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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Understand congenital hypotrichosis and its characteristics with Meri Sehat. Gain insights for informed decisions and care.

Congenital Hypotrichosis

Madeeha Syed

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

The Bald Truth

Overview

The bald truth is that hair loss in men can happen easily and quickly, and usually it&#39;s out of their control. While the reasons why hair loss occurs in men are somewhat murky, there are some things that can exacerbate the effects of natural balding. The good news is there are things you can do about it. We&#39;ve compiled a list of several ways for you to deal with baldness if it hits you or your loved ones. 
&nbsp;

Understanding the causes of hair loss

To start off with, lets first understand what causes hair loss in men. These include: 
&nbsp;

<ul>
	<li>Family History: A big chunk of the diseases or the disorders a person face is because of their family medical history. If your family has a history of male pattern baldness, there is a very slim chance for you to escape it.&nbsp;</li>
	<li>Hormones: We know you might feel like every other issue is now blamed on hormones but they have a crucial impact on our bodies. These <a href="https://merisehat.pk/article/what-is-hormonal-acne">hormones</a> are often imbalanced due to some medical condition or medicines that are taken for it that may lead you to lose your hair.</li>
	<li>Stress: This is another culprit of many issues in our body. However, losing hair due to stress is relatively temporary and is reversed in most cases.</li>
	<li>Hairstyles And Treatments: Too much product, styles that pull your hair, etc., may cause traction alopecia and causes your hairline to go backwards. This type of hair loss is permanent in many cases. 
	&nbsp;</li>
</ul>

Options For delay the process

If we are being blunt, there is no cure or a reversal of baldness or extreme hair loss. However, there are several options out there that may either delay the process or provide you with other options to copy with the issue.&nbsp;

&nbsp;

<ul>
	<li>Minoxidil: Originally created to treat high blood pressure, the side effect of the medicine included excessive hair growth with made the experts reconsider the use of the drug and target it towards treating baldness. The results are best shown in people who are 40 or under.&nbsp;</li>
	<li>Finasteride: Finasteride is a drug that can help fight male pattern baldness. It is available in both oral and topical forms, and works by decreasing the amount of DHT in the scalp. DHT seems to cause hair follicles to become thinner, so reducing DHT may help promote hair regrowth and slow hair loss. Unlike minoxidil, finasteride does not affect hair growth on other parts of your body.</li>
	<li>Surgery: If you&#39;re experiencing hair loss, the good news is there&#39;s a treatment for it. The bad news is that it requires surgery. Hair transplantation works for men with male pattern baldness. A hair transplant involves removing hair follicles from the back of the head, where they are resistant to DHT, and placing them on the scalp. As with any surgery, hair transplants carry the risk of complications. The American Society of Plastic Surgeons states that the risks include excessive bleeding and wide scars. Additionally, there is a chance the skin plugs may die, which requires further surgery to fix.</li>
	<li>Laser Combs: Laser combs are a newer form of hair loss treatment. Advocates claim these devices promote hair growth by using concentrated light to stimulate hair follicles. This treatment has mixed results and may work best when combines with other forms of treatment. 
	&nbsp;</li>
</ul>

Hair loss affects all ages, races, and sexes and literally has no boundaries. No one is immune from this epidemic and will eventually witness, if not experience it for themselves. It is an unavoidable fact of life that sometimes the best laid plans, the most fervent prayers or the strongest medications cannot eradicate. While some men see their hair grow back in after years of balding, for others their hair loss is a life long battle. This makes it even more important to live a healthy lifestyle and take active measures to ensure that you are doing everything possible to prevent hair loss.&nbsp; 
&nbsp;

Common Symptoms

Some common symptoms of male-pattern baldness include thinning or receding hairline, excessive hair on the side of the head, slow hair growth and even complete baldness at the top of the head over time. All men may benefit by getting more regular exercise and increasing activity during their free time. It is also recommended to have a balanced diet that includes vegetables, fruits and protein as well as staying away from fast food. Another natural remedy that can contribute to hair re-growth is using coconut oil regularly.

Umna Salah

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

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The Disease That Slapped: Alopecia And Its Daily Life Struggles

Introduction

While the Oscars do not really contribute anything to society, the 2021 Oscars did. The famous Will Smith slap increased awareness for the hair loss disease known as <a href="https://merisehat.pk/disease/alopecia">Alopecia areata</a>. 
&nbsp;

Alopecia is a very common condition that is highly prevalent in Pakistan, especially in males. Men are known to suffer a lot more than women, with around 72% of males suffering from alopecia and only 28% women<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

Alopecia is a complicated disease to understand. It&#39;s not just vanity that makes it so hard to talk about alopecia, but the fact that even though there are treatments available, they aren&#39;t very effective.&nbsp; 
&nbsp;

It is scary because it causes much more than just hair loss; it can negatively impact your self-esteem and overall health.&nbsp; 
&nbsp;

Understanding Alopecia

You might be wondering what it&rsquo;s like to have alopecia. If you have it, you know that it&#39;s hard to explain to people what&#39;s going on and that they don&#39;t really understand. You feel like you&#39;re losing control of your hair, your identity, and sometimes even your emotions when everyone around you is used to seeing a full head of hair on every person they meet. 
&nbsp;

It makes it difficult for people with alopecia to interact with their social circles and at their workplace, where their appearance is seen as an asset or even a sign of professionalism depending on the industry they chose for work (for example, banking).&nbsp; 
&nbsp;

In fact, studies show that employers are more likely to hire someone who looks &quot;attractive&quot;, over someone who is unkempt or disheveled looking. This is because outward appearance is associated with competence and intelligence among others factors such as reliability, which make up part of our overall experience interacting with other individuals within any given social context<a href="#accordion">[6]</a>.

&nbsp;

You feel like you have to explain, defend, or apologize for your alopecia. It&#39;s hard to explain, and even harder to understand. You continue to defend and justify your choices to your friends and family members who haven&rsquo;t walked in your shoes, and don&#39;t know what it&#39;s like living with the condition.&nbsp; 
&nbsp;

And then there are the people who think they know exactly what you&#39;re going through because their aunt/uncle/brother-in-law/dog had some kind of hair loss once. But here&#39;s the thing: just because someone knows someone who has dealt with alopecia doesn&#39;t mean they know what it&#39;s like for YOU personally! 
&nbsp;

It is very common, especially for women who deal with alopecia, to suffer from psychological disorders including depression and anxiety<a href="#accordion">[6]</a>.

&nbsp;

It&#39;s the one part of your body that you can control, and it&#39;s the one thing you can style to show off who you are and how you feel. Your hair is an expression of yourself. It tells people who you are, what makes you happy and what makes you sad.&nbsp; 
&nbsp;

It&rsquo;s been observed that younger people who suffer from alopecia are prone to emotionally suffer from the hair loss the most.&nbsp; 
&nbsp;

There always comes a point where most people completely shave off their head and start owning it, but before that happens, younger females tend to generally get affected by it the most<a href="#accordion">[3]</a>.

&nbsp;

Hair loss is not just vanity, it&#39;s a real medical problem. Alopecia, or hair loss, is a condition that affects millions of people. It&#39;s also the most common autoimmune disease in the world, with around 2% of the population suffering from it<a href="#accordion">[4]</a>,&nbsp;both men and women being affected alike. Not only is this condition very common, it&#39;s one of the most misunderstood conditions people suffer from at some point in their lives. 
&nbsp;

Some people with cancer or other conditions (such as diabetes or thyroid disease) might experience temporary alopecia, which would go away once those underlying health problems have been treated successfully. However, for others who suffer from permanent forms, like baldness, there isn&#39;t much to do, except treat themselves psychologically via therapy sessions.

&nbsp;

It&#39;s obvious that something isn&#39;t right, so people are going to wonder what&#39;s wrong with you. They might ask questions or make comments, and it could be embarrassing when they don&#39;t know why you&#39;re going bald and you do. You would probably want to avoid the topic, but then people would just think there&#39;s something more serious going on if they don&#39;t hear an explanation from you. 
&nbsp;

They might also assume things based on your appearance. For example, if your hair loss is noticeable enough (and not normal), people might assume it&rsquo;s cancer or some other serious health problem &mdash; even though this isn&#39;t necessarily true!

&nbsp;

It is important to note that there are no good treatments for alopecia. There is no cure, and even the most effective treatments have side effects<a href="#accordion">[5]</a>. One of the most common medicines used in alopecia treatment, minoxidil is known to cause contact dermatitis, itching, and even burning in the area where it is applied<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

If you decide to try a new treatment, it&#39;s best to do your research and consult a professional doctor before you commit yourself or spend any money on it. 
&nbsp;

While some people might achieve results with over-the-counter shampoos and moisturizers, these products are unlikely to have any significant impact on your condition. Unless, they are used continuously and consistently over long periods of time. These products also don&rsquo;t serve the purpose if you have severe or advanced hair loss, because they do not address the underlying cause of your hair loss, which is often autoimmune.

&nbsp;

Alopecia is often mistaken for cancer and this could be extremely frustrating. The best way to handle these comments is by saying: 
&nbsp;

<ul>
	<li>&ldquo;It&rsquo;s alopecia. It&#39;s a real disease.&quot;</li>
	<li>&ldquo;Don&#39;t worry, it&#39;s not contagious.&quot; (If you are wearing a hat, take it off)</li>
	<li>&quot;It&#39;s not a choice or lifestyle; I have no control over my hair loss.&quot;</li>
</ul>

&nbsp;

Conclusion

Living with alopecia comes with its own set of struggles that are not just limited to the disease itself. A lot of it is because of how the disease is perceived by the public. However, the newer generation is more progressive and accepting of different appearances of people. Although your alopecia might not be completely curable, or have remission a lot of times, always consult your healthcare practitioner before subjecting your skin or your body to any unknown substances or remedies.

Key Points

<ul>
	<li>2% of the entire world population suffers with this autoimmune hair loss disorder, known as alopecia.&nbsp;</li>
	<li>In Pakistan, around 72% of the sufferers are men.</li>
	<li>Alopecia is known to cause severe self-esteem issues.</li>
	<li>Psychological disorders, like depression and anxiety, are common complications of alopecia, but there is no definite scientific connection between the two.</li>
	<li>Public perception of the disease is very different. The patient might experience discriminating attitude, particularly in professional settings where their hiring rate is impacted due to their appearance.</li>
</ul>

&nbsp;

[1] Amer Ejaz, K. J. M. S., 2009. Pattern and profile of alopecia areata in Pakistan. Journal of Pakistan Association of Dermatologists , 19(3).

[2] Drug Office - HK, 2016. Drugs for Alopecia. [Online]  Available at: https://www.drugoffice.gov.hk/eps/do/en/consumer/news_informations/dm_35.html#d [Accessed 11 Aug 2022].

[3] Healthtalk.org, n.d. Alopecia (young people).

[4] Miteva, A. C. V. F. a. M., 2015. Epidemiology and burden of alopecia areata: a systematic review. Clin Cosmet Investig Dermatol., Volume 8, pp. 397-403.

[5] N., H. A.-M. ·. J. M. ·. A. M., 2019. Complementary and Alternative Treatments for Alopecia: A Comprehensive Review. Karger, Volume 5, pp. 72-89.

[6] Nigel Hunt, l. i. a. p. a. S. M. s. l. i. b., 2005. The psychological impact of alopecia. BMJ, 331(7522), pp. 951-953.

Congenital hypotrichosis is described as being born with less hair than normal<a href="#accordion">[1]</a>. 
&nbsp;

Unlike alopecia where there&rsquo;s hair loss, hypotrichosis is a condition where there&rsquo;s no hair growth. In congenital hypotrichosis, babies are born with less hair than would appear to be normal at birth. However, in newborns, the amount of hair can range between extremes and still be considered normal.

Congenital hypotrichosis usually results from a genetic mutation, or abnormality during embryonic development. Worldwide, 1 in 10,000 individuals suffers from the disease<a href="#accordion">[2]</a>. 
&nbsp;

Understanding  Congenital Hypotrichosis

Some common types of congenital hypotrichosis are:

<ul>
	<li>Congenital Aplasia (Aplasia Cutis Congenita) - This is an embryonic developmental defect where the skin fails to form. The baby is born with a skin patch resembling an ulcer or open wound, often at the center of a &lsquo;whorl pattern&rsquo; of hair growth. Over time, the skin may scab and form a scar. However, in the case of a large patch, surgery may be needed to close the wound.</li>
	<li>Triangular Alopecia - It is quite similar to congenital aplasia, except it occurs in a triangular patch of skin over the temple. Hair follicles in that triangular patch may fail to grow. However, unlike congenital aplasia, there are no open ulcers on the patch. Doctors often transplant the donor&rsquo;s hair follicles onto the affected area.</li>
	<li>Congenital Atrichia - Also called papular atrichia, this condition is characterized by an absence of a patch. The child usually loses all of their hair early in childhood, and the hair never grows back. This occurs due to the hair follicles entering the telogen phase in the early stages of childhood. Researchers believe it results from a single gene defect. 
	&nbsp;</li>
</ul>

Depending on its distribution, congenital hypotrichosis can be classified as regional or general. 
&nbsp;

Typically, children are born with no sign of hair growth, not only on the scalp but also on the eyebrows or skin. In some cases, the child experiences unusual hair fall within one year of birth. Moreover, in cases of congenital aplasia, the baby will have open ulcers or wounds on the scalp. However, in some cases, children are born with short, fine hair at birth.

Other common signs and symptoms of congenital hypotrichosis are:

<ul>
	<li>Keratosis Pilaris</li>
	<li>Pruritus of the scalp</li>
	<li>Scarring of the scalp</li>
	<li>Loss of hair all over the body 
	&nbsp;</li>
</ul>

Furthermore, due to the loss of hair, children are more susceptible to infections and sunburn. 
&nbsp;

Several other conditions can also cause hypotrichosis. These include:

<ul>
	<li>Marie Unna hypotrichosis</li>
	<li>Graham-Little Syndrome</li>
	<li>Ofuji Syndrome</li>
	<li>Cartilage-hair hypoplasia</li>
	<li>Jeanselme and Rime Hypotrichosis</li>
	<li>Metaphyseal Chondrodysplasia</li>
	<li>Scalp nevi 
	&nbsp;</li>
</ul>

Based on the association with other conditions, children may be born with the following features:

<ul>
	<li>Skin, teeth, and nails abnormality</li>
	<li>Deafness</li>
	<li><a href="https://merisehat.pk/disease/epilepsy">Epilepsy</a></li>
	<li>Errors of Metabolism</li>
	<li>Skeletal abnormalities 
	&nbsp;</li>
</ul>

Hair loss not only affects an individual on a physical level but also psychologically. Children with congenital hypotrichosis often experience mental health issues due to insecurity regarding their appearance. 
&nbsp;

Congenital hypotrichosis results from genetic abnormalities or defects during embryonic development. These abnormalities interfere with the functioning of hair follicles.

A normal hair growth cycle has three phases: the growing phase (anagen), the regressing phase (catagen), and the resting phase (telogen). In congenital hypotrichosis, the hair follicles enter the telogen stage early in childhood. This disrupts the communication between the modified keratinocytes and fibroblasts. The lack of communication does not let a new anagen phase start. Thus, the hair is unable to grow. 
&nbsp;

There are no specific screening tests for congenital hypotrichosis. Doctors usually rely on a child&rsquo;s clinical presentation to confirm their diagnosis. 
&nbsp;

The diagnosis of congenital hypotrichosis depends on the clinical history and physical examination. At the time of delivery, the child may lack hair on the scalp, eyebrows, and skin. However, in some cases, the child may experience unusual hair fall within the first year. In congenital aplasia, a patch with ulcers of wounds will be present on the baby&rsquo;s scalp. 

Doctors may also conduct hair microscopy to identify the stages of the growth cycle for the hair samples. 
&nbsp;

Since it results from a genetic alteration, there is no cure for congenital hypotrichosis. However, in some cases, such as triangular alopecia and congenital aplasia, the abnormal patch may be surgically removed and implanted with hair follicles from a healthy donor. 
&nbsp;

The permanent loss of hair can predispose one to infections and sunburn. 
&nbsp;

Congenital hypotrichosis is a genetically transmitted disease, so any family history can make the offspring susceptible to this disease. However, many cases occur without any family history of the condition. 
 
&nbsp;

Since congenital hypotrichosis results from genetic abnormalities, there are no known preventive measures. Parents with children suffering from congenital hypotrichosis can be referred for genetic counseling to determine their risk of passing it on to further offspring. Moreover, it can help determine whether hypotrichosis is part of a syndrome.&nbsp; 
&nbsp;

Key takeaways

<ul>
	<li>Congenital hypotrichosis is characterized by congenital hair follicle deficiency. Children are born with less hair than normal. However, the amount of hair in a newborn child can vary between extremes and still be considered normal early in life.</li>
	<li>Unlike alopecia where there&rsquo;s hair loss, hypotrichosis is a condition where there&rsquo;s no hair growth.</li>
	<li>Congenital hypotrichosis usually results from a genetic mutation or abnormality during embryonic development.</li>
	<li>Typically, children are born with no sign of hair growth, not only on the scalp but also on the eyebrows or skin. In some cases, the child experiences unusual hair fall within one year of birth. Moreover, in cases of congenital aplasia, the baby will have open ulcers or wounds on the scalp.</li>
	<li>The permanent loss of hair can predispose one to infections and sunburn.</li>
	<li>There are currently no treatments available for congenital hypotrichosis.</li>
</ul>