of significant concern and there are a variety of techniques available to address this problem. This article reviews the most common causes of thinning hair and discusses available treatments. Since the scope of hair loss is extensive, I will concentrate on two problems: male pattern hair loss (MPHL) and female pattern hair loss (FPHL.)
Both MPHL and FPHL have complex causes - mother and father inheritance, hormonal susceptibility as well as individual, not yet identified, factors. Clearly, there is a genetic component to hair loss in men and women that involves both parents. Androgens (male-type hormones seen in both men and women) also play an important role, particularly in MPHL. Dihydrotestosterone (DHT), a potent androgen, is especially important. Its higher levels in the scalp skin are seen in males with hair loss problems. Hair loss in women is much less understood but fortunately, some of the treatments for men are also effective for women.
Minoxidil (Rogaine?) is one drug that works for both men and women. Initially, it was used to treat high blood pressure but, soon after, a notable side effect of increased hair was noted. Currently, it is used topically to decrease hair loss and, in some cases, to increase hair density. It is interesting to note that women have better results than men when using minoxidil. Finasteride (Propecia?), a potent oral agent that decreases production of DHT, is very effective in the treatment of MPHL. It is indicated for men over 18 years old and should not be handled by women who are or might potentially become pregnant. Propecia? 1 mg per day has been shown to decrease hair loss and increase hair density in significant portion of treated men. These results are far superior to using Rogaine? alone or placebo.
Patients interested in more permanent, non-pharmacologic method of hair restoration may be good candidates for hair transplantation. Recent advances in methodology and art of hair transplantation, allow this procedure to create naturally looking hairline with restored hair density. Generally speaking, when the hair is transplanted from the area that is growing well (such as back of the scalp) to the area of thinning or absent hair (such as frontal scalp) then such hair will grow in the new area as if it was the old site. In another words, the hair shaft with its immediate surroundings behaves as if it was growing in non-hair losing site. This donor dominance is at the core of all hair transplantation techniques.
Incorporating sophisticated harvesting methods from the back of the scalp such as single or multi-blade techniques allows least amount of hair graft wasting and increasing efficiency of single transplant session. Furthermore, utilization of micrografts (single-hair), follicular unit graft (naturally occurring 'bundle' of hair follicles [usually 1 to 3 hairs]) and minigrafts (4 to 8 hairs) allows customization of hair placement to produce naturally looking frontal hairline (usually micrografts and small follicular unit grafts) as well as significant hair density in the rest of the scalp. In most cases more than one hair transplant session is needed for optimal results. Such advanced techniques can be used successfully for both men and women.
Scalp hair loss is not just a medical problem as it frequently affects the well-being and self-esteem of the individual. Fortunately, there are several successful methods designed to decrease hair loss and help restore fuller head of hair. From topical preparations and oral medications to the art and science of hair transplantation, patients have multiple options to treat their hair loss issues. It is important that physicians offer patients a full spectrum of options as this will result in happier more satisfied patients.
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Mariusz J. A. Sapijaszko, MD FRCPC is the Director of the Western Canada Dermatology Institute located in Edmonton, Alberta. He is also the Clinical Assistant Professor at the Division of Dermatology, University of Alberta, in Edmonton. His areas of expertise include cosmetic and laser surgery. Learn more on www.youthfulimage.com