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Hair grows in cycles or phases ie. anagen (growth phase), catagen( regressive phase) and telogen (resting phase). The telogen hair are shed and a new cycle of anagen begins. The duration of these phases depend on site of hair. The hairfall of upto 100 hair a day is considered normal as those hair are in the shedding phase.

One must understand that hair loss per se is not a disease but usually a symptom of imbalance in the body. Hair loss is divided into two types: cicatricial alopecia (scarring hair loss) and non- cicatricial alopecia (non scarring hair loss).

In cicatricial alopecia, the hair producing cells get permanently damaged (due to burns or other skin diseases) and there is no chance of hair regrowth over that area. Hair may regrow in non-cicatricial alopecia.

It is important to elucidate the cause of hair loss. The major causes of it are:

  • Pattern baldness or androgenetic alopecia:- Male pattern baldness leads to a receding hairline and/or baldness over crown of the head. Female-pattern baldness causes the hair to thin in the front, on the crown, or on the sides.
  • Alopecia areata:- Usually presents as round to oval bald patches
  • Fungal infection of scalp:- more common in children
  • Tractional alopecia:- Hairstyles that pull on the hair, such as tight pigtails
  • Repeated hair pulling
  • Telogen effluvium which occurs 3-6 months after a stressor like febrile episode, trauma, pregnancy, etc
  • Anagen effluvium: due to anticancer drugs

In males, androgenetic alopecia is the most common which presents as receding frontal hairline with deepening of the lateral groves and thinning of hair in midscalp and crown.  This is the most common type of hair loss in males.

There are four main factors which determine whether a person will go bald:

  • Susceptibility to androgenetic alopecia
  • Rate of progression of hair loss
  • Age of onset of hair loss
  • Pattern of hair loss

The causes of androgenetic alopecia are not clearly elucidated. It is thought to be due to increased sensitivity of hair follicles to DHT hormone which is responsible for miniaturization of hair and its fall.

In females, the pattern of androgenetic alopecia is different, ie. there is diffuse hair loss with thinning in mid scalp and widening of hair partition with an intact hairline. Deficiency of iron and thyroid hormone imbalance may be seen in women complaining of hair loss.

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