Is alopecia reversible?

How is a hair?

Each hair is made up of an internal part called the root and an external part called the stem. The first is alive and ends in the bulb, in whose central hole is the dermal papilla. This houses the blood capillaries, responsible for feeding the root, that is, for bringing the nutrients, oxygen, and energy it needs to develop to the hair.

The stem is made up of several chemical substances and the protein that we find, mainly, is keratin, which accounts for between 80% and 95% of the total weight of the hair. The stem consists structurally, in turn, of an inner core or medulla, a middle layer called the cortex, and an outer -protective- layer called the cuticle.

Each hair grows about four millimeters below the skin, inside tiny cavities called hair follicles. From these cavities, present on the entire surface of the epidermis, except the palms of the hands, the soles of the feet, the navel, and the mucous membranes, the hair projects towards the outside of the skin, where it becomes visible.

What is its life cycle?

The capillary cycle that a hair experience is divided into three phases:

· Anagen: it is the phase of active growth, in which the hair grows approximately one centimeter per month. Between 85% and 89% of the follicles are in this phase, which lasts from 2 to 6 years.

· Catagen: is the rest phase. Growth slows and the hair begins to separate from the dermal papilla. It lasts between 4 and 6 weeks and contains 1% of the follicles.

· Telogen: this is the detachment phase, in which the hair is expelled to the outside. In its place, a new one will begin to grow. It lasts between two and three months and between 9% and 14% of the hairs are found in it.

What is alopecia?

Alopecia, according to the World Academy of Dermatology and Venereology (AEDV), is defined as "the loss of hair follicles by area", that is, the absence of hair or baldness. Hair loss can and often does lead to baldness (alopecia), but this doesn't always have to happen.

The usual thing is to lose between 80 and 100 hairs a day. From there, we can begin to talk about abnormal hair loss, which can affect both the scalp and other areas of the skin where there is hair, such as the beard, eyebrows and eyelashes, armpits, or genitals.

It is a very frequent disorder in the population and a common reason for medical consultation.

Who is affected?

In general, alopecia affects a large part of the population, around 45% of white men and women over the age of 40, according to some sources.

As we will see later, the most frequent form of alopecia among the population, which is androgenetic alopecia or common baldness, is responsible for 95% of the cases of this problem, according to data from the Clínica Universidad de Navarra. This affects mainly men, but also women. According to the World Academy of Dermatology and Venereology (AEDV), 40% of men between the ages of 18 and 39 suffer from it, and 95% of those over 70, but also 35% of women of childbearing age and up to 50% of menopausal women.

How does it manifest?

Although it depends on the type of alopecia that is suffered, in general, it manifests itself as follows:

· Decreases the amount of hair: in common baldness, it occurs above all in the frontotemporal (front and side) and occipital (rear) parts of the head.

· The thickness of the hair is reduced, it becomes thinner and weaker.

· Hair loss increases, it falls out early, without completing its natural cycle.

· Volume and density are lost in the hair.

· Discomfort and discomfort in the scalp may be suffered.

What types of alopecia are there and what causes them?

Alopecia can be classified in several ways. For example, depending on its location, it can be localized or diffuse. Depending on its cause, it can be primary (due to a disease of the hair itself) or secondary (due to a disease of some other organ). By the time of onset, it can be congenital or acquired. And depending on whether it is reversible or not, it can be divided into:

· Non-scarring alopecia: in this type of hair loss, the alteration of the hair follicle is reversible and, in addition, the surrounding skin does not suffer inflammation. They are the most frequent and, among them, are:

· Androgenetic alopecia (common baldness): It is the most common type of alopecia, it progresses slowly and its incidence increases with age. It is motivated by genetic, metabolic, local, and hormonal factors. The most important hormonal factor is androgens; Apparently, there is a greater sensitivity in the hair follicles of these people to the action of androgens, which little by little are reduced until they disappear. It affects both sexes, but especially men -who have a greater amount of androgens- and with different patterns. The male is characterized by the hair loss on the frontal and upper regions of the skull. At first, what is called entrances appear and, later, the region of the head popularly known as the crown begins to be affected. In contrast, in women, hair loss is diffuse,

· diffuse fall: It is a more or less intense hair loss, which can be both acute and chronic, but which is not located in a specific area of the scalp. The reason for this loss is an external or internal attack on the follicles, which alters the life cycle of the hair and stops it in some of its phases. Although several types of baldness are included in this group, the most frequent is effluvium acute telogen. It is a rapid and extensive fall, which occurs when many hairs enter the telogen phase at the same time. There is usually a trigger factor that causes vitamin and mineral deficiencies: a major illness, an infection with fever, some medications, various surgeries, childbirth, a period of intense stress, significant weight loss…Hair loss occurs approximately 3-4 months after the triggering event occurs. In most cases, hair loss stops soon and grows back normally.

· Alopecia areata: hair loss occurs in very localized areas and the resulting bald spots are in the shape of a rounded patch or plaque. It is believed that its character is immunological: the immune system attacks the hair follicles, which interrupts the hair growth cycle. It is more common in children and young adults, although it can affect people of any age. Since the follicles are not damaged, the hair usually grows back, but there is a possibility that the baldness may spread to the entire head or body or relapse.

· Traumatic alopecia: hair loss is due to physical trauma of different kinds. For example, a repeated traction mechanism -like the one produced by some hairstyles-, pressure -like the one exerted by the rubbing of the pillow on the baby's scalp- or trichotillomania, which is the compulsive manual pulling of the hair To release inner tensions.

· Cicatricial alopecias: they are irreversible alopecias and are usually produced by diseases of the scalp. They can be produced by various diseases (for example, infectious or tumor) or by physicochemical agents (for example, mechanical trauma or burns). It is important to see a dermatologist for precise diagnostic guidance in these cases.

Can alopecia be reversed or stopped?

Non-scarring alopecia, as we have said, can be reversible. The most appropriate treatment in each case will depend on the cause of the alopecia:

· Androgenetic alopecia: Although there is no totally effective treatment, there are drugs that can stop the progression of alopecia and others capable of increasing the growth of terminal hair, as long as treatment is started on time. The most widely used drugs whose efficacy has been demonstrated are minoxidil, a vasodilator that is applied as a solution to the skin; and finasteride, a drug that is taken by mouth and blocks the production of androgens. Topical minoxidil can partially stop hair loss, but treatment should start as soon as possible to be effective. In this case, it should be taken six to twelve months or even a lifetime. For its part, finasteride also slows down the process and, in some people, it can increase hair growth. Its administration is only approved in men, although it is also used in postmenopausal women. If female androgenic alopecia is caused by increased levels of androgens (or in some cases with normal androgen levels but greater sensitivity to its action ), hormonal treatment may be performed, the choice of which will depend on whether the origin of the increase is in the adrenal gland, or if it is caused by an ovarian problem. In any case, this choice will be made by the professional after the corresponding study. In cases where the alopecia has advanced too much or if medical treatment is impractical, there is the option of an autotransplant of hair or resorting to prostheses (wigs). If female androgenic alopecia is caused by increased androgen levels (or in some cases with normal androgen levels but greater sensitivity to its action), hormonal treatment may be performed, the choice of which will depend on whether the origin of the increase is found in the adrenal gland, or if it is caused by an ovarian problem. In any case, this choice will be made by the professional after the corresponding study. In cases where the alopecia has advanced too much or if medical treatment is impractical, there is the option of an autotransplant of hair or resorting to prostheses (wigs). If female androgenic alopecia is caused by increased androgen levels (or in some cases with normal androgen levels but greater sensitivity to its action), hormonal treatment may be performed, the choice of which will depend on whether the origin of the increase is found in the adrenal gland, or if it is caused by an ovarian problem. In any case, this choice will be made by the professional after the corresponding study. In cases where the alopecia has advanced too much or if medical treatment is impractical, there is the option of an autotransplant of hair or resorting to prostheses (wigs). Hormonal treatment may be performed, the choice of which will depend on whether the origin of the increase is in the adrenal gland, or if it is caused by an ovarian problem. In any case, this choice will be made by the professional after the corresponding study. In cases where the alopecia has advanced too much or if medical treatment is impractical, there is the option of an autotransplant of hair or resorting to prostheses (wigs). Hormonal treatment may be performed, the choice of which will depend on whether the origin of the increase is in the adrenal gland, or if it is caused by an ovarian problem. In any case, this choice will be made by the professional after the corresponding study. In cases where the alopecia has advanced too much or if medical treatment is impractical, there is the option of an autotransplant of hair or resorting to prostheses (wigs).

· Alopecia areata: to treat this type of baldness, corticosteroids can be effective, applied both topically and infiltrated, alone or in association with other drugs and irritating agents, in which the risk-benefit assessment must be carried out by the specialist. .. In some cases, but especially in children, some vitamins may be effective. In general, the treatments are unsatisfactory.

10 tips to care for hair

Following the following guidelines on a day-to-day basis will help us keep our hair healthy and strong for longer:

1. Don't waste time.

At the first signs of alopecia, do not wait and see your doctor or dermatologist as soon as possible. Only an early diagnosis will allow you to choose the most appropriate treatment for your case and stop or even reverse hair loss.

2. Wash your head as often as necessary.

Excess sebum derived from lack of hygiene can deteriorate the hair follicle and cause premature baldness. For this reason, it is necessary to wash your head at least once or twice a week. If you need it, you can do it even daily. Use a mild shampoo, then rinse your hair until you're sure no soap residue remains. Also wash it if you bathe in a pool, to make sure you completely remove the chlorine.

3. Brush your hair every day.

Do not do it with too much force and use a comb whose teeth are not sharp.

4. Avoid too-tight hairstyles.

For example, bows or pigtails that are too tight. They can cause hair loss in the areas that suffer the most direct aggression.

5. Better to air dry than blow dry.

It is convenient to avoid high temperatures when you dry your hair, so it is more advisable to let it air dry or use a towel than to use the dryer. In case of using it, keep it far enough away from your hair and do not leave it fixed at one point.

6. Do not abuse dyes.

Avoid dyeing or bleaching your hair too often, as it can end up taking its toll on your health and luminosity.

7. Follow a balanced and varied diet.

It should be abundant in fruits and vegetables and include foods from all food groups, as only a full supply of nutrients will allow your hair to grow and stay strong and healthy. It will also help you strengthen your immune system and keep infections at bay.

8. Avoid stressful situations.

This problem can trigger hair loss, both in men and women.

9. Don't smoke.

In addition to being very harmful to health in general, tobacco dries out the skin and weakens the hair.

10. Don't trust miracle solutions.

There are many hair products and treatments on the market whose efficacy is not approved. Follow only those recommended by healthcare professionals.