The patient who loses hair: alopecia
notes by dr Claudio Italiano
Alopecia, a word that derives from the Greek alópecs and which means fox, since
the fox loses the hair in patches in spring, manifests itself more frequently on
the scalp, usually develops gradually and can be:
b) in patches.
d) not cicatricial.
Tinea capitis, infection with fungal
Scarring alopecia is defined in this way because there is permanent loss of hair,
because the hair bulb, which is the organule from which the hair originates, is
destroyed. Then the skin becomes smooth and the follicle outlets disappear.
Non-scarring alopecia is defined as the momentary loss, caused by damage to the
hair follicles that saves the follicle outlet, so that the future hair regrowth
is possible. For example, a temporary loss is due to chemotherapy or due to the
use of other medications, radiotherapy, connective tissue diseases, tumors,
endocrine diseases, eating disorders with malabsorption, etc.
Nomally, each person loses about 50 hairs a day, which are replaced by new hair.
The hair grows through three distinct moments: anagen, catagen and telogen.
This is the most important phase of growth in which the cells of the bulb of the
hair bulb live a metabolic activity. The anagen phase, ie hair growth, varies on
average from 3 to 6 years. The hair is never all in the same phase of growth,
except in particular pathological conditions, but they grow so different from
each other that it is difficult to find two contiguous follicles in the same
phase. Hair during the anagen phase grows 0.3-0.4 mm per day.
It is the phase of involution, which lasts from 2 to 3 weeks, during
which the hair follicle undergoes various morphological and metabolic
modifications. The lower segment disappears, the length of the follicle is
reduced by about a third, the papilla becomes atrophic, the bulb decreases in
size and the melanocytes cease the production of pigment. If you tear a hair at
this stage you can see that its terminal part, corresponding to the bulb, is
white. The various alterations that occur lead the hair to its last telogen
It is the resting phase during which the follicle is completely inactive and as
wrapped in a connective tissue bag that offers it shelter until the beginning of
the new growth phase. The hair is inside the follicle, retained by poor
intercellular ligaments that make it remain in the scalp until the beginning of
the new phase of anagen and sometimes even for several successive phases. The
telogen phase lasts from 2 to 4 months. At these various stages of the hair
follows its fall. Every day about 10-30 hairs die, which under ideal conditions
are immediately replaced by new elements, because the follicles have vital
cycles synchronized with each other: in fact, the total volume remains unchanged.
When a pathogenic noxa (psychological stress, a metabolic problem, a hormonal
disorder) causes the follicles to pass from an anagen to the telogen phase, then
an alopecia is determined. A third phenomenon is the increase of the kenogen
phase: when the hair shaft comes off at the end of the telogen. Thus aging,
genetic predisposition and hormonal modifications can contribute to the gradual
thinning of the hair and the retraction of the hairline. This type of alopecia
occurs in around 4%% of adult men and can also occur in postmenopausal women.
People who have thin, relatively sparse hair like natives of tropical areas may
not immediately recognize alopecia. In men, hair loss more often affects
temporal areas, producing a hairline in the shape of M. In women, widespread
thinning affects the center-frontal area. In both sexes, hair loss also occurs
on the trunk, pubis, armpits, arms and legs. In the woman it is possible in the
post-partum period, during the lactation, between the second and the fourth
month. This loss of hair, widespread and transient, can be scarce or dramatic
and probably accentuated in the frontal areas. Anxiety, high fever, and even
certain hairstyles or methods of combing (for example, boys using fixative gel!)
can cause alopecia.
Risk hair loss for hairstyles with gel
Anamnesis and objective examination
If the patient is not being treated with chemotherapy or radiotherapy, ask from
the beginning when he first noticed the thinning or hair loss. Does it affect
only the scalp or the whole body? And accompanied by itching or rash? Then you
must carefully seek other signs and symptoms that can help you distinguish
between a normal or pathological loss of hair. Ask about recent weight loss,
anorexia, nausea, vomiting and modification of the alvo. Also inquire about
alterations of urine, such as hematuria or oliguria. Has the patient been
particularly tired or irritable? Did you have a cough or difficulty breathing?
Investigate the presence of arthritic pain or joint stiffness and intolerance to
heat and cold. Ask the patient about the exposure to insecticides.
If the patient is a woman, it is necessary to find out if she has had menstrual
irregularities and to collect the anamnesis on her pregnancies. If the patient
is a man, he must investigate any sexual dysfunction, such as reducing libido or
impotence. Subsequently. ask about hair care. Does the patient frequently use a
hair dryer with hot air or electric curlers? Do you periodically use dyes or
lighteners or do the permanent? Ask black patients if they use a hot comb to
straighten their hair or a comb with long teeth to get an African look. Have you
ever braided your hair? You must collect your family history of alopecia and ask
at what age relatives have started losing their hair. Also gather information
about the patient's emotional habits, that is, if he usually pulls his hair, he
rolls it over his fingers.
The objective examination must begin by detecting vital parameters and then
evaluating the extent and characteristics of hair loss from the scalp.
Is it patchy or symmetrical? Are the hair that surrounds a bald area fragile and
dull? Do they have a different color than the other hair? They fall easily? The
underlying skin should be inspected for follicle outlets, erythema, loss of
pigment, scaling, hardening, broken hair and hair regrowth. Then, the rest of
the skin is examined. The size, color, structure and location of each lesion
must be noted. The presence of jaundice, edema, hyperpigmentation, pallor or
hyperchromic areas should be monitored. The nails must be examined for the
presence of vertical or horizontal depressions, thickening, brittleness or
whitening. While doing this you must look for the fine tremors in your hands.
The muscles must be observed to find the presence of muscular weakness or ptosis.
They are then searched with the palpation of lymphadenopathy, increases in the
volume of the thyroid or salivary glands and the presence of masses in the
abdomen or thorax.
see Alopecia parte seconda
Le tigne: infezioni da funghi di cute, unghie,
capelli Micosi del pelo