Scientific Area

Seborrheic alopecia (seborrheic hair loss)

CATEGORIES SCIENTIFIC AREA

Scientific collaboration between Professor Marco Toscani and Dr. Pasquale Fino, Chair of Plastic, Reconstructive and Aesthetic Surgery, Umberto I Health Center – “Sapienza” University of Rome.

Seborrheic hair loss is a form of premature hair loss that generally afflicts men in their youth (onset between 20 and 30 years of age), mainly affecting the frontal region and the crown. The cause, as the name of the condition suggests, is related to an excess production of sebum that provokes or accelerates hair loss. The symptoms that accompany seborrheic hair loss are itchiness, scalp pain and greasy dandruff that flakes.

Cause dell’alopecia seborroica: l’eccessiva produzione di sebo

Seborrheic hair loss is a form of premature hair loss that generally afflicts men in their youth (onset between 20 and 30 years of age), mainly affecting the frontal region and the crown. The cause, as the name of the condition suggests, is related to an excess production of sebum that provokes or accelerates hair loss. The symptoms that accompany seborrheic hair loss are itchiness, scalp pain and greasy dandruff that flakes.

Trattamenti tricologici e cure dell’alopecia seborroica

Excess sebaceous gland activity is caused by hormonal imbalances or by an enzyme named 5-alpha reductase, which converts testosterone into dihydrotestosterone (DHT). The quantity of these converting enzymes and receptors that capture the androgens (testosterone) present on the scalp varies from case to case and influences the amount of sebum that is produced. The seriousness of the seborrheic hair loss depends on how the enzymes and receptors are distributed on the scalp.

Both in men and women, the levels of 5-alpha reductase are much higher in follicles in the temporal, frontal and crown regions than in those of the parietal and occipital areas. The difference lies in the number of receptors in the follicles, which in women is much lower than in men, meaning that they are less subject to seborrhea and greasy hair. In women the defect may nevertheless occur and is generally related to hormonal or digestive disorders. For this reason, in the presence of hair loss accompanied by seborrhea, it is not easy to understand up to what point DHT is the common cause of both phenomena and at what point, in turn, the excess sebum becomes a relevant cause of the hair loss due to its specific ability to obstruct the hair follicles, thereby altering hair growth.

In practical terms, this translates into cases of androgenetic hair loss overlapping and coexisting with seborrheic hair loss. The components of sebum (cholesterol, triglycerides, free fatty acids, squalene and sphingosine) cause an acidification of pH and therefore a metabolic disturbance and cutaneous cell turnover. Moreover, altered levels of sphingosine, an amino alcohol that controls bacterial proliferation, worsen the situation leading to a condition of seborrheic dermatitis.

Another cause of this disease seems to be related to fungus of the Malassezia genus, in particular Malassezia furfur (previously known as Pityrosporum ovale) and Malassezia globosa, present in notable quantities in areas affected by seborrhea. However, no specific relationship with this fungus has been proven yet. An increase in cell multiplication can be observed in the affected areas. The production of sebum does not increase but changes its composition, thus irritating the scalp. Furthermore, the hair can become frizzy, messy, non-uniform and above all very oily. The condition can also involve the face (near the nose, mouth and eyebrows) and the auricle (outer ear). The basic treatment consists of trichological treatments aimed at removing excess sebum thanks to their hygienic and regenerating properties. Low frequency laser, with its hygienic and antibacterial properties, is also very useful for revitalizing the scalp, thereby supporting metabolic activity in hair follicles and bulbs.
Although accompanied by the risk of possible side effects, finasteride may be used as a pharmaceutical therapy.

Dandruff or pityriasis

Dandruff is a scalp condition that usually arises between the ages of 10 and 25. It may improve between the ages of 45 and 55 or may continue during old age.
Its cause is a result of an accelerated turnover of epidermal cells, which following an increase in migration speed, are unable to reach complete maturity before detaching. Whitish-yellow flakes (masses of corneum cells) form and detach, gathering in patches or often spreading evenly across the scalp.

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Damaged hair

Changes in the hair shaft lead to deterioration with the appearance of ruined or damaged hair.
In healthy hair, the cuticle is whole, with overlapping shingles. Hair with whole ends appears shiny, elastic and brushes easily.

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Hyperhidrosis

Excess sweat production on the entire surface of the body or just in some areas (especially the scalp, palms of the hands, soles of the feet) is called hyperhidrosis.
Some of the causes that may lead to temporary hyperhidrosis are physical hyperactivity, fevers, saunas, vomiting and dysentery. Causes that may instead lead to a repeated state of hyperhidrosis are hyperthyroidism, hypoglycemia and alcoholism

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Dry hair

Both men and women of any age may have dry hair. This situation is endured not only as an aesthetic problem, but in time may represent a problem concerning hair health. Dry hair often appears weak, fragile and tends to become brittle and to break.
Dry hair often has split ends and other forms of damage to the shaft.

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Split ends

The phenomenon of split ends, also called trichoptilosis, is a hair problem that depends on an alteration of the hair shaft with concurrent modification and deterioration of the structure, form and physiology of the hair.

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Androgenetic alopecia (pattern hair loss) or baldness

Androgenetic alopecia is the most common type of hair loss and affects the majority of white men, with varying degrees of seriousness. It is less frequent in other ethnic groups. Often it can be associated with a family history of baldness, but the absence of other affected family members does not exclude the diagnosis. The condition is characterized by progressive hair loss in the crown area, the front hairline and the temporal area.

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