Hair loss is a main concern for men and women, many of them battling sudden balding or thinning hair and search for solution. Healthy hair reflects our personality and image, if we lose a lot of hair we may feel less in control and it can affect our self-esteem.
It’s normal to lose between 50 and 100 hairs a day, with about 100,000 hair on your head that is a small loss. New hair normally replaces the lost hair, but hair loss can develop gradually over the years or happen abruptly.
Some women notice a change in hair pattern, the volume and condition of the hair appears to lose original shape, more hair come out when washing or brushing with thinning at the crown of the head.
Hair loss is related to various reasons especially hormonal changes, pregnancy and childbirth due to drop in estrogen level which spans to the breastfeeding period. Also related to hormonal contraceptives, major illnesses, surgeries or traumatic events. Medical conditions like thyroid disease, scalp infections, high blood pressure, arthritis and depression.
Hair loss due to menopause is the result of hormonal imbalance specifically related to a lowered production of estrogen and progesterone which help hair growth.
Men too, are notoriously prone to hair loss due to testosterone level or hereditary predisposition which is extremely common or due to certain medications & others.
Male pattern hair loss (MPHL): synon. Androgenetic alopecia (AGA) is a common hair loss disorder affecting up to 80% of males & progresses over time by the age of 80.
It is characterized by androgen related progressive thinning of hair in a defined pattern. It results in diminished self-esteem, and distress in affected men, irrespective of age or stage of baldness. Thence the size of the problem & the need for an effective treatment for hair baldness.1-7
Other patterns depending on the causation like Auto-immune or infection-related Alopecia Areata, Frontal Fibrosis Alopecia (receding hair line in ageing process), Cicatrical Alopecia (a fibroproliferative disorder), Lichen planopilaris Alopecia (a relatively common caused by lichen planus), hereditary alopecia, infections (ringworm, St. aureus, Folliculitis, Seborrheic Dermatitis=SD etc), medication induced (including Chemotherapy) or by medical illness or hormonal as in female pattern hair loss (FPHL).
Consultation & Clinical assessment are performed by Dr. Nadia Yousri to identify the cause & the pattern of hair loss in both genders in order to determine the best treatment procedure based on proper & individual case selection. Assessment would also include arranging for blood tests to help uncover underlying medical conditions that can cause hair loss & possibly Scalp Biopsy (scrapes samples from the skin or plucked hairs to examine the hair roots under the microscope. This can help to diagnose any scalp infection as a cause of hair loss.
Male Pattern Hair loss treatment
A) Pharmacologic (over the counter VS prescriptive)
Treatment of Androgenic alopecia progresses over time and although the current available medical treatments like finasteride (Propecia), Spironolactone (Aldactone) and minoxidil (Rogaine) in the form of foam or shampoo etc. Though they could be effective in arresting the progression of hair falling & restart hair re- growth, but they allow only partial regrowth of hair at its best. It also could take few months to see an improvement, let alone bearing up with some inconvenient side effects, for example, Propecia uncommonly may cause Erectile Dysfunction in men.
Others prescriptive medications include anxiolytics (Amitriptyline for stress) dihydrotestosterone, 5-alpha-reductase, topical application of VEGF: vascular endothelial growth factor & prostaglandins (PG’s). others specific treatments like anti- infections or for SD e.g antidandruff shampoo, antifungal, Nizoral & Salicylic Acid etc.8-10
B) Non-Surgical Hair growth Treatments
There are Non- Surgical procedures that help in preventing and reversing hair loss by promoting hair regrowth. These procedures are becoming more popular nowadays because they can be done as an office procedures, with no analgesia required (well tolerated with no or minimal discomfort), no down time, in addition to proven effective results in restoring the hair thickness and resuming hair growth.11-12
These Non-Surgical Procedures include: –
1- Botulinum A- Neurotoxin (BTX) injection in the scalp
In a study 63 patients with AGA were treated with BTA injection in the scalp, 30 sites were injected with 100 U of BTA in each site and repeated every 3 months for a total of 4 times. Hair counts, head photographs, evaluation scores, and self-assessment were assessed in patients with AGA.
Hair growth and density were significantly augmented, and the area of hair loss was attenuated after each treatment as revealed by head photographs. The effective rate of BTA was 73.3% following 4 times treatment. The study concluded that BTA is a safe and effective therapeutic strategy for the treatment of AGA without adverse effects, and BTA combined with FNS exhibited a superior therapeutic effect than BTA alone.13
2- Steroid injection in the scalp (may help Autoimmune Alopecia Areata) or topical Metformin may be useful in Cicatrical Alopecia.
3- Growth factor either topical application or through intradermal injections of a hair formulation into the scalp skin in single-arm interventional pilot study in which 1000 patients (of both genders) had intradermal injection of a formulation containing vascular endothelial growth factor, basic fibroblast growth factor, insulin-like growth factor & keratinocyte growth factor, all suspended in a sterile injectable vehicle.
These Intradermal injections of such hair formulation were injected into the scalp once every 3 weeks for a total of eight sessions. Hair pull test was performed before every session. Two months after the completion of the eight sessions. Relevant safety assessments through physical examination, questionnaires, and appropriate laboratory examination were conducted throughout the study. Significant reduction in hair fall was seen in 83% of the patients on hair pull test.14-15
Vampire Hair Treatment/ PRP Hair therapy
Platelet Rich Plasma is one of the best trendy treatment for hair loss nowadays with very good results backed by many studies. PRP can be considered in patients refractory to medical treatment. The procedure involves taking own patient’s blood sample & spin it to obtain Platelets’ Rich Plasma that will be injected in the scalp with minimal discomfort that can be tolerated by the patient. There is no down time. Four to Six sessions are need in average with 4 weeks apart.
Platelet Rich Plasma (PRP) could work as prevention & as a treatment of hair loss. A sample of your own blood is taken to extract plasma which contains a range of growth factors and proteins that speed tissue repair when injected into patient scalp help to promote hair growth. Treatment would require 3 sessions with 4 weeks apart for hair follicle to respond.16-18
4- Autologous Cell therapy for hair loss & in Hair cloning: are still under study. Autologous cell grafting with Hair specific Growth factors (Rigenera cones) showed encouraging. 19
5- Stem Cell Based Therapy for Hair Loss is still advancing.20-22
6- Hair Mesotherapy with special nutrients, HA & other peptides that are supported by both experts’ opinion & practice evidenced results.
7- Other Non-Surgical procedures include Carboxythera-y in Hair Loss Treatment, LED therapy, Low Level Laser therapy-LLLT (approved by The Food & Drug Administration as a treatment for hereditary hair loss in men & women).23-29
All these kinds of procedures are performed by Dr. Nadia Yousri herself with excellent results recorded.
C) Surgical : Hypoderm Hair Transplantation (Replacement) which is beyond the scope of this blog.
D) Life style:
A healthy lifestyle of low stress, proper diet, and gentle hair care should help promote healthy hair growth for a long time.
Dr. Nadia YOUSRI is highly experienced in all the Non-Surgical procedures for Hair treatment with excellent results.
Dr. Nadia Yousri, OB&GY, Sexual Wellness & Regenerative Aesthetic Gynaecology Consultant™, FRCOG, PhD, MSc, DFFP, Published 18/05/2021, copyrights reserved to drnadiayousri.com©®
YouTube: Dr. Nadia Yousri: https://youtu.be/PdTObUhTnyo
Links to the press:-
1-A review of the treatment of male pattern hair loss.
York K, Meah N, Bhoyrul B, Sinclair R. Expert Opin Pharmacother. 2020 Apr;21(5):603-612
2- The Inflammatory Aspect of Male and Female Pattern Hair Loss.
Peyravian N, Deo S, Daunert S, Jimenez JJ. J Inflamm Res. 2020 Nov 10;13:879-881.
3- Variant PAD13 in central centrifugal cicatricial alopecia. Malki L, et al. New England Journal of Medicine. 2019
4-Interventions for female pattern hair loss. Van Zuuren EJ, et al. JAMA Dermatology. 2017; doi:10.1001/jamadermatol.2016.5790
5-Lichen planopilaris. Shapiro J. Accessed March 26, 2020. https://www.uptodate.com/contents/search.
6-Age-related hair changes in men: Mechanisms and management of alopecia and graying. Mirmirati P. Maturitas. 2015..
7- Guidelines for the diagnosis and treatment of male-pattern and female-pattern hair loss, 2017 version. Drafting Committee for the Guidelines for the Diagnosis and Treatment of Male- and Female-Pattern Hair Loss.
Manabe M, Tsuboi R, Itami S, Osada SI, Amoh Y, Ito T, Inui S, Ueki R, Ohyama M, Kurata S, Kono T, Saito N, Sato A, Shimomura Y, Nakamura M, Narusawa H, Yamazaki M;. J Dermatol. 2018 Sep;45(9):1031-1043.
1-Cold caps and scalp cooling systems. https://www.breastcancer.org/tips/hair_skin_nails/cold-caps. Accessed Jan. 31, 2020.
2-Chemotherapy and you: Support for people with cancer. National Cancer Institute. https://www.cancer.gov/publications/patient-education/chemotherapy-and-you.pdf. Accessed Feb. 3, 2020.