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Hair Care

Diffuse Thinning: All You Need To Know

What is diffuse thinning?

Diffuse thinning is a common ailment characterized by a general loss of hair throughout the scalp. It can be caused by a plethora of disorders, both acute and chronic. As opposed to localized alopecia areata, which can lead to patchy bald spots, diffuse alopecia areata can make your scalp look easily visible through the alopecia areata.

Diffuse hair thinning can be attributed to a substantial number of follicles entering a dormant telogen hairs phase, which in turn leads to increased shedding and slow to no hair regrowth [1]. It can commence suddenly due to stress or develop progressively as observed in androgenic alopecia.

It can be a distressing condition and directly affects the mental health of a person, especially women [2].

Who can experience diffuse thinning?

Diffuse alopecia is most prevalent in adults but can affect children and adolescents as well [3]. It is a standard complaint in women suffering from telogen effluvium or anagen effluvium.

Men also notice diffuse thinning as one of the initial manifestations of male androgenetic alopecia which eventually advances to male pattern baldness. It is essential to pinpoint the reason behind diffuse hair thinning because it can develop as an indication of a systemic illness in some people [1].

What are the signs of diffuse thinning?

The most common and apparent signs, helpful in the identification of diffuse thinning, are stated below;

Intense hair shedding

We normally shed up to 100 strands of hair per day [3]. An early sign of hair thinning is losing a lot of hair, either sudden or progressive. It can be observed as the presence of more hair than usual on the pillow and hairbrush.

Reduction in hair density

One of the clear manifestations of hair thinning is a loss in hair density and volume particularly near the crown, hairline, and hair part.

Easily visible scalp

People suffering from diffuse alopecia will be able to see their scalp easily through the thin strands especially when the hair is wet and beneath overhead lights.

Pattern of diffuse thinning

The areas of the scalp affected by thinning differ between males and females. Thinning near the hairline, mid-frontal zone, and crown is commonly seen in men while women experience a gradually broadening mid-part with thinning near the crown and vertex scalp starting from the mid frontal point [4].

Recession of hairline

Men with thinning hair due to MPHL will most likely notice an accompanying recession of the hairline and frontal balding in an M-shaped pattern. But it is rarely seen in women with FPHL [5].

Causes of diffuse thinning

The presence of diffuse alopecia in an individual can be attributed to multiple predicaments. Some of these conditions are as follows:

Telogen effluvium

It is a non-scarring affliction that can lead to a sudden loss of hair due to a large number of hair follicles prematurely surpassing into a dormant phase (telogen). Injury, insult, or any change in the body routine, three months before hair shedding began, can indicate the presence of TE.

Although, once the trigger has been managed, hair thinning is expected to cease with the hair follicles re-entering the anagen phase and continuing growth.

Several conditions can induce telogen effluvium in an individual ranging from but not limited to; stress, trauma, diet-related deficiency or crash dieting, postpartum, surgery, and use of certain drugs.

According to a study, out of 100 female patients (aged 14 – 60) who complained of diffuse hair loss, acute telogen effluvium was found as a cause in 92% of women [6].

Chronic telogen effluvium

This condition is responsible for prolonged periods of uncontrolled hair shedding which sometimes lasts for years. The onset of chronic telogen effluvium is correlated with thyroid disease, autoimmune disorder, anemia, and intake of certain medications [2].

It is speculated to be caused by a reduction in the anagen (growth) phase of the hair [7]. Similar to TE, miniaturization of the hair follicles are absent in chronic telogen effluvium and it can be reversed.

In a study involving 180 patients presented with diffuse hair loss, 28 had chronic telogen effluvium [1]. Thinning of hair is not apparent in CTE and is only noticeable after 40 to 50 percent depletion in the hair volume. Another feature absent in CTE but commonly associated with thinning hair is the broadening of the hair part.

Androgenetic alopecia

Androgen-related hair follicle dormancy is suspected to be one of the leading reasons behind chronic and progressive male pattern hair loss. However, the part played by androgens in female pattern hair loss is still vague; gradual miniaturization of the hair follicle is found to be common in both cases.

Androgenetic alopecia has a direct impact on the frontoparietal region which causes diffuse thinning in the center of the scalp, apparent as a wide mid hair part in females [7]. It is frequently observed in individuals who have a genetic predisposition to pattern hair loss.

A differentiating factor between androgenetic alopecia and telogen effluvium is very mild or unnoticeable hair shedding in MPHL/FPHL. Although, it is likely for these two conditions to co-exist in the same person.

Anagen effluvium

It is a non-scarring and abrupt hair loss that ensues during the anagen (growth) phase of the hair. It occurs in the weeks preceding the administration of a specific therapy or certain medications, which can disrupt the hair growth cycle.

Chemotherapy, radiation therapy, and some autoimmune diseases are responsible for the onset of anagen effluvium. It can lead to about 90% hair loss in a short period but is reversible upon the discontinuation of the causative agent [1].

How is diffuse thinning diagnosed?

Diffuse thinning or baldness is usually diagnosed by adopting a systemic approach. Common components of this framework are;

History and examination

In most cases, the etiology is easily detected by taking a thorough history of the patient. A doctor may ask about the onset of hair loss, the intensity of hair shedding, drug history, or any stressful episode that happened in the last 3 to 6 months. A physical inspection of the scalp and observance of any signs indicating hyperandrogenism is also crucial to determine the cause of thinning.

Blood tests

Laboratory studies are usually employed in case a thyroid disease, anemia, and any hormonal abnormality is suspected by the physician. This in turn helps to narrow down the reason behind hair loss.

Hair pull test

It is a less accurate method of determining abnormal hair shedding in a patient. In a hair pull test, a bunch of 50 to 60 hair is tugged with a slight force to quantify how many strands come off the scalp.

Trichogram

This procedure is semi-invasive as it involves plucking a bunch of hair strands and observing their bulbs under a low-power microscope [5]. A trichogram evaluates hair bulbs at various stages of their growth cycle.

Scalp biopsy

It is a dermatological procedure that is performed to differentiate between scarring and non-scarring alopecia. It is used to analyze the hair follicle in detail and multiple scalp biopsies provide a more accurate diagnosis of the prevailing condition [8].

Can you treat diffuse thinning?

The treatment of diffuse thinning depends upon the condition behind this complication. Telogen effluvium and anagen effluvium are self-limiting and reversible disorders [1].

Androgenetic alopecia, on the other hand, is non-reversible but a plethora of medications and procedures are available that can be employed under the guidance of a dermatologist to slow down the progress of female hair loss (and male hair loss) and induce regrowth.

The sooner you intervene, the better are the chances of gaining maximum benefit from the available treatments and therapies.

How to treat diffuse thinning?

Diffuse thinning of hair due to telogen effluvium can be reversed by treating the underlying condition. On the other hand, multiple pharmacological and clinical treatments are available to arrest androgen-related diffuse hair loss. Some of these are detailed below;

Minoxidil

It is an FDA-approved topical treatment that is available in different concentrations (2% and 5%) and forms (liquid and foam). It is responsible for stretching the anagen (growth) phase of hair and improving the hair count and weight significantly [5]. Minoxidil is one of the first-in-line interventions when dealing with patients who have female pattern baldness or male pattern baldness.

You might also want to know: Top Alternatives To Minoxidil Worth Trying

Finasteride

This is a highly effective drug passed by the FDA for use against androgen-related alopecia. It lowers the DHT (dihydrotestosterone) levels on the scalp by inhibiting the activity of the enzyme called 5 alpha-reductase. Dutasteride is a more potent 5 alpha-reductase inhibitor that is used as an alternative in people who fail to see results with finasteride [4].

Spironolactone

This medication is used off-label for its androgen binding capacity and its role in inhibiting ovarian androgen production [5]. Some patients complain about certain side effects when using spironolactone, due to its effect on aldosterone.

Plasma rich therapy

PRP is a clinical process that entails the extraction of a plasma solution rich in platelets from the blood, which is then injected into the scalp. This leads to a release of various growth factors which in turn stimulates new hair growth of the scalp hair [5].

Low light laser therapy

It is a comparatively new approach in the fight against hair loss. Low light laser therapy has shown promising results in some studies but more research is required to understand its mode of action and effectiveness.

Micro-needling

This dermatological treatment is suspected to induce hair growth by making small punctures on the surface of the scalp which can surge the production of collagen and growth factors in the affected area. However, more research is required to prove its efficacy.

Hair transplantation

People with dense hair in the donor site and progressive frontal hair thinning may benefit from this hair restoration method [7]. The treatment involves the extraction of healthy hair from the back of the scalp and depositing them in the recipient (affected) area.

It is important to use any medication or opt for any treatment therapy only under the guidance of a licensed practitioner.

Natural remedies

An abundance of natural remedies and complementary supplements have been targeted for their effectiveness against alopecia. Some of the active ingredients used in these alternative therapies have displayed promising results in the studies done to see their benefits in treating hair loss [9]. A few of these natural products are listed below:

  • Rosemary oil
  • Caffeine
  • Curcumin
  • Melatonin
  • Onion juice
  • Saw palmetto
  • Garlic gel
  • Pumpkin seed oil
  • Vitamin D and B7 (Biotin)
  • Zinc
  • Capsaicin

These active ingredients are effective as a supplement to other hair loss treatments. However, more investigation is required to gauge their efficacy.

Diffuse thinning: A treatable condition

Diffuse thinning is a distressing condition that negatively impacts hair volume and density, resulting in thin and lackluster locks. It can be induced by various disorders responsible for disrupting the hair growth cycle.

Although with early diagnosis and intervention one can slow the progress and even reverse the hair loss in some cases, depending upon the underlying cause. Acute thinning usually resolves on its own, while plenty of medications and therapies are available to counter chronic diffuse thinning.

However, it is crucial to consult with a specialist who can diagnose the reason behind diffuse thinning and advise on the possible treatments tailored to one’s personal needs. Make sure to call emergency in case of an allergic reaction from any of the above treatments mentioned.

Dr. Ahmad Chaudhry M.D.
Dr. Ahmad Fayyaz Chaudhry earned his MBBS degree from Punjab Medical College, Faisalabad, in 2020. During graduation, he enrolled himself in the Dermatology Ward DHQ Hospital Faisalabad for all the necessary training required to pass the bachelor's exam and encounter dermatological diseases daily. Currently, he is posted as a House Physician in the Medical Unit 3 Allied Hospital Faisalabad, where he encounters all kinds of hepatic, cardiac, neurological, and dermatological diseases daily.

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