Unraveling the Mystery of Hair Loss

Hair loss, medically known as alopecia, can be a distressing condition that is often accompanied by scalp disease or scarring. It can manifest as localized or diffuse hair loss and affect various parts of the body, not just the scalp. Hair loss can occur due to factors such as hair shedding, poor hair quality, or hair thinning, leading to areas of complete baldness. In some cases, it may be associated with skin diseases or scarring, making it challenging to find effective remedies.

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Hair loss is a common issue experienced by both males and females, children and adults, and individuals with different hair colors and types. It can be an isolated problem or linked to an underlying disease or condition, and the duration of hair loss can vary from temporary to permanent depending on the cause. As our hair follicles are formed during fetal development, it is inevitable that we will notice some degree of hair loss later in life.

Hair grows on most parts of the skin surface, except for the palms, soles, lips, and eyelids. The thickness and length of hair vary depending on the location. Vellus hair is fine, light-colored, and short, while terminal or androgenic hair is thicker, darker, and longer. Hair growth occurs within follicles, with each hair shaft growing at a rate of approximately 1 cm per month. This growth is facilitated by cell division within the hair bulb at the base of the follicle. The cells produce three layers of the hair shaft, namely the medulla, cortex, and cuticle, primarily composed of the protein keratin, which also forms the main structure of the skin and nails.

Hair growth follows a cycle with three main phases: anagen, catagen, and telogen. However, these phases are not synchronized, and each hair may be at a particular phase randomly. The anagen phase is the active growth phase, accounting for the majority of actively growing hairs. The catagen phase is an intermediate phase lasting 2–3 weeks, during which hair growth stops, and the follicle shrinks. The telogen phase is a resting phase that lasts 1–4 months, with up to 10% of hairs in a normal scalp in this phase. The duration of the anagen phase determines the length of the hair. For example, short hairs like eyelashes, eyebrows, and body hair have a shorter anagen phase of around one month, while the anagen phase can last up to 6 years or longer for scalp hair.

Hair loss can have various causes, including decreased hair growth (anagen hair loss), increased shedding of hair (telogen hair loss), conversion of thick terminal hairs to thin vellus hairs (male and female pattern hair loss), congenital or acquired hair shaft abnormalities, or an inflammatory skin disease that damages or destroys the hair bulb.

The clinical features of hair loss depend on the underlying cause. Symptoms such as itchiness and soreness are generally absent unless there is accompanying inflammatory skin disease. However, some individuals may experience a burning and prickly discomfort known as trichodynia during hair shedding.

Anagen hair loss is characterized by tapered or broken-off hair. The duration of the anagen phase can vary, and individuals with short anagen syndrome may have otherwise normal hair that cannot grow long.

Anagen shedding, also known as anagen effluvium, has a sudden onset and can be caused by autoimmune diseases like severe diffuse alopecia areata, certain medications (particularly cytotoxic/chemotherapy drugs), or inherited or congenital conditions such as loose anagen syndrome. It is characterized by the presence of short broken hairs and empty follicles. If anagen effluvium is caused by a drug or toxin, hair growth can return to normal within 3–6 months after discontinuation.

Hair loss is a complex condition influenced by various factors, and understanding the underlying causes and clinical features can help guide appropriate management and treatment strategies. Consulting with a healthcare professional or dermatologist is recommended for a comprehensive evaluation and personalized advice based on individual circumstances.

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