Common in men from their forties, baldness, also called “alopecia” can also affect women or occur early. What are its causes and how to react?
Definition: what do we call “baldness”?
Baldness is excessive hair loss. It is an area of skin where there is a decrease, thinning or absence of hair. “The term ‘baldness’ is used more to refer to the usual male androgenetic alopecia, “ says Dr Vabres. The hair loss too is called an effluvium and corresponds to a fall of more than 100 hairs a day.
Causes of baldness
The most common pattern of baldness is male pattern baldness. It is a normal and physiological phenomenon that affects almost half of men in adulthood. In humans, the hair or pilosebaceous follicle is sensitive to the action of androgens. ” This action leads to a miniaturization of the follicle: the terminal follicle with hair, long and thick in gauge becomes a small follicle which produces down thus giving the appearance of a bald scalp “, explains Dr Vabres.
This phenomenon can also occur in women, less pronounced with hair that becomes thinner. She also has a good hereditary part. We do not know, to date, the genes involved. There may also be other causes of baldness, including alopecia areata which manifests as patches without hair in parts of the scalp or all over the scalp.
Iron deficiency – which is expressed by low ferritin levels and which occurs most often in women with very heavy periods – can also be a cause of hair loss.
Finally, an effluvium can occur after pregnancy during a period during which women lose their hair quite profusely. This phenomenon, due to synchronization of the follicles during pregnancy, is reversible: “The hair will grow back” reassures Dr. Vabres.
It is an androgenetic type of alopecia. It can occur as early as puberty. “16-year-olds can have hair that is starting to fall out, ” says Dr Vabres. A few years later, these men will usually present with a crown of hair or complete baldness.
In humans, alopecia is generally of a genetic form: we speak of androgenetic alopecia or androgenetic alopecia. It occurs more or less late in life. It is the genetic manifestation of particular sensitivity to androgens.
The “life” of the hair consists of three phases:
- The anagen phase is the phase when the size of the follicle is maximum. This descends into the skin and descends to the hypodermis: it produces a thick, long hair of sufficient calibre.
- The catagen phase is the phase where the follicle stops growing. It is a relatively short transition phase compared to the previous phase.
- The telogen phase: the hair is dead but it remains planted in its follicle and after a few months, it goes away.
A certain number of pathologies can manifest themselves as alopecia and disrupt the different phases of the hair’s life. Alopecia areata is one of the biggest causes of alopecia, even in children. It is an autoimmune disease: ” The body stops hair growth ” explains Dr. Vabres. It then miniaturizes the follicle which then produces an invisible down. Alopecia areata most often affects small areas of the scalp. Anti-inflammatory treatments in the form of dermo-corticosteroid lotion, immunosuppressants and Minoxidil may then be prescribed by your doctor.
Unlike alopecia of genetic origin, the hair will grow back. ” But, hair can grow back white, ” says Dr Vabres. In women, postmenopausal fibrosing frontal alopecia is found. “It is a relatively recently identified disease,” says Dr Vabres. It touches the edge of the hair behind the forehead and it will be totally bald.
Symptoms of baldness and location
Baldness is manifested by hair loss and areas of the scalp where hair becomes thinner or becomes completely absent. It can affect the vertex, that is to say, the top of the skull, the temporal gulfs, take the form of a crown or affect the entire skull.
The doctor and more specifically the dermatologist diagnoses baldness. This diagnosis depends on the topography, ie the distribution of the location of the alopecia as well as the examination of the hair. ” We also now have a technique called dermatoscopy, ” explains Dr Vabres. It allows to examine the hair and is particularly useful in alopecia areata because, during this disease, the appearance of the hair is very characteristic: it is as if broken and looks like exclamation marks, i.e. they are narrower at their base.
Baldness in women: what to do?
” When a woman has baldness, we ask for a possible hyperandrogenism,” says Dr Vabres. This is also manifested by menstruation disorders or hyper-hairiness. The body then produces too many androgens. This hyperandrogenism may be linked to disorders of the adrenal gland. The initial diagnosis of hyperandrogenism is made by hormonal testing during a blood test. The two other causes of female alopecia are androgenetic alopecia and frontal fibrosing alopecia. “The latter also occurs in premenopausal women,” says Dr Vabres.
To date, there is no therapeutic means of treating frontal fibrosing alopecia: in this form of alopecia, the hair follicle is destroyed: the hair cannot grow back. In the other cases, the follicle is not destroyed and can theoretically produce hair again. ” We then speak of non-scarring alopecia ” explains Dr Vabres. Typically, your doctor will prescribe Minoxidil locally which stimulates the pilosebaceous follicle as well as a dermo-corticosteroid lotion to apply to the scalp. L has cortisone in high doses, usually in the form of hospital perfusion, as well as methotrexate. ” However, this is not a panacea” acknowledges Dr Vabres. Cyproterone acetate (Androcur ), which can cause meningiomas,” is reserved for the most severe cases of hyperandrogenism and cannot be prescribed only for androgenetic alopecia “warns Dr Vabres.
It may, however, be relevant to change your contraception because it may be responsible for hyperandrogenism when it is only progesterone-based. However, the combined pills (3rd and 4th generations) presenting more contraindications, vigilance must remain in place. Research is underway on JAK inhibitors (for Janus kinases).
Finally, iron supplementation will be prescribed when alopecia is caused by a deficiency.
Baldness in men: what to do?
Your dermatologist may prescribe a 5 alpha-reductase inhibitor (finasteride) to limit hair loss as well as spironolactone. ” The effectiveness, however, is modest, ” admits Dr Vabres. And to add ” We are relatively poor in terms of treatment “. Hair transplantation, which has made a lot of progress in recent years, can ultimately be a good solution.