Alopecia, digital reality and numerical evidence
Dr. Eduardo López Bran, head of the Dermatology Service at the Hospital Clínic Universitari San Carlos, surgeon and specialist in trichology and hair transplantation, How can we find out what clinical situation our hair is in, especially when baldness rears its stubborn head Fringe and sassy in the crown?
“With the naked eye it is impossible to distinguish in which phase of their life cycle the hair follicles are”, he underlines.
“We must always resort to the digital trichoscope; a state-of-the-art device that combines the epiluminescence microscopy and the capture of high-definition images, aided by intelligent computing,” he answers.
With the trichoscope, eight unquestionable parameters of high diagnostic accuracy are obtained. And even then, it won’t be enough.
“To find out the type of alopecia that afflicts the patient, since there are 150 causes, the dermatologist will have to have a detailed and meticulous clinical history beforehand and have carried out a conscientious trichological examination”, he adds.
Digital trichoscope to determine the origin of each alopecia
Each hair on the scalp or on our body completes a cycle, called the hair follicle cycle.
The cycle fulfills three phases: phase anagen, growth that lasts approximately between two and six years; phase catagen, transition with weakness over a period of a few weeks; and phase telogen or hair loss, which lasts between three and six months.
“At the end of each cycle, a new one begins, as our body hair is in constant renewal. It is a progressive replacement: hair by hair”, he says.
People don’t keep old hair. This hair shedding process is carried out gradually so that we are completely naked from the point of view of follicular protection.
“In cases of baldness, the key to alopecia is centered on this periodic renewal or cycle. The hair will grow finer, shorter and less pigmented,” he explains.
Since there are different types of alopecia, up to 150, and more than one can coexist in the same patient, it will be necessary in many cases to use high-precision digitized trichoscopy to establish the type of alopecia that a person suffers from and the corresponding evolutionary grade.
Case study: the EFESalut journalist loses his hair
In a trichoscopic examination, the details and characteristics of both the scalp and the hair are observed. It is a basic and indispensable examination to confirm 100% the origin of hair loss.
The biologist and researcher specialized in alopecia, Lorena Pozo Pérezof the Hospital Clínic Universitari San Carlos, performs the diagnostic test with a video dermatoscope “DermoGenius ultra polarized“, with polarized light.
The dermatoscope uses a German-made optical system in combination with a five-megapixel camera. The system offers high-resolution images that exceed Full HD. In addition, handling is intuitive and the weight (220 g) guarantees ergonomic operation.
“The technique is very simple. The dermatoscope that connects to a computer (PC) via a USB or HD connection. In this way we will capture the images in the study area obtaining eight fundamental parameters, which will be of great help in evaluating the patient’s hair conditions”, he emphasizes.
How is the procedure carried out?
We define the area to be evaluated, in this case the crown area. A template with a circumference of one centimeter in diameter is placed. This shaved area is then stained with a special dye to facilitate trichoscopic analysis, so that the capillary image is much sharper.
Then the rest of the dye is removed, the study area is sanitized and high-resolution digital photographs are taken.
The trichoscope will provide us with eight parameters: capillary thickness, density, percentage of downy hair and terminal hair, as well as its own density; also the percentage of hairs in the anagen phase and in the telogen phase.
In fact, knowing the total number of hairs in the target area, studied area, is one of the keys to making a personalized follow-up of the patient’s hair loss and the state of conservation or possible subsequent hair gain; that is, how alopecia develops.
Lorena Pozo Pérez, biologist and researcher.
The results of the digital trichoscope are instant: androgenetic alopecia
“The data that the trichoscopic evaluation offers us are really strong: the passage of time, genetic predisposition and hormonal factors confirm an androgenetic alopecia or incipient common baldness”, says Dr. Eduardo López Bran.
Hair under androgen attack has a special sensitivity to male hormones (testosterone and dihydrotestosterone), even if these hormones are found in normal levels in the blood.
“The continued effect of these male hormones on the hair bulb receptors causes hairs to become weaker and smaller while progressively shortening their growth cycle,” he describes.
They also influence or affect diet or stress, in addition to other environmental factors.
“In general, the life we lead is conducive to hair loss, already latent, being put at cruising speed due to a combination of factors,” he warns.
Comparative table between the parameters of capillary normality and the case in the study: the values of the digitized area of the EFESalut reporter.
“Digital trichoscopy, it is clear in the case, offers a set of data of absolute precision that will join the clinical assessment of the specialist to obtain both a precise diagnosis and the most appropriate treatment for the control of the loss of hair,” says the Galician dermatologist, expert in hair microsurgery.
Treatment cannot be indicated without a correct diagnosis of alopecia
This trichoscopic tool is also very useful for monitoring the patient’s progress, objectively establishing the appropriate responses to the various treatments.
“It will allow us to rule out that there is another type of associated alopecia and it will also help us compare each moment of the alopecia process associated with the corresponding treatment: if it is effective and to what extent,” he points out.
“Digital trichoscopy is not a subjective, visual impression, both of the specialist and of the patient himself. They are clear, precise data that allow us to make a precise diagnosis”, he emphasizes.
How to stop losing hair or regrow hair
All anti-baldness therapies are developed and tested under the microscope of scientific research, and have demonstrated their effectiveness and good safety profile.
Treatments in the topical presentation maintain a moderate and limited effectiveness, so they are usually used in mild cases. Oral dosing has shown more effectiveness than topical use (lotion or cream).
For example, treatments infiltrated through mesotherapy become a complement, since they enhance the effects of the same drugs in oral doses.
“And all of them demonstrate a very good safety profile, which is explained to each patient before the guideline, and they generally do not cause problems or side effects”, he puts the white on white.
Even so, it is advisable to carry out correct hair hygiene, day after day and week after week; and, at the same time, help the hair follicle with a diet rich in vitamins, trace elements and amino acids, fundamental constituents of hair keratin.
“In your case, Gregorio, with incipient androgenetic alopecia, we can stop or delay hair loss with pharmacological treatments: Finasteride, Minoxidil and Dutasteride. Also with platelet-rich plasma (PRP) and low intensity laserrelates
“We can also offer you one hair transplant“, he adds.
“With individualized capillary microsurgery definitive results are achieved a appropriately selected patients: men and women will be very satisfied because the operation is undetectable and their aesthetic image will have been rejuvenated, since age does not forgive”, concludes Dr. Eduardo López Bran.