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Hair loss from trichotillomania

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.

Trichotillomania alopecia: meaning and psychological causes

Trichotillomania is a type of hair loss due to voluntary pulling by the patient which often ends up breaking the hair shaft. In general, the patient twists the hair around a finger.
The gesture is occasional when going to sleep or concentrating on a task, but may become repetitive or obsessive.
It can lead to one or more areas of hair loss, usually in an irregular and bizarre shape. In these patches, the hair appears broken into different lengths, features a normal color and structure and does not detach easily. The most commonly affected areas are the frontoparietal regions of the side corresponding to the dominant cerebral hemisphere.

The condition mostly arises during infancy (men) and adolescence (women). At these ages the phenomenon is an expression of distress, a way to call for attention from the parent. While, if present in an adult, the psychological problem is more serious. Psychiatric disorders such as anxiety, depression, obsessive compulsive disorder and psychosis are to be considered.

Seborrheic alopecia (seborrheic hair loss)

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.

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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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Sebaceous glands

The sebaceous glands are glands that secrete sebum, an oily, acidic substance with a pH of 3.5. They are connected laterally to the hair follicle. Sebaceous glands are found with a density of approximately 100/cm2 throughout all areas of the skin. In the human body, they are located across the entire surface of the skin, except for the palms of the hands and the soles of the feet.

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Hair loss (telogen effluvium)

The term Telogen Effluvium was introduced for the first time by Kligman (*) in 1961 to introduce an acute hair loss of benign origin that follows an intense and short period of stress of different types. Subsequently, Rebora (**) introduced the concept of chronic Telogen Effluvium.

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Hair types and morphology

Some parameters and characteristics should be taken into consideration when assessing hair types and morphologies: shape, density and appearance. The appearance of hair, in the form of lanugo, occurs during the fourth month of pregnancy.

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Alopécia areata

A alopécia areata é uma doença ligada a um distúrbio crônico da imunidade que afeta os folículos na fase anágena (crescimento) e que geralmente causa manchas sem pelos no couro cabeludo e em outras áreas do corpo.

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