제 28 호 Hair loss
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Hair loss
By Myung-Kwan Kang, Editor-in-chief
How do you feel about losing your hair? Hair shedding is a natural part of life, but the situation changes when it develops into alopecia. Many people assume that alopecia is purely a genetic condition that comes with age, but the reality is different. Alopecia affects millions of people worldwide and may impact even more. Often dismissed as a cosmetic concern, its impact goes far beyond appearance. Thinning hair or bald spots can lower self-esteem, trigger social anxiety, and even contribute to depression. In today’s society, where personal image and confidence play a vital role in professional and social life, hair loss has become an increasingly important issue. Let’s take a closer look at alopecia and understand its effects in more detail.
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Types of Hair Loss
1. Androgenetic Alopecia (Male and Female Pattern Baldness)
Androgenetic alopecia is the most common form of hair loss, affecting millions of men and women worldwide. In men, it often starts as a receding hairline at the temples or thinning at the crown, gradually forming the characteristic “M” shape. In women, the hair usually becomes thinner across the entire scalp rather than forming distinct bald patches. This type of alopecia is largely influenced by genetics and hormones, particularly dihydrotestosterone (DHT), which can shrink hair follicles over time.
2. Telogen Effluvium
Telogen effluvium is a temporary form of hair shedding triggered by physical or emotional stress, illness, or hormonal changes. Hair enters the resting phase (telogen) prematurely, leading to noticeable thinning across the scalp. Unlike genetic forms of hair loss, telogen effluvium often resolves once the underlying cause is addressed.
3. Alopecia Areata
Alopecia areata is an autoimmune condition in which the body’s immune system mistakenly attacks hair follicles. This results in sudden, round patches of hair loss, often appearing on the scalp but sometimes affecting other areas of the body. While hair may regrow naturally in some cases, the condition can recur, causing significant emotional stress for those affected.
4. Traction Alopecia
Traction alopecia results from constant tension or pulling on the hair, commonly caused by tight hairstyles such as braids, ponytails, or hair extensions. While early intervention can reverse hair loss, prolonged stress on hair follicles may lead to permanent damage.
Causes and Physiological Mechanisms of Hair Loss
1. Genetic Factors
Genetics play a central role in many types of hair loss, particularly androgenetic alopecia, the most common form of hereditary baldness. Specific genes regulate hair follicle sensitivity to androgens, particularly dihydrotestosterone (DHT). Individuals who inherit these genetic traits have hair follicles that gradually shrink over time, producing thinner, shorter hairs, eventually leading to permanent hair loss. Family history of baldness, especially on the maternal or paternal side, significantly increases the likelihood of developing androgenetic alopecia.
2. Hormonal Influence
Hormones, especially androgens, are critical contributors to hair loss. Dihydrotestosterone (DHT), derived from testosterone via the enzyme 5-alpha reductase, binds to androgen receptors in hair follicles. Excessive DHT levels can miniaturize follicles, shorten the hair growth phase (anagen), and prolong the resting phase (telogen). This mechanism is particularly pronounced in male and female pattern baldness. In women, hormonal fluctuations during pregnancy, menopause, or thyroid dysfunction can also trigger hair thinning.
3. Autoimmune and Inflammatory Factors
Autoimmune conditions, such as alopecia areata, occur when the immune system mistakenly attacks hair follicles, causing sudden, patchy hair loss. Inflammatory responses around the follicles can disrupt normal hair cycling and impair follicle function. Chronic inflammation, whether from autoimmune reactions, scalp infections, or other dermatological conditions, can contribute to both temporary and permanent hair thinning.
4. Nutritional Deficiencies
Proper nutrition is essential for hair follicle health. Deficiencies in protein, iron, zinc, vitamin D, and biotin can compromise keratin production, impair follicle function, and accelerate hair shedding. Malnutrition or restrictive diets, common in certain medical conditions or lifestyle choices, increase the susceptibility to telogen effluvium, a stress-related form of temporary hair loss.
5. Environmental and Lifestyle Factors
Physical and emotional stress can trigger hair shedding by forcing hair follicles into the resting (telogen) phase prematurely. Traumatic events, surgery, severe illness, or psychological stress are common triggers for telogen effluvium. Additionally, exposure to toxins, pollutants, UV radiation, and chemical treatments such as dyes or relaxers can weaken hair shafts and damage follicles.
6. Medication and Medical Conditions
Certain medications, including chemotherapy agents, anticoagulants, beta blockers, and retinoids, can induce hair loss. Chronic illnesses, including autoimmune diseases, thyroid disorders, and systemic infections, also contribute to alopecia. Understanding the patient’s medical history is critical for distinguishing between drug induced or disease related hair loss and other etiologies.
Hair loss occurs through a series of biological processes that disrupt the normal function of hair follicles. One of the main mechanisms is the disruption of the hair growth cycle. Hair follicles naturally cycle through growth (anagen), transition (catagen), and resting (telogen) phases, but in hair loss conditions, follicles may enter the resting phase prematurely and shorten the growth phase. Over time, this imbalance causes hair thinning, increased shedding, and follicle miniaturization, resulting in finer and shorter hairs.
Inflammation, oxidative stress, and altered cellular signaling further contribute to hair loss. In autoimmune-related conditions, immune cells attack hair follicles, impairing normal hair cycling. Reactive oxygen species and other cellular stressors damage follicular cells, while dysregulation of signaling pathways such as Wnt/β-catenin or TGF-β can push follicles into early regression or resting phases. Together, these mechanisms determine the progression, severity, and pattern of hair loss, highlighting the importance of understanding follicular biology for effective treatment.
Hair Loss in Adolescents and Young Adults
In recent years, hair loss has become increasingly common among adolescents and young adults. One of the primary contributors is stress, which can result from academic pressure, employment concerns, or social relationships. High levels of stress can disrupt the hair growth cycle, pushing follicles prematurely into the resting phase, a condition known as telogen effluvium. Studies in Korea indicate that nearly half of young hair loss patients identify stress as a key factor in their condition.
Lifestyle and nutritional factors also play a critical role. Irregular eating habits, restrictive diets, and deficiencies in protein, iron, zinc, or vitamins can compromise follicle health and accelerate hair shedding. Modern youth often adopt high-stress, fast-paced lifestyles with irregular sleep patterns and frequent exposure to hair treatments such as dyes or heat styling, all of which contribute to weakening hair follicles and increasing susceptibility to hair loss.
Hormonal changes and societal pressures further compound the issue. Androgen fluctuations during adolescence, combined with heightened concern over personal appearance driven by social media and societal standards, can exacerbate hair thinning and loss. Experts emphasize that the rise in hair loss among young people is a multifactorial problem, influenced by genetics, environment, lifestyle, and psychological stress.
Why Hair Loss Remains a Persistent Problem
Despite advances in medical research and treatment options, hair loss continues to affect millions of people worldwide, and solutions remain elusive for many. One major reason is the complexity of its causes. Hair loss can result from a combination of genetics, hormonal imbalances, nutritional deficiencies, stress, autoimmune disorders, and lifestyle factors. Because these causes often overlap, identifying a single treatment that works universally is extremely challenging.
Another reason is the variability in individual response to treatment. Medications like finasteride or minoxidil may be effective for some, but not all, and their success often depends on early intervention, consistent use, and adherence to lifestyle recommendations. Additionally, some treatments have side effects that limit long term use, creating further obstacles for patients seeking sustainable solutions.
Finally, misinformation and social stigma contribute to the persistence of hair loss as a societal concern. Many individuals delay seeking professional help due to embarrassment or false beliefs that hair loss is purely cosmetic or unavoidable. As a result, hair follicles may already be significantly miniaturized or damaged by the time treatment begins, reducing the likelihood of complete recovery. Addressing hair loss effectively requires a combination of early diagnosis, individualized medical care, and public education to break the cycle of misinformation and stigma.
Prevention and Treatment Strategies for Hair Loss
Preventing hair loss and managing its progression require a multifaceted approach that extends beyond medications. One key strategy is maintaining scalp and follicle health. Regular scalp care, including gentle cleansing, massage, and avoiding excessive heat or harsh chemical treatments, can improve blood circulation, strengthen follicles, and reduce mechanical stress that contributes to hair breakage.
Lifestyle modifications also play a crucial role. Adequate sleep, balanced nutrition rich in protein, iron, zinc, and vitamins, and consistent stress management through mindfulness, exercise, or therapy help create an internal environment that supports healthy hair growth. Studies have shown that chronic sleep deprivation and prolonged psychological stress can accelerate hair thinning, highlighting the importance of holistic wellness.
Emerging non-pharmacological interventions show promise as well. Low level laser therapy (LLLT), microneedling, and platelet rich plasma (PRP) treatments stimulate follicle activity and improve scalp health without systemic side effects. While these treatments are still being researched for long-term efficacy, they provide additional options for individuals seeking alternatives to traditional drugs.
Finally, early detection and personalized care are essential. Regular monitoring of hair density, follicle health, and underlying hormonal or autoimmune conditions allows for timely intervention. Combining preventive measures with individualized therapies increases the likelihood of maintaining hair density and slowing or reversing hair loss over time.
Hair loss is a complex and multifactorial condition that affects people worldwide, spanning all ages and genders. While genetics, hormones, stress, nutrition, and lifestyle all contribute to its onset and progression, effective management requires a holistic approach. Early detection, personalized treatment, and consistent preventive measures—ranging from scalp care and nutrition to stress management and emerging non-pharmacological therapies—are essential for slowing or reversing hair loss. Moreover, addressing social stigma and misinformation is critical to encourage timely professional intervention. By understanding both the biological mechanisms and the broader lifestyle and psychological factors involved, individuals can take proactive steps to maintain healthy hair and overall well-being.
Sources:
https://www.snuh.org/health/nMedInfo/nView.do?category=DIS&medid=AA000231
Hordinsky, M., & Ericson, M. (2017). Androgenetic alopecia: pathophysiology and treatment. Journal of the American Academy of Dermatology
https://www.kci.go.kr/kciportal/landing/article.kci?arti_id=ART001668658&utm_source=chatgpt.com
https://www.healthline.com/health-news/why-millennials-losing-hair-earlier?utm_source=chatgpt.com
