Depression causing hair loss

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Hair loss - why, what to do, how to stop and treat alopecia

Hair loss is a common complaint of patients: hair falls out, what should I do? Alopecia is a clinical problem, especially for general practitioners. The diagnosis is often associated with androgens (a group of steroidal male hormones produced by the testes in men, ovaries in women), unfairly or mistakenly ignoring other causes, including life-threatening patients, but amenable to therapy.

Contents

• Alopecia: what is it?
• Causes of alopecia
  • Telogen secretion
  • Nutrition (natural food sources)
  • Trauma alopecia
  • Endocrine imbalance
  • Medicinal cause
  • Infections
  • Special diseases
  • Malignancy
• Who is a trichologist and why is his advice valuable?
• Symptoms of hair loss
• Pathogenesis of hair loss
• Classification and stages of hair loss
• Complications
• Diagnosis
• Hair loss: treatment
• Forecast. Prevention

Alopecia: what is it?

The condition associated with hair loss with consequences for the psychosocial functioning of patients (especially women) is called alopecia. Most patients report loss of self-esteem, negative impact on social life, increased depression. The resulting visceral reactions may include:

• shame;
• anger;
• embarrassment;
• disgust;
• vulnerability;
• grief.

Hair is an important component of personal identity with great cosmetic value. The rate of hair loss per day in a healthy person is up to 100-150 pieces. Increased hair loss leads to anxiety. People suffering from this disorder often feel worse, less social contacts, more mental disorders. The psychological impact of baldness is stronger in women.

This disorder is considered a complex clinical problem for physicians, especially primary care and general practitioners, due to its diverse etiology.

The cause of partial or complete loss of hair in most cases is unknown. Clinicians often attribute the etiology to stress or link it to androgens, ignoring other causes, including life-threatening but treatable ones.

Careful history taking, proper examination methods, and prudent use of laboratory tests are necessary to establish a correct diagnosis. A methodical assessment of this disease can lead to the formulation of a proper hair loss treatment plan.

Causes of alopecia

Why does hair fall out on the head? There are seven main systemic causes of hair loss, ranging from infectious agents to the consumption of unsafe supplements.

Telogen secretion

Telogen secretion is a disorder of hair loss. The acute form worsens the quality of life, and spontaneous recovery occurs after at least three months, more often it takes up to six months. Full recovery takes about 12 months. This diffuse alopecia is a non-scarring alopecia, with an unspecified frequency of manifestation, since most cases are subclinical. Affects < 50% of the scalp, usually occurs about a calendar quarter after the initiating event.

An acute form of telogen secretion is provoked by:

• psychological stress;
• fever;
• medical treatment;
• change of season;
• diet;
• childbirth.

Although this disorder can be corrected by removing the underlying cause, there are multiple triggers. In about 30% of cases they cannot be identified.

The growth of each hair occurs in three stages: an intensive growth phase (anagen), followed by catagen, a regressive state caused by apoptosis (natural cell death). The final stage is telogen, meaning the resting and release phase.

Excessive hair loss occurs when an irritant causes a large number of anagen hairs to stop growing prematurely. As well as entry into the telogen phase, which leads to an increase in the number of telogen hairs on the scalp from 5% to 10%, up to 20% or more.

There are different types of telogen shedding, all of which share the common clinical feature of increased telogen hair loss. What to do if hair falls out on the head?

There are no specific medical treatments for isolating telogen. Recovery time depends on the extent of the initial damage. The main treatment for alopecia should be directed to the pathogen. Some reasons:

• fever;
• postpartum;
• use of oral contraceptives;
• strict diet;
• effects of anesthesia during surgery.

Chronic release of telogen lasts more than six months, this differs from acute.

Nutrition (natural food sources)

Nutrition plays a key role in maintaining hairline. It can be harmful in excess or deficiency. Protein in the form of keratin is the main component of hair. Not surprisingly, insufficient protein intake, such as in patients with kwashiorkor or anorexia nervosa, has been associated with baldness. With protein-deficient alopecia, microscopy can show their reduced diameter, atrophic anagen bulbs. There may also be color changes, loss of elasticity of the hair strands, and the texture becomes dry.

Hair loss treatment should focus on adequate protein intake from natural food sources. In an amount of at least 60-80 grams per day, unless contraindicated, for example, as in patients with kidney disease.

Essential fatty acids, such as linoleic, alpha-linoleic, are also key components of cell membranes, lamellar bodies of the stratum corneum. Symptoms of their deficiency include depigmentation, hair loss on the scalp and eyebrows. Too much vitamin A is another well-known cause of hair loss. Due to excessive supplementation, some diseases, such as chronic kidney disease, increase vitamin A levels in patients. The recommended daily dose is 10,000 IU.

Metallic cofactors are a necessary category of nutrition.

Deficiency of zinc can lead to numerous skin conditions including brittle hair, periorbital dermatitis, skin superinfections. The ideal daily zinc intake is 8 mg for women, 11 mg for men and pregnant women. Treatment for zinc deficiency is 25-50 mg in adults, 0.5-1 mg in children.

Selenium is another key metal that has long been associated with hair loss when taken in excess. Studies of acute selenium toxicity revealed alopecia in 72% of those affected. The current recommended intake for selenium is 70 mcg/day for men and 55 mcg/day for women.

Iron is another metal that has been postulated for its association with alopecia, although the link between iron deficiency and baldness is still debated. Many scientists hold the position that the condition of the hair improves with the treatment of iron deficiency, regardless of the absence or presence of anemia. Current literature suggests that an adequate ferritin level is 40 mg/L, although anecdotal studies support a range of 10-70 mg/L.

Nutrition (food supplements) is a loosely regulated but rapidly growing industry with a gigantic annual turnover. Currently, there are more than 85,000 nutritional supplements on the global consumer market, but no more than a thousand are officially tested per year. Most companies are infringing, selling their product containing banned ingredients such as phenolphthalein.

They can have a toxic effect on the hair, causing it to fall out. Arsenic, lead and mercury are the main culprits. Their long-term use can lead to toxicity, subsequent baldness. Other chemical impurities found in various supplements include:

• acrylamides;
• ethyl carbamate;
• melamine;
• radionuclides;
• sildenafil;
• fluoxetine;
• phenolphthalein;
• aromatase inhibitor;
• various anabolic steroids.

The connection between baldness and these substances is well known.

Steroids can disrupt endocrine regulation, causing changes in the regulation of hair growth. A sudden drop in estrogen levels can lead to hair loss. In breast cancer, patients treated with aromatase inhibitors are two and a half times more likely to experience baldness.

For consumers, the harmful substances in these dietary supplements can cause baldness, but the ingredients are not immediately recognizable because they are not listed on the labels.

Trauma alopecia

Traumatic alopecia (traction alopecia) is a common form of hair loss. Caused by forceful hair removal or breaking of hair shafts by pressure, traction, friction, or any other physical injury. Wearing tight hairstyles that injure the hairline:

• tails;
• pigtails;
• bundles;
• heavy strands;
• dreadlocks;
• hair extensions.

Frequent use of curlers or a hair dryer. Heavy use of relaxants or straightening chemicals. Wearing tight hats. Fluctuations in hormone levels. All this contributes to baldness.

Trichotillomania (TT) is the obsessive desire or habit of plucking hairs, consciously or unconsciously. The psychiatric classification includes TT in the category of obsessive-compulsive and related disorders.

Endocrine imbalance

In addition to androgen imbalance, both excess and deficiency of thyroid hormones can lead to baldness. This is a single endocrine anomaly or a manifestation of endocrine pathway disorders, for example, in patients with pituitary insufficiency.

Hypothyroidism increases the percentage of telogen in patients. A third of them may experience baldness. With hypothyroidism, cell division is inhibited in the epidermis, skin appendages. Hair damage is usually irreversible, even with thyroid hormone treatment.

Diffuse alopecia areata also occurs in up to 50% of patients with hyperthyroidism and may manifest outside the scalp, although this mechanism is not well understood.

Medicinal cause

Taking certain medications can also lead to baldness:

• antihypertensives;
• antiarrhythmics;
• statins;
• antimetabolites;
• psychotropic agents;
• anticonvulsants;
• anticoagulants;
• antiretrovirals;
• H2 blockers.

In terms of reported cases, affected patients tended to show improvement after discontinuing medication.

The itching of the head and hair loss returned after repeated use of the same remedy. Treatment involves stopping or changing the causative drug.

Infections

Among bacterial infections, treponema pallidum can cause baldness in 4% of patients during secondary syphilis. The clinical picture can be either diffuse or heterogeneous, or a combination of them. The most common location is on the scalp, although other areas such as the eyebrows and chest may be affected. Syphilitic alopecia can often be confused with focal alopecia. A good diagnostic method of differentiating between them is the detection of eosinophils at the sites of the lesion. Spirochetes can also be found in affected hair follicles on biopsy.

Baldness is associated with several viral agents, including viruses:

• Epstein-Barr;
• chickenpox;
• hepatitis C;
• HIV;
• cytomegalovirus.

VZV (Varicella-Zoster Virus) is a common culprit in alopecia due to its prevalence. It causes scarring alopecia.

Special diseases

Metabolic imbalance in patients with liver and kidney failure can cause hair loss: hypervitaminosis A, hyperammonemia and hypoproteinemia. Diagnosis requires the appointment of a metabolic panel, and treatment should be directed to the underlying excess or deficiency.

Rheumatological disorders can also manifest themselves in hair loss. This phenomenon is observed in more than 50% of patients with lupus at some stage in the course of the disease. Alopecia without scarring occurs during outbreaks in acute lupus, may resemble telogen discharge. In patients with discoid lupus erythematosus, lesions become cicatricial, and scalp lesions can lead to more than 50% baldness. The remaining hair fibers may be dry and brittle. Histopathological findings may include epidermal atrophy and lymphocytic infiltration in the follicle area.

Connective tissue diseases, especially dermatomyositis, can cause patchy diffuse alopecia. Treatment directed at the underlying pathology, such as immunosuppressants, is often necessary to prevent further baldness. However, with effective treatment, alopecia is reversible for some time after the start of therapy.

Amyloid deposition in amyloidosis can impair the function of the hair follicles, causing a diffuse or patchy lesion of the hairline. A biopsy is required for a definitive diagnosis.

Cutaneous sarcoidosis occurs in 25% of patients with systemic sarcoidosis, although it may appear in the absence of systemic disease. Scalp sarcoidosis is a rare manifestation of the disease and is initially described as a reddened, scaly, atrophic area of ​​hair loss. Local destruction from sarcoidosis, if left untreated, can lead to scarring of the hair follicles, akin to scarring alopecia.

Malignancy

Both systemic and cutaneous hematological malignancies such as leukemia may be accompanied by hair loss regardless of chemotherapy. The presentation is usually associated with mycosis fungoides, the most common form of cutaneous T-cell lymphoma. The phenomenon is called "mucinous alopecia" to describe alopecia and associated itchy papules or plaques. In fact, up to 30% of patients with alopecia mucinosus have mycosis fungoides. Treatment is directed at the underlying cutaneous T-cell lymphoma, although patients with indolent mycosis fungoides have a good prognosis with no further spread of hair loss.

In conclusion, it should be mentioned that baldness can be of an immune nature, as in cases of alopecia areata and other pathologies. There are many individual clinical conditions, and their combinations can confuse even a doctor, so to find out the true culprit of baldness, you need to contact a trichologist.

Who is a trichologist and why is his advice valuable?

What to do if hair falls out on the head? Along with contacting your therapist, it is useful to contact a doctor of a narrow specialization - a trichologist. Often this is a general practitioner - a therapist who has completed an additional training program, or a dermatologist. But unlike the latter, the trichologist focuses on the patient's hairline. In addition to diagnosis, treatment, he can explain how to strengthen hair from falling out. Develop an individualized care program to encourage their normal growth. Trichology - treatment of hair loss.

Symptoms of hair loss

Early signs of baldness include:

• thinning, thinning hair;
• appearance of bald patches;
• slow hair growth;
• more hairs remain on comb or pillow after sleep;
• itching of the scalp, which can have several causes. For example - dandruff (is not sufficient evidence of alopecia), as a concomitant condition.

Pathogenesis of hair loss

The culprits of alopecia are usually:

• androgens;
• genetic predisposition;
• autoimmune responses;
• chronic inflammation;
• oxidative stress;
• internal and external environmental factors;
• psycho-emotional factor and others.

Until now, there are no effective treatments for baldness that do not cause side effects. Perhaps because the influence and interaction of many factors affecting the immune system and signaling pathways that regulate the biology of hair follicles are underestimated.

If hair loss occurs, the causes may be multifactorial and there may be more similarities than differences in the spectrum of baldness disorders.

Like most multigene, chronic systemic skin diseases, alopecia is the result of an accumulation of many causes: genetic and environmental. Which lead to the ultimate molecular pathophysiology. In turn, leading to dysregulation of signaling pathways, inadequate immune and inflammatory responses.

Chronic inflammation at the follicle level appears to be the cause of various types of hair loss. It has already been proven that even with non-inflammatory alopecia there is a micro-inflammatory and fibrous component.

Numerous immune pathways are involved in the normal physiology of the follicle, as well as in the pathophysiology of alopecia. Within the internal follicular environment, numerous cytokines, growth factors, and transcription factors signal the follicle to enter the anagen or catagen phase. They play an important role in regeneration.

It is known that in the case of microinfection, overproduction of cytokines causes premature catagen, release of ROS, apoptosis (natural cell death), and further spread of inflammation.

To this end, in any therapy developed for the complex treatment of hair loss, it is necessary to take into account not only triggering factors, but also their subsequent signal cascades.

The condition of inflammation and oxidative stress in the environment of the follicles that causes hair loss is facilitated by:

• ultraviolet;
• contaminants;
• toxins;
• stress;
• aging;
• smoking;
• antigenic effect of bacteria and fungi.

Recent studies have further elucidated the molecular mechanisms underlying the role of psycho-emotional stress in the onset and aggravation of hair loss. Chronic stress can lead to inflammation in the area of ​​the funnel of the follicle, its physiological disorders. Via endocrine and neuroimmune mediators such as corticotropin-releasing hormone, cortisol, all of which have receptors on the follicle.

We need to look for a common thread in all hair diseases - a complex dysregulation of immune, inflammatory and signaling cascades that regulate follicle homeostasis. Therefore, any drug/treatment that targets individual triggers such as androgens may be incomplete. If you do not take into account pleiotropic side effects, as well as the interactions of various signaling molecules. In addition, the pathogenesis of this disease is multifactorial, it requires additional consideration:

• stress;
• aging;
• environment;
• inflammation and others.

Classification and stages of hair loss

Each hair on the body constantly goes through cycles of growth (anagen), regression (catagen), rest (telogen) and loss (exogen). Baldness is usually due to a problem with the hair cycle or due to inflammation directly affecting the follicle. Dermatologists traditionally divide baldness into categories according to different causes and morphology:

• inflammatory;
• non-inflammatory;
• genetic;
• acquired;
• scar;
• not scarred;
• androgen-mediated and not.

The main categories of alopecia without scarring are:

Alopecia areata (OA). May affect any part of the body. With the defeat of a large area - total alopecia. If baldness of the whole body occurs - universal. The etiology is not exactly known, but the autoimmune theory of OA seems more plausible.

Isolation of anagen. Alopecia that occurs during the anagen phase of the cell cycle. It is observed in cancer patients who receive chemotherapy.

Androgenetic alopecia. A type of hair loss influenced by hormones and genes.

Isolation of telogen. The result of a shift in the hair growth cycle from the anagen phase to the telogen phase. It can be triggered by hypothyroidism or hyperthyroidism. Other causes: stress, alcohol, drugs, strict diet, poor nutrition.

Shingles. The classic type of herpes zoster (viral nature) causes baldness without scarring, unlike other types such as kerion and favus (fungal nature of diseases).

Traumatic alopecia. Occurs as a result of mechanical, chemical damage to the hairline, the habit of pulling out hairs. Trichotillomania is a type of traumatic alopecia in which the patient constantly pulls out their hairs.

Scarring alopecia is divided into three main types:

Mucinous alopecia. Occurs when mucinous material accumulates in hair follicles and sebaceous glands, causing an inflammatory response that prevents hair growth.

Neoplastic alopecia. Observed with metastatic infiltration of the scalp with malignant cells.

In the inflammatory variety of herpes zoster (favus or kerion), when the fungi cause the formation of an abscess, which can culminate in scarring alopecia.

Complications

Patients with alopecia are at an increased risk of psychosocial complications such as anxiety and depression. People in these states may take psychotropic drugs, exacerbating the condition of baldness. Many of these medications are associated with mild to moderate hair loss. Mood stabilizers such as lithium and valproic acid can cause hair loss of varying severity and duration. Patients taking selective OZR inhibitors also experience baldness. It is important that doctors take these points into account when prescribing therapeutic courses, and also examine patients for the presence of autoimmune and other diseases. One study found that patients with alopecia areata are at an increased risk of developing insulin resistance.

With hair loss, psychosomatics becomes an important reason for the deterioration of the general condition of a person.

Diagnostics

Diagnostic measures begin with the collection of an anamnesis, clarification of the patient's medical history.

Key information for history taking includes the number of hairs that fall out, the duration of the pathology, and their distribution over the scalp and body. Important:

• patient history;
• recent changes in diet;
• social stressors;
• information about medications taken, and much more.

Clinicians should not be quick to attribute a patient's hair loss to androgen imbalances or stress. There are many equally important alternative causes to be tested.

Depending on the clinical suspicions, clinicians should ask targeted questions related to the seven categories of baldness etiologies, looking for possible causes. For example, almost all chemotherapy drugs cause some degree of baldness. For female patients, a history regarding the menstrual cycle, hormonal drugs is useful in establishing the cause of hair loss in girls associated with hormones.

Diagnosis should go beyond dermatological symptoms, since many systemic diseases and infections can be accompanied by alopecia as one of the manifestations.

Physical examination should be aimed at determining the degree of disease, characteristics of alopecia, inflammation. Initial imaging should focus on the distribution of alopecia, in which the diffuse pattern raises clinical suspicions of a systemic cause.

During examination, the patient should be combed. Baldness can also be quantified with a standardized flush test as part of the initial assessment. This is particularly useful for diagnosing chronic telogen shedding prior to more invasive procedures such as trichogram and biopsy.

A rough examination of the fibers of the hair strands can provide additional clues to the patient's pathology. The terminal hairs are pigmented compared to the fine vellus hairs seen in some patients with Cushing's disease or anorexia nervosa. The texture of the hair fibers, especially if they are dry, brittle, may indicate poor hair nutrition. Examination can also reveal brittle hair disguised as hair loss.

Visualization and palpation of the scalp reveals inflammation, scarring, or erythema, which may signal an underlying infection or malignancy.

Instrumental Diagnostics - Scalp dermoscopy can offer a magnification of 20 to 70 times to better visualize the features.

A shiny, smooth skin surface indicates the absence of active hair follicles. The characteristic color of the skin may indicate the underlying inflammation. An important sign is hair loss outside the scalp. Additional loss of the eyebrows suggests thyroid disease, while hair loss on the torso may be a manifestation of amyloidosis or secondary syphilis.

Laboratory diagnosis may be useful in narrowing differential diagnoses. Performing a trichogram can help calculate the ratio of telogen to anagen, give clues to systemic causes. Hair follicles can be examined to determine their relative proportion among the growth phases. The trichogram allows for microscopic evaluation of the hair shaft and follicle, which can be used to distinguish between mechanical, chemical, genetic, and infectious etiologies.

What tests should be done for hair loss? A complete blood count may reveal acute infections or anemia. Studies of iron content, ferritin levels can reveal impaired iron-binding ability. Chemical analysis may reveal a metabolic imbalance that indicates liver or kidney disease. After interpreting the results of the primary tests, the attending physician will explain why hair loss occurs, what tests to take to clarify the cause of baldness.

Additional tests for hair loss are ordered for each patient depending on the individual history:

• antinuclear antibody test and erythrocyte sedimentation rate may confirm suspicion of autoimmune disorders;
• tests for specific nutrient deficiencies and excesses such as zinc, selenium and vitamins;
• tests for the detection of toxic substances such as lead and arsenic for severe clinical suspicion;
• advanced endocrine studies and imaging may be useful in identifying underlying androgen imbalances or malignancies;
• If a doctor wants to evaluate a patient's androgen levels, they will order a prolactin and globulin test.

Scalp biopsy. Its main indication is the differentiation of scarring and non-scarring alopecia. Sometimes a biopsy can help diagnose underlying conditions such as amyloidosis and mucinosis.

A wide range of causes is a diagnostic challenge for doctors, requiring effort and time.

With a systematic approach, doctors can identify the underlying cause of alopecia. In addition to minimizing hair loss and maximizing hair regrowth, patients can further benefit from early diagnosis of systemic diseases:

• nutrient deficiency;
• endocrine imbalance;
• collagen or vascular diseases;
• malignant neoplasms.

Given the serious psychosocial consequences associated with baldness, prompt resolution of the disease can greatly improve a patient's quality of life. It is easier to achieve a cure with an accurate diagnosis and a clear plan for adequate treatment.

Hair loss: treatment

What to do if the hair on the head falls out a lot? Only an appeal to the doctor will be the right decision. He knows how to treat alopecia. It is desirable that the appeal be timely.

How to treat hair loss? The doctor draws up an individual treatment plan in accordance with the etiology, type of baldness, containing local corticosteroids, immunosuppressive drugs. Androgenetic alopecia is treated with anti-androgen medications, as well as minoxidil spray, but the patient may eventually need a hair transplant.

In alopecia areata, moderately effective corticosteroids, as well as minoxidil spray, in combination with topical immunomodulators such as tacrolimus, may benefit the patient. Antifungal drugs are the mainstay of treatment for head zoster. How to treat hair loss? Strictly comply with medical prescriptions.

To achieve the desired therapeutic result, the following is additionally prescribed:

• cryotherapy;
• plasma therapy;
• photobiotherapy;
• microcurrent therapy;
• mesotherapy;
• polynucleotide biorepair.

In some cases, resort to surgical intervention.

Forecast. Prevention

The prognosis must be determined for each case. If we talk about statistics, then according to studies, about 8.5% of patients with total and universal alopecia have achieved a complete recovery. In many patients (approximately 50% of the total cases), after treatment, there is at least a temporary restoration of partial or complete hair regrowth. The response to treatment is often unpredictable, and healthcare professionals must be aware of the prognosis and its consequences in order to properly counsel patients. To prevent the development of damage to the hairline will help the usual preventive measures:

• a healthy diet that avoids deficiencies;
• a competent choice of hygiene products that do not harm the skin;
• timely medical examination, early diagnosis;
• avoid tight, voluminous hairstyles, chemical and thermal effects on the hairline.

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