Diffuse Hair Loss

Diffuse hair loss is a common condition that occurs when hair is lost evenly across the scalp. It can affect both men and women at any age, but women are more likely to experience it. It is a reason for mental agony for males and females of all ages. One important thing that we should keep in mind is that up to 100 hairs lost per day is a normal phenomenon due to shedding of the telogen hairs and one should not be panic about that as the lost hairs are normally regrowing hairs from the healthy hair follicles. Loss in excess of that is pathological and should seek medical advice

Some common causes of diffuse hair loss include:

Acute Telogen effluvium (TE)
The most common cause of diffuse hair loss in adults, TE is characterized by a sudden loss of hair that occurs 2–3 months after a triggering event. This event could be a major surgery, pregnancy, high fever, or certain medications. A preceding viral fever especially dengue and covid are found to be very common preceding event in our population

Pattern hair loss- Male Pattern Hair Loss & Female Pattern Hair Loss- (MPHL & FPHL)
This type of hair loss causes gradual thinning of the hair at the centre of the scalp, or a widening of the central parting line.

Chronic telogen effluvium (CTE)
This type of hair loss is characterized by excessive shedding of hair from a scalp that looks normal. It can be due to various underlying medical conditions, most commonly anaemia, thyroid disorders, liver and kidney diseases.

Other possible causes of diffuse hair loss include: nutritional deficiencies, endocrine imbalances, and chemotherapy or radiation therapy.

When hair is lost from almost all parts of the scalp, it is called Diffuse Alopecia. Abnormal hair shedding (or effluvium) may occur during the telogen or anagen phase of the hair cycle.
Telogen Effluvium is the most common cause of diffuse hair shedding . A triggering event causes an increased number of anagen hairs to prematurely enter the catagen and then telogen phase. occurs when the anagen phase is interrupted, causing premature termination of hair growth and abrupt hair shedding.

Anagen effluvium is most commonly due to chemotherapy ( Drug-induced alopecia) and usually begins one to two weeks after treatment is started. It may result in 80–90% loss of body hair, including eyebrows and eyelashes . It may also be caused by poisoning with thallium, colchicine or selenium

Pattern hair loss

Male pattern hair loss is caused by a genetic predisposition Genetic predisposition is the susceptibility to a disease or condition as a result of inheriting risk factors from one or both parents that affects the sensitivity of hair follicles to circulating androgens ; for this reason, it is sometimes called androgenetic alopecia. The characteristic pattern is a bitemporal recession and balding at the vertex and frontal regions.

Female pattern hair loss has a strong genetic component, but the role of androgens is unclear.

The pattern is thinning over the top of the scalp with a widening of the midline

part Pattern hair loss in females occurs earlier and more severely in polycystic ovary syndrome, with a virilising tumour, or on exposure to an exogenous androgen such as testosterone.

What all tests should be done before treating Diffuse Hair Loss?

Laboratory workup to be done under supervision of a Dermatologist or Physician

• Complete blood count and ferritin for anaemia and iron deficiency
• Thyroid function tests for thyroid disease
• Serum zinc level
• Renal and liver function tests
• Antinuclear antibodies if features suggest systemic lupus erythematosus
• Hormonal evaluation (free androgen index, sex

hormone-binding globulin, prolactin) in women with clinical signs of hyperandrogenism. A detailed gyanaecological evaluation is to be done in women with sex hormone abnormalities

How to Treat Diffuse Hair Loss?

1. Topical minoxidil was the first drug approved by the FDA for treatment of Pattern Hair Loss. It is available in 2% and 5% solution and 5% foam, and the 5% solution has been shown to be more effective.
2. Anti-androgen drugs- Spironolactone (Aldactone)- is especially helpful for women with polycystic ovary syndrome (PCOS); If spirolactone is not effective, another medication with anti-androgen properties such as finasteride may help. Dutasteride is another possible treatment for androgenetic alopecia Bicalutamide is a novel nonsteroidal, pure antiandrogen medication that has a better safety and tolerability profile than flutamide which was previously used. Oral Cyproterone Acetate- 50 mcg ethinyl-estradiol and 2 mg cyproterone acetate on days 1–14 and an additional 20 mg cyproterone acetate on days 5–20 of their menstrual cycle found a significant increase in the number of anagen hairs on the frontal scalp Clascoterone is a novel topical androgen receptor inhibitor. It has shown promising results for use in patients with acne vulgaris. It is thought that the antiandrogenic properties of clascoterone may be helpful in treating Pattern Hair Loss.
3. Iron supplements-  Iron deficiency could be a cause of hair loss and supplementation improves hair growth in such cases.
4. Platelet-rich plasma (PRP)- is a more recent treatment modality for AGA that has risen in popularity due to its effectiveness, autologous nature, minimal side effect profile.
5. Exosomes- Mesenchymal stem cells (MSCs) are stromal cells that can self-renew and differentiate into various types of specialized cells. The concept of MSC-derived exosomes is emerging in the treatment of Pattern Hair Loss.
6. Microneedling with a depth of 0.6 mm in combination with minoxidil and other hair growth promoting medications was found to be more effective in many patients with Diffuse Hair Loss.
7. Hair Transplantation: Patients with Pattern Hair Loss who do not have success with medical treatment may opt for a hair transplant. In fact, the most common indication for hair transplantation in both men and women is AGA in recent times.

All the above mentioned treatment modalities should be undertaken only under the guidance of an expert dermatologist as self treatment by the patient with many of the treatment agents following commercial advertisements and treatment under inexperienced health care professionals are likely to invite more treatment related adverse effects than advantages.Visit our clinic Dr.Samads cutis care the best skin care treatment in Kerala tailored to your needs.