Unlike other epidermal structures which grow continuously, hair has a cyclical pattern of growth. The growing phase or anagen lasts an average of 1000 days on the scalp followed by an involutional phase known as catagen which is quite short, lasting only a few days. The hair then enters a resting phase, telogen, lasting about 100 days. In man, hair growth is normally asynchronous, with each individual hair following its own cycle independently of the others. The basal layer of the hair bulb from which the hair itself is produced is known as the matrix and contains melanocytes from which melanin pigment is incorporated into the hair. The type of melanin determines the colour and in grey or white hair, pigment production is reduced or absent.
Hair loss is known as alopecia, said to be derived from the Latin “alopex”, a fox, presumably because of the bald patches of mange seen in wild foxes. Adult male pattern alopecia is so common as to be considered normal. Circulating levels of testosterone are not raised in bald men but there is evidence that availability of the hormone to the hair follicle is increased. In postmenopausal women there may be widespread thinning of the hair but loss of hair at the temples often occurs to some degree at an earlier age.
Alopecia or hair loss may be diffuse or localized. If it is simply due to a physiological derangement of hair growth, the follicles remain intact, whereas inflammation may lead to scarring and loss of the hair follicles.
Forms of hair loss (Alopecia)Diffuse hair loss An interruption of the normal hair cycle leads to generalized hair loss. This may be due to changes in circulating hormones, drugs, inflammatory skin disease, and “stress” of various types.
Telogen effluvium occurs if all the hairs enter into the resting phase together, most commonly after childbirth or severe illness.(image)
Post febrile alopecia occurs when a fever exceeds 39degree C, particularly with recurrent episodes. It has been reported in a wide range of infectious diseases, including glandular fever, influenza, malaria, and brucellosis. It also occurs in fever associated with inflammatory bowel disease.
Dietary factors such as iron deficiency and hypoproteinaemia may play a role, but are rarely the sole cause of diffuse alopecia.
Severe malnutrition with a protein deficiency results in dystrophic changes with a reduction in the rate of hair growth.
Congenital alopecia may occur in some hereditary syndromes.
Anagen effluvium occurs when the normal development of hair and follicle is interfered with, resulting in inadequate growth. As a result, hairs are shed earlier than usual, while still in the anagen phase.
Endocrine causes of diffuse alopecia include both hypothyroidism and hyperthyroidism, hypopituitarism, and diabetes mellitus. In hypothyroidism the hair is thinned and brittle, whereas in hypopituitarism the hair is finer and soft but does not grow adequately.
Systemic drugs—cytotoxic agents, anticoagulants, immunosuppressants, and some antithyroid drugs—may cause diffuse hair loss, usually an “anagen effluvium” as mentioned above.
Inflammatory skin disease, when widespread, can be associated with hair loss, for example in erythroderma due to psoriasis or severe eczema.
Deficiency states are a rare cause of alopecia. Patients who suffer from hair loss are often convinced that there is some deficiency in their diet and may sometimes produce the results of an “analysis” of their hairs which show deficiencies in specific trace elements. In fact it is very difficult to cause actual hair loss even in gross malnutrition and in those dying from starvation in refugee camps, the hair growth in the scalp is usually present. In chronic malnutrition or kwashiorkor, the hair assumes a curious red/brown colour which may be due to iron deficiency.
Alopecia areata is a common form of hair loss. It is seen in 2%of patientsThere may be small patches of hair loss or the whole scalp may be affected. Resolution occurs in a few months or the condition may persist for years. There may be slight inflammation of the skin in the affected areas—in keeping with the possibility of an underlying immune reaction against the hair follicles. There is also an association with autoimmue disease and atopy. In the affected areas the follicles are visible and empty. The hairs about to be lost have an “exclamation mark” appearance and in some areas that are resolving, fine vellus hairs are seen. Patches commonly occur on the scalp, face, or eyebrows.
In alopecia totalis, the whole head is involved, and in alopecia universalis hair is lost from the whole of the body. In many patients, particularly if it is a first episode, regrowth occurs within a few months with fine pale hairs appearing first, being replaced by normal adult hair. In older patients, non-pigmented hair may persist in previous patches of alopecia. Factors associated with a poor prognosis are:
(1) Repeated episodes of alopecia
(2) Very extensive or complete hair loss (alopecia totalis)
(3) Early onset before puberty
(4) In association with atopy
Differential diagnosis includes trauma from the habit of plucking hair (trichotillomania) in mentally disturbed patientsand traction alopecia from tight hair rollers or hair styles that involve tension on the hair. In fungal infections (tinea capitis) there is scaling and broken hairs. Fungal spores or hyphae are visible in hair specimens on microscopy. Inflammation is present with loss of hair follicles in lupus erythematosus and lichen planus.
Hair loss Treatment:Homeopathic approach: The best homeopathic approach is the individualized treatment considering the complete totality some of the rubrics that are taken are
HEAD - FALLING out, hair, alopecia
HEAD - HAIR – falling
HEAD - HAIR – baldness
Generals - HAIR, general, head and body - falling, out, of hair
Sensation and complaints-skin-hair falling of, head from
Important remedies include FL-ac; phos; sep; thuja;bar-c etc..other remedies include aloe; bacill; jaborandi ,kali p,kali c,graph, cuprum sulh(Clarke), Brassica napus oleifera,allium c; allium sativa..