Hair loss, however, should be distinguished from normal shedding. Normal shedding, when we lose 50 to 100 strands a day, is considered a natural balance: some strands fall out while others grow in. When this balance is disrupted—meaning that more hair is falling out than is regrowing—it is regarded in dermatology as a disease, specifically hair loss, or alopecia.

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The issue of hair shedding affects both genders and various age groups. There are different types of shedding: some that occur very early, even in childhood, may be linked to atopic dermatitis, others to different metabolic diseases, and some are part of vitiligo. The type most commonly seen in younger populations is alopecia areata, characterized by hair loss in specific areas of the scalp in patches. This phenomenon can also affect eyebrows, the beard area, or chest (in men) and may manifest as universal alopecia when it affects the entire body.

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"What characterizes alopecia areata, regardless of the underlying process, is that the hair follicle is always preserved," explains dermatologist Dr. Jasmina Kozarev. "However, the hair lacks the ability to grow properly and achieve normal morphological characteristics. Therefore, appropriate treatment for alopecia areata in the first instance involves identifying the cause, followed by various stimulating procedures that promote hair regrowth."

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Alopecia areata was once primarily treated with corticosteroids, but this therapy is not causal—it only addresses the inflammation present, which is a consequence. Thus, it treats the symptom, not the cause. Another common technique in treating alopecia areata is PRP (platelet-rich plasma), but there are no official clinical studies confirming its effectiveness. What exists are anecdotal cases. The PRP technique involves extracting platelets from the patient's blood, concentrating them, and then reinjecting them into the scalp.

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Other forms of alopecia are related to damage to the hair during certain growth phases when issues arise in the hair follicle itself. In this context, there are anagen, telogen, and androgenetic alopecias. The latter is associated with the action of androgen hormones and occurs in both men and women. Women, of course, have lower levels of androgen (male) hormones. However, at certain periods in life, they may experience an imbalance, characterized by an increased number of testosterone receptors on the hair follicle, leading to the destruction of the follicle itself. Androgenetic alopecia in women can appear very early, for example, as early as 17-18 years old, and is typical in women during menopause.

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Another aspect of this story is that aging leads to the deterioration of the functional characteristics of the skin around the hair follicles. The environment around the hair changes. These changes are a result of constant, progressive narrowing of blood vessels, which become less perfused, meaning that the amount of active substances reaching the follicles will be minimized. This phenomenon is typical for certain genotypes or families where it is noted that with aging, there is a complete loss of elasticity in the scalp (cranial vault). The skin becomes almost fixed to the scalp, the bony part of the head. This fixation, this fibrosis that occurs, prevents good circulation and blood flow. Almost all individuals with androgenetic alopecia experience some degree of fibrosis in that part of the scalp.

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"And this introduces new elements when it comes to treatments," emphasizes Dr. Kozarev. "An effective treatment does not only involve how to suppress testosterone receptors, which can be done with appropriate hormone therapy, but the environment where the follicle is located must also be changed, along with the surrounding stem cells. Stem cells are most abundant at the base of the hair follicle. If alopecia has lasted a long time (but is not scarring, which is crucial), there is a possibility of finding a stem cell in the basal membrane, which means we can use lasers to stimulate new hair growth. New hairs typically appear within three weeks of the first laser biostimulation session. Sessions are usually conducted once a week for six consecutive weeks, followed by a monthly maintenance schedule where we monitor the regrowth of new hair."

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Dr. Jasmina Kozarev received an award from the European Association of Dermatologists five years ago for her innovative medical technique in dermatology precisely on this topic. However, this was not the end of the story regarding new hair. On the contrary, a new chapter opened: how to keep the newly grown hair healthy and vital. The starting point in seeking solutions to this problem is that hair grows from stem cells. A stem cell is our genome, meaning if we have a genetically higher number of testosterone receptors on our follicle, the same will be present on that newly created hair. The following year, Dr. Kozarev spent her time trying to formulate a protocol to keep this new hair healthy.

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"The first step involved using medicinal techniques to block testosterone receptors," explains Dr. Kozarev. "These are local therapies, not systemic. This is very important, as all men fear that using blockers will have other unwanted effects on testosterone. This concern is understandable, but with these local therapies, the chances of that are absolutely nonexistent. They can be completely at ease in this regard! The second step involves the fact that this newly grown hair is practically a new organ on the skin, so it will require better blood flow and a greater amount of antioxidants, substances that need to act anti-inflammatory, or stimulate growth. This is where we enter the realm of dermatological endocrinology, where nutrition is tailored individually for each patient. We know which are the strongest antioxidants and which can be applied locally or as supplementation, of course, always specifically for each patient. Therefore, the problem of alopecia is very complex. It would be easiest to say that PRP is the best and most effective technique, but simply, it is not the case.

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The combined technique is carried out in four phases: it begins with laser biostimulation, followed by the local application of products that are blockers of testosterone receptors, then the introduction of mineral-vitamin supplementation, and finally, techniques that lead to increased vascularization of the affected area.

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The exceptional effectiveness in treating alopecia at our clinic is based on this technique, precisely defined protocols, and Dr. Kozarev's vast experience, as well as the fact that she formulates the combined technique according to each patient individually.

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In cases of alopecia where the cause is scarring, entirely different techniques are applied. These are scars resulting from traffic accidents or injuries, as well as certain dermatoses that lead to scarring, where hair loss is part of the evolutionary process. If the initial phase of inflammation is addressed before the hair follicle is permanently destroyed, new hair can be created. However, if the scar is older than a year, then the only option is transplantation.

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When it comes to alopecia in women, it most often affects the population over 40 years old, women who have just given birth, those undergoing medical treatments or drug therapies, and ladies whose hairstyles frequently require tight pulling of hair (ponytails, tight braids) or the application of aggressive chemical products on their hair. The causes of hair loss can be numerous (hereditary factors, hair styling methods, extreme stress or shock to the body, toxic substances, certain medical conditions, menopause...)

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Menopause is a specific period in every woman's life that brings many changes. When it comes to hair, typically one of two things happens: either hair begins to grow where we do not want it, or we notice that hair is thinning! One reason for this phenomenon may be the change in hormone levels during menopause. Levels of estrogen and progesterone decline, meaning that androgen (male hormone) levels increase. Other factors, such as stress, possible dieting, as well as heredity, can also contribute to hair loss during this period. During and after menopause, hair may become thinner because hair follicles shrink. Hair grows more slowly and falls out much more easily in these cases. FPHL often means that thinner hair is concentrated on the top and crown of the head.

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SYMPTOMS

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Signs that a patient is experiencing hair loss include:

• Presence of a greater number of strands on the brush, floor, in the tub, on the pillow

• Presence of patches with thinner hair or none, including the area on the top of the head that is expanding

• Noticeably thinner ponytail

• Excessive hair breakage

 

DIAGNOSTICS

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Before determining treatment or therapy, it is necessary to conduct a detailed diagnosis, which in the first phase involves collecting the following data:

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• What medications or supplements the patient may be taking

• What her diet looks like

• Whether the patient has been exposed to recent or current stressful situations

• Is there hair loss in any family member

• What is her hairstyle, i.e., how she usually styles her hair, what products she uses

• Does she have a habit of pulling her hair tight

 

In the second phase, a detailed dermatological examination follows, which includes:

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• A test in which the hair is gently tugged to determine how many strands fall out

• Blood analysis to determine vitamin and mineral levels, as well as hormone levels

• Scalp examination under a microscope

• Scalp biopsy (if necessary)