Finasteride isn’t available over the counter, it requires a doctor’s prescription.
Look, there’re only 2 FDA approved medications that have undergone doubleblind studies to prove they work for the treatment of Hair Loss.
Fewer studies was done in women, and So it’s not yet FDA approved in this group, the other FDA approved medication is Finasteride. Which had been proven to work in men. What are the medication options for male pattern hair loss? Using it intermittently ain’t helpful. Advised that medication is better at retaining hair than at regrowing lost hair. Understanding the pattern and duration of hair loss can be instructive.
Diffuse loss may point ward a telogen effluvium, anagen effluvium or androgenetic alopecia.
Focal versus diffuse hair loss patterns may indicate different disease processes. Hair loss that began in childhood can be hereditary or have genetic influences that going to be explored. Accordingly a focal area of loss could point ward alopecia areata, a localized tinea capitis, or trichotillomania. For these reasons, the trichogram is rarely used today.
Hairs shafts are hereafter cut 1 cm above the root, and the roots are evaluated on a slide side by side.
Anagen hairs are distinguished from telogen hairs and anagen/telogen ratios are established.
So a trichogram or pluck test requires the use of a hemostat with a rubberized end in which 60 to 80 hairs are firmly grasped and forcefully plucked, twisted, and lifted out of the scalp. Forceful tug of the anagen hairs will surely show artefactual changes so that dystrophic or damaged anagen hairs shouldn’t be considered pathologic but a result of their forceful removal. Now, a scalp biopsy provides a great deal more information than a pluck test can afford. Ok, and now one of the most important parts. Did you know that a further refining question should be if the hair is coming out by the roots or showing signs of abnormal breakage, Therefore if the hair is shedding. Although, infections like tinea capitis and similar conditions that cause structural hair shaft defects can also lead to abnormal hair breakage.
Hairs that fall out by the root might point ward telogen effluvium or androgenetic alopecia. Conversely, hair breakage could arise due to harsh chemical treatments/haircare products or some sort of anagen effluvium, like following chemotherapy for cancer. Accordingly the deep levels only contain anagen and terminal hairs. It’s a well like the periphery of an active lesion of alopecia areata, a scalp biopsy can be a very informative procedure in which a biopsy of 4mm wide and 4 mm deep is undertaken in an area of active hair loss. Originally, the biopsy was sectioned vertically to evaluate the longitudinal nature of every hair shaft but day the thought is that a transverse or horizontal section can be more informative looking at the how the hair shafts relate to each other and the anagen to telogen ratios can be better understood. Anagen/telogen ratios and terminal/vellus hair ratios can be calculated with horizontal sectioning.
Did you know that the upper levels typically contain all telogen and anagen hairs as well as terminal and vellus hairs.
The mid levels contain the anagen and telogen hairs but only terminal hairs.
Now look, the biopsy is sectioned horizontally to evaluate the upper level at the papillary dermis, at the ‘mid level’ at the reticular dermis, and in the deeper levels at the subcutaneous fat. Of note, the individual shouldn’t shower for at least one day prior to the pull test. By the way, a pull test can be administered in which approximately 60 hairs are grasped between the thumb, forefinger, and middle finger and gently tugged. Abnormal anagen hairs can also be pulled out, as with loose anagen syndrome or with dystrophic and fragile anagen hairs. Now look, the pulled hairs can therefore be evaluated on a glass slide under a microscope. Seriously. Generally speaking, a pull test will pattern and distribution of the hair loss may also be instructive.
Using a contrast sheet of paper to evaluate the hair against a white background can also improve one’s ability to read the hair characteristics.
Evaluation of the hair shaft may also prove to be helpful to determine the caliber, fragility, length, and shape. Alopecia areata gonna be random in distribution, whereas androgenetic alopecia will have a distinct and known pattern. Attentive physical examination will be undertaken of the scalp and hair, after a careful history is taken from the patient. In non scarring alopecias, this location of hair loss will still maintain visible follicular units, whereas with scalp scarring the location of hair loss will have no follicular units and on p of that may have associated appearance of scarring, scaling, and associated redness. Normal, physiologic hair loss could be approximately 100 to 150 hairs per day. Usually, someone losing fewer than 100 hairs per day might be considered to have no active shedding. However, daily scalp counts can also be helpful. As a result, the individual can determine progress or worsening of hair shedding because This process can be repeated at intervals. Days in which showering occurs should’ve been noted, as increased shedding is expected on those days. So this process should span a ‘7day’ period.
Did you know that the shed hairs are collected from brushes, sinks, and the shower and placed daily into separate plastic bags.
Questions that could elicit a positive history of telogen effluvium will include a recent fever, recent anesthesia, pregnancy, crash diet, etcetera For a female, Therefore if the hair is simply thinning, other questions should’ve been asked regarding thyroid abnormalities, irregular menses, or iron deficiency, Therefore in case the hair is shedding.
Another important distinction concerns if the person is shedding hair or simply showing thinning of hair. Alopecia areata and telogen effluvium are characterized by active hair shedding, whereas androgenetic alopecia is typically a condition of progressive hair thinning. Any virilizing signs in women including irregular menses, hirsutism, or acne could be evaluated with both free testosterone and dehydroepiandrosterone sulfate. Nevertheless, a serum antinuclear antibody could be important, when lupus is suspected. Thyroid function tests, specifically thyroidstimulating hormone, can be required as part of a thorough work up. Associated laboratory work up can also be helpful similar to serum ferritin to rule out iron deficiency anemia as a cause of hair loss, particularly in women with a diffuse patterned hair loss.