Hair Loss - Diagnosis & Therapy

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Hair Loss - Diagnosis & Therapy
Hair Loss - Diagnosis & Therapy
Video: Hair Loss - Diagnosis & Therapy
Video: Importance of Diagnosing Pattern Hair Loss, and Stopping and Reversing Hair Thinning 2023, February

Hair loss: diagnosis & therapy

Full head hair is generally considered to be the ideal of beauty. The self-confidence of many affected suffers all the more when it comes to increased hair loss. The possible causes for this range from genetic predisposition to pregnancy and various diseases. There are different types of hair loss with different causes. The treatment depends on the trigger.


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  • Advice, downloads & tools
  • Life cycle of hair
  • How is hair loss diagnosed?
  • Forms, causes and therapy of hair loss
  • Hereditary hair loss
  • Circular hair loss
  • Scarring hair loss
  • Diffuse hair loss
  • Whom can I ask?
  • How are the costs going to be covered?

Life cycle of hair

Normally, people have around 80,000 to 100,000 hairs on their heads - blondes a little more, redheads less. There are around a million bag-shaped hair follicles that are only a few millimeters in size on the head. About one in ten of these hair roots is currently active and forms a new hair. The hair life cycle is divided into three sections:

  • Growth phase : 80 to 90 percent of the hair is in this phase. It lasts on average about two to six years and determines the maximum hair length. Hair grows about an inch per month. People with a rather short hair growth phase can therefore not get very long hair, even if they rarely have it cut.
  • Transition phase: this section is short-lived.
  • Resting phase: After this period of around two to four months, the hair falls out on its own. Normally we lose around 50 to 60 hairs per day, with one hair wash it can be up to 100 hairs.

If more hair falls out, this life cycle is disturbed and the cause should be clarified by a dermatologist. Different treatment options are available depending on the trigger.

How is hair loss diagnosed?

In a conversation with the person concerned, the doctor clarifies whether there is a family history of hair loss or a one-sided diet. In addition, a connection with possible causes (e.g. infections, metabolic diseases or hair-damaging influences) is searched for. This is followed by a physical examination of the scalp in particular and, if necessary, microscopic examinations of the hair roots and skin samples. Blood tests may also be necessary.

Forms, causes and therapy of hair loss

There are different types of hair loss with different causes. The respective treatment depends on the trigger. The possibilities range from various local therapies to systemic therapies and so-called mesotherapy. Low-dose substances are injected directly into the scalp.

If these treatments are not or not sufficiently effective and the suffering is great, a wig, a toupee or hair braid can help. Hair transplantation should only be considered with caution and only performed by specialized professionals, as it can lead to complications such as rejection reactions and chronic infections.

Tip Only contact reputable, specially trained doctors and discuss the chances of success and the costs of the respective method in advance.

Hereditary hair loss

Causes: This genetically and hormonally determined form (androgenetic alopecia) is responsible for hair loss in around 95 percent of cases - both in women and, even more frequently, in men. The hair follicles shrink due to the increased sensitivity of the hair roots to male hormones (androgens). Hair production is restricted and hair also falls out faster. In men there is an increased beard growth. An increase in the sebum glands on the head also contributes to the loss of scalp hair.

Symptoms: Hair loss often begins in puberty. About every second man is affected in the middle years of life. Often, "receding hairlines" appear first, which over time develop into a partially or completely bald head.

In women, the entire scalp hair thins. At the same time, an undesirable increase in hair develops on other parts of the body, e.g. on the legs, lower legs, toes or on the face.

Therapy: There are no preventive measures for this form whose effects have been scientifically proven. There are drugs available for treatment that can stop hair loss. Hair no longer grows in areas that are already bald because the hair roots have already shrunk and this cannot be reversed. Different preparations are sometimes used for women and men. Most of the time, permanent use is required.

  • Treatment for men: The active ingredient finasteride affects testosterone metabolism. It must be taken regularly and over a long period of time. Potency problems are a possible side effect.
  • Treatment for women: Combined hormone preparations (estrogen and progestin) - e.g. the contraceptive pill in younger women - act as an antagonist to testosterone. Estrogenic solutions can be applied locally to the scalp. These only work during their application. Women - especially during pregnancy - must not use finasteride.
  • Treatment in women and men: The active ingredient minoxidil must be dosed lower in women than in men. It is applied locally to the scalp. How it works is not yet fully understood. Minoxidil may expand the blood capillaries due to its antihypertensive effects, thereby promoting blood circulation. In addition, it appears to shorten the resting phase of the hair cycle.

Circular hair loss

Causes: The triggers of the so-called alopecia areata are not exactly known, autoimmunological factors are discussed. The body's own defense cells attack the hair roots. The frequent occurrence within a family also suggests a genetic predisposition. Young people are affected relatively often (around one in 1,000). Especially at this age, the psychological suffering is very high. An important trigger factor for this presumably autoimmune disease appears to be stress.

Symptoms: The main characteristic is suddenly appearing circular hairless areas on the head. Since pigmented hair is mainly affected, those affected often turn gray in a relatively short time. In rare cases, the entire body of hair can fall out (alopecia universalis). The hair can grow back spontaneously after a few months, but then be lost again.

Therapy: Since the causes are mostly unknown, treatment is difficult and often has little or only temporary effect. In some cases spontaneous healing occurs. Various local measures are used to alleviate inflammation at the hair roots, for example:

  • blood circulation-enhancing tinctures, minoxidil,
  • anti-inflammatory drugs,
  • local use of diphencyprone (DPCP) or squaric acid,
  • Irradiation with UV light,
  • oral zinc administration.

Scarring hair loss

Causes: Inflammation of the scalp leads to irreversible hair loss with scarring. The following factors are possible triggers:

  • Physical damage: eg X-rays, burns, chemical burns;
  • Deep infections: mostly with bacteria or fungi, less often with viruses;
  • Autoimmune diseases: e.g. lupus erythematosus or morphea;
  • Unclear cause (idiopathic): chronic, purulent, deep folliculitis (folliculitis decalvans).

Symptoms: Perifollicular inflammation and excessive cornification of the skin (hyperkeratosis) can be found in the area of ​​the scalp hair. Usually scars on the scalp can be seen between the inflamed areas.

Therapy: If possible, a causal treatment - ie usually effective against bacteria or fungi - is carried out. Depending on the severity, glucocorticoids, retinoids or immunosuppressants can also be used.

Diffuse hair loss

Causes: Above all, illnesses, nutrient deficiencies or external damaging influences on the hair itself are triggers, including:

  • After birth or after puberty;
  • Infections: e.g. shingles, erysipelas;
  • Metabolic disorders: eg diabetes, increased blood lipids, diseases of the liver or thyroid, disorders of sex hormones;
  • Deficiency symptoms, for example due to one-sided diets (especially insufficient supply of iron, zinc, folic acid, vitamin B12);
  • Hair-toxic substances: environmental pollutants, drugs (eg chemotherapy);
  • Influences that damage hair: e.g. frequent wearing of headgear, intensive combing and brushing, teasing, tight hairbands, tinting, dyeing, bleaching, perming, frequent washing with alkaline shampoos, hot blow-drying, intensive sun exposure.

In addition, diffuse hair loss can also occur with chronic stress, after childbirth or puberty, seasonally or as a normal age-related process.

Symptoms: The main hair thins overall more and more. When the cause is eliminated, the hair can grow back as long as the hair roots are still intact.

Therapy: treatment or elimination of the cause.

Whom can I ask?

In the event of sudden or prolonged hair loss, you can contact the following offices:

  • General Practitioner,
  • Specialist in dermatology and venereology.

It is advantageous if the doctor has special training and sufficient experience in the treatment of hair loss. Discuss the possible therapy options, their potential chances of success and the associated costs in advance.

How are the costs going to be covered?

In most cases, the costs for therapeutic measures must be borne by the patient himself. The diagnostic clarification of the causes, however, is usually taken over by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB).

However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

From a performance point of view, wigs are qualified as aids. Therefore, the general regulations for the purchase of or the assumption of costs for aids apply. You can find more information under Health Services: Therapeutic Aids & Aids.

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