Permanent hair loss that is leading to baldness is usually the syndrome of Androgenic Alopecia also known as male/female pattern baldness which is a genetically inherited characteristic of androgenic reactions into scalp hair that affects both men and women to have hair thinning or miniaturization. Male pattern baldness is more common than females. There are other causes of hair loss too that is non-androgenic, but male pattern baldness reserves to be the basic diagnosis in most hair restoration cases.
Male baldness is classified into various stages under a scale called Norwood Scale – which usually leaves some amount of hair in the patient’s back of the scalp, which is the source with which allows a hair restoration surgery possible. While females have a diffusive hair loss which is only classified by the density of hair thinning, baldness is rare in women.
Hair grows from an organ called a hair follicle which resides underneath the surface of the scalp and sustains life and growth to the hair shafts or strands that we love, style and boast of. The hair follicle is a bulbous structure that can be noticed at the end of a broken hair.
Hair growth happens in 3stages or phases wherein each hair follicle produces a hair (anagen phase) grow till a certain length and shed off thereafter (catagen phase) and soon a new hair grow from the same follicle again (telogen phase). Hence the hair growth cycle goes on throughout a person’s lifetime and as long as the hair follicle is healthy the hair continues to grow.
Dihydrosterone (DHT) is an androgenic hormone which is formed from testosterone through the 5-alpha reductase. The adult DHT acts as the primary androgen for life and growth of hair in adult men including growth of facial and body hair, and the same DHT levels is also responsible for genetic hair loss, however, despite being an overtly exploited subject, it is still under studied about how the DHT causes baldness.
Male pattern baldness follows two distinct patterns wherein the hairlines start to recede from either the top or center of the scalp gradually spreading. It is called a vertex pattern if the hair loss occurs from the top of the scalp and anterior pattern if it occurs from the center of the scalp. Either of the patterns conclusively stabilise at a point when most of the hair in the center and front of the scalp has cleared off to baldness while some varying density of hair remains quite immune to baldness at the person’s back of the scalp.
Female Pattern hair loss occurs less than males but is not quite uncommon, with 30% to 40% of women affected worldwide. Its cause is the same as imbalance in the DHT level. Female pattern baldness is actually a wrong literature, since women get a thinning hair density in a diffusive manner, often with the broadening line of the center hair part, and does not follow any pattern as such. Female hair loss is classified under the Ludwig scale into 3 stages which a lot of hair loss and hair thinning but not complete baldness usually. Other than androgenic reactions, child birth, cancer and chemotherapy; some surgery or major illness and drug reactions can also cause female hair loss.
As the hormonal disorder of pattern baldness is the most common cause of hair loss, there can be other causes too, referred as non-pattern baldness.
Other than androgenic reactions, permanent hair loss can be triggered or speed up with poor diet and malnutrition, lack of sleep and such lifestyle habits, any prolonged illness and treatment, side effect of certain drugs can also damage hair follicles to speeds up the hair growth cycle from anagen to the telogen phase. This is called telogen effluvium which is the next most common syndrome of hair loss after androgenic alopecia.
Traction alopecia is partly a man-made condition of permanent hair loss wherein over pulling and straining hairstyles such as braiding, cornrows, croydon’s facelift, and the associating ironing, straightning, perming all together leads hair follicles to exaggerate and shrink permanently and this affects only the most strained area and does spread as such, but it usually happens of the front of the scalp since usually for these hairstyles, it is that region that is mostly strained. Traction alopecia is very common in african-american descent men and women, since cornrows and braiding is a patent style largely donned by them.
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