FAQ

Health insurers will reimburse the costs of a consultation (in whole or in part) if the Intermedica Kliniek invoice mentions a referrer. If you want to be eligible for reimbursement, you must bring a referral from a general practitioner or specialist.

See also the answer to the question: "Does my health insurer reimburse the Intermedica Kliniek invoice" elsewhere on this page.

However, you can also make an appointment without a referral letter from your GP or specialist. In that case, the consultation costs are entirely at your own expense.

An appointment at the Intermedica clinic for diagnosis and treatment is almost always possible within 10 days.

Intake & analysis during a hair consultation

During your first visit you will be welcomed by one of our employees. He or she will ask you about the questionnaire that you will have received by post or e-mail with the written confirmation of your appointment. An electronic patient file (EPD) is prepared based on this questionnaire. This is followed by an intake interview in which the questionnaire is used as a guideline. During this intake interview, a number of photos are taken of your hair, these form the basis for a hair count and determination of the hair status.

A blood sample is then taken for research into your general health and causes of hair abnormalities. This involves measuring: GPT (liver function), glucose (sugar), and hemoglobin (iron). After analysis, the EPD is supplemented with the findings.

Consult with a dermatologist

You will consult a specialized dermatologist in the second part of your visit. This person may perform an additional physical examination of the head and will discuss his/her diagnosis with you, provide treatment advice and possibly prescribe medication. A doctor/consultant will provide part of the explanation. The supervising dermatologist is always ultimately responsible for the diagnosis and treatment proposal.

Administrative

Upon your departure, you will receive information from the receptionist about prescribed medicines, a folder with a copy of the report letter that we also send to your GP (and, if applicable, another referrer) and the consultation invoice.

The total duration of a first consultation is approximately one and a half hours.

Knowing more? Read this blog post: "Intermedica appointment: This is what you can expect"

A doctor may only prescribe a medicine if he/she has ensured that the medicine will be effective. This requires you to come to the clinic for an examination. The starting position is also recorded so that we can properly assess the progress of the treatment and make timely adjustments if necessary. A specialized dermatologist will discuss the treatment with you.

Following your visit, one of our doctors may prescribe a prescription medicine. Prescription medicines are supplied by a pharmacy. In the case of a repeat prescription, you can then call, email or use the request repeat prescription function on this website. So you don't have to come to the clinic again and again for this.

If you are unsure whether you want to come to the clinic to consult a doctor about your hair problem, you can opt for a nutritional supplement that is available without a prescription. You can find these in our Dermatheek online store. The composition of each nutritional supplement is included in the description.

A hair root examination, in which hairs are pulled from the scalp and studied under a microscope, is not necessary. First and foremost because hairs actually have to be pulled randomly from the scalp. If you have a long, thick hair in your hand you will not pull it out because there is nothing wrong with it. In this way, the thin hairs are overrepresented in the study, which has consequences for the results. Even the very small hairs are not plucked out because they are overlooked. In addition, the analysis takes a lot of time and a patient must return for the results.

In the Intermedica Clinic, microscopic photos are taken on which counts and thickness measurements are made. This gives a much better picture, the measurement is reliable, gives a realistic picture of the hair abnormality and can be carried out quickly. The fact that the hair does not have to be pulled out of the scalp appeals to both the patient and us!

Hairs have the fastest dividing cells in the body. Iron is needed as a coenzyme for the division process. By replenishing the iron reserves in the liver, hair loss due to iron deficiency is prevented.

The loss of long hair almost always concerns the normal change of hair. Because the hairs are long, we assume that they have grown out (are in the telogen phase), after which they fall out and are replaced by new hairs. This concerns normal hair changes that will never make you bald. However, it is possible that there are periods in which more hair changes than average. In case of severe hair loss we speak of a telogen effluvium. Because this often occurs with low iron levels, the dermatologist will prescribe iron tablets.

There is a period of three months between shedding a hair and it falling out. The hairs that are falling out today were shed three months ago. The iron tablets may not have had any influence on this yet. Normalization of hair loss can only occur three months after starting iron tablets. It usually takes several months to sometimes a year before complete normalization occurs.

All people who come to the clinic with the complaint of “hair loss” or “excessive hair loss” are checked to see whether iron deficiency is a possible cause. This is determined by measuring the hemoglobin in the blood. If the hemoglobin is too low, iron is usually prescribed. If the hemoglobin is good, iron deficiency cannot be a cause of hair loss. If another cause of the hair loss is subsequently identified, such as androgenetic alopecia, the hemoglobin will no longer be determined during a follow-up examination.

The cost of a hair consultation is 195 euros (from 1 July 2023 €215). Answering questions, handling complaints and prescribing (repeat) prescriptions is included in the consultation rate for a period of one year after the first visit date.

Interim visits to the clinic are included in the consultation rate for the first DBC up to 120 days after the first visit date. Interim consultations are only agreed on the basis of a prior (telephone) consultation or initiative of the dermatologist.

Approximately one year after the start of a treatment, a control consultation follows and the treatment results (based on photos, hair thickness and hair density measurements) are compared with the situation at the time of the first visit. The cost of a check-up consultation (new DBC) is 195 euros (from 1 July 2023 € 215)

Costs of medicines prescribed following a consultation at the Intermedica Kliniek are of course not included in the consultation costs.

Consultation fees must be paid at the time of your visit. You can pay by card, but cash payments are also accepted. You will receive a DBC invoice that you can submit to your health insurer.

RATES from 01-01-2023

First visit rate (new DBC): €215

Interim check-up rate up to 120 days after the first visit (doctor's initiative): free of charge

Control visit rate (new DBC): €215

An invoice from the Intermedica Kliniek is only reimbursed by health insurers when a consultation takes place following a referral from the general practitioner or a medical specialist. The reimbursement can be full or partial, because the percentage paid out depends on the health insurance you choose.

Your health insurer bases the reimbursement on the passer-by rate (see our rates).

As with all medical costs, the reimbursement paid by the health insurer will be offset against your deductible.

Every health insurer is legally obliged to reimburse the agreed part of the visitor rate. (Healthcare Act, Article 13) This provision is stated in your basic health insurance. If you want to know what percentage of the passer-by rate your health insurer reimburses, you can contact them and inquire. If there is a residual percentage, this is your own contribution.

This scheme is applied if there is no healthcare purchasing agreement ('contract') between a clinic and a health insurer. The Intermedica Kliniek does not have a healthcare purchasing agreement with health insurers.

If you inquire with your health insurer, ask the question: “What percentage of the rate of a non-contracted care provider is reimbursed?” You may need the following information:

AGB code Intermedica Kliniek: 22.220300

NZA number: 291-0160

Declaration code (DBC code): 15C632 hair and nail abnormalities/mild ambulatory/adnexal skin

Care activity code: 190060

Healthcare product code: 120701027

You will be seen by a dermatologist during a consultation.

The invoice you receive from us contains all the information required to enable a declaration to the health insurer.

Making an appointment without a referral is also possible. The consultation costs are then at your own expense.

It is not necessary for you to bring a new referral for a repeat consultation or check-up. You can submit the invoice for the check-up appointment to your health insurer.

Medicines for hereditary baldness (androgenetic alopecia) are almost never covered by health insurance. You must take into account an amount of approximately €50.00 per month.

Medicines for non-hereditary hair diseases are usually reimbursed by basic insurance. You still have to take into account the deductible of your health insurance, which means you still have to pay part of the medication yourself.

In almost all men, the hairline at the front is interrupted between the ages of 12 and 22, causing so-called inlets. In fact, it is part of a masculine appearance because the development of indentations is much less common in women. If the inlets do not become larger after about 22 years of age, there is no problem. It's just part of it.

If the inlets become larger, hereditary baldness may occur. The inlets “grow” towards each other and the crown also becomes thinner. You can tell whether the inlets are getting bigger by looking at the hairline there. There are many thin, short hairs on the hairline, which means that the hairline is no longer tightly defined. If this is the case with you, it is advisable to make an appointment for an examination. The situation can then be assessed and it will be checked whether the process can be stopped.

Everyone's hair becomes thinner over time. However, if the hair falls out excessively within a relatively short period of time, two causes can generally be identified.

If the hairs that fall out are thick and have the length of the hairstyle, there may be a telogen effluvium. Due to an event three months before the start of excessive hair loss, the hairs that are at the end of the growth phase and are about to shed are shed en masse. In fact, this is a natural process and the hair will recover over the course of a year. Recovery can be accelerated by targeted use of a nutritional supplement. You can read more information and treatment options for telogen effluvium elsewhere on this website.

If the fallen hair is predominantly thin and short, the scalp becomes visible, a widened middle parting occurs and/or the ponytail becomes thinner, there may be a hereditary cause (androgenetic alopecia). Hair loss leads to permanent baldness, but can be slowed down by various means. You can read more information and treatment options for androgenetic alopecia elsewhere on this website.

Hair loss is normal when an average of 80 to 100 hairs fall out per day. This concerns the long hair (hair with the length of the hairstyle) that has reached the end of the groove phase after four to five years of growth. These hairs may temporarily fall out more than normal due to circumstances (extreme heat, extreme cold, anesthesia, stress, weight loss, etc.). Such a circumstance occurs three to four months before the start of excessive hair loss. Hair loss usually normalizes again within six months, but sometimes it takes longer. There is nothing you can do about a telogen effluvium, as this type of hair loss is called, because it is normal hair loss. If hair loss continues for too long, you can consider using a targeted nutritional supplement.

If, in addition to long hair, many short, thin hairs also fall out, there may be hair loss due to heredity (androgenetic alopecia). The first manifestation of this is a widened center parting and/or a thinning ponytail in women, deeper inlets and a thinning crown in men. This hair disorder leads to permanent hair loss and baldness. An expert dermatologist can examine and diagnose this. If there is androgenetic alopecia, it can be inhibited with a lotion or stopped with a medicine.

If the hair no longer grows properly, it must be determined whether the growth cycle of all hairs has been shortened once or whether some of the hairs lose length with each change.

If the haircut keeps getting shorter, the hair that has fallen out is predominantly thin and short, the scalp becomes visible, a widened middle parting occurs and/or the ponytail becomes thinner, there may be a hereditary cause (androgenetic alopecia). The hair loss leads to permanent baldness. Hair that has been affected (short and thin) may possibly be saved by using a medicine. An expert dermatologist can examine and diagnose this.

Due to drastic treatment, for example, chemotherapy, hairs that normally grow to 60 cm in length may only reach a length of 20 cm or less. The hair then retains this length. This situation does not require treatment.

Each hair follicle can produce a new hair approximately twenty times.

A calculation example:

If a hair continues to grow for five years (and can therefore become approximately 50 cm long before it changes), only 9 hair germs have been used at the age of 45. The hair follicles can therefore still produce 11 hairs. This means that the hairs that are now falling out will all be replaced by new ones. It takes about three months for the successor to emerge through the skin. The hair grows about 1 cm per month, so it takes another year from the breakthrough before the hair grows back to its length.

This does not apply to the extremely short hairs (smaller than 1 cm) that arise from a condition such as androgenetic alopecia. With this condition, the life cycle of a hair is greatly shortened and hairs are exchanged more quickly. When many hair follicles have used up all the hair germs, you will notice this in a thinner head of hair. Certain medicines, such as finasteride and dutasteride, can ensure that the hair has a 'normal' life cycle.

Many women come to the Intermedica Clinic who indicate that their hair is "breaking off". Closer examination usually shows that they come to this conclusion because they see many short hairs among the normal hairs. Then it is often the case that these hairs are not broken off, but simply no longer grow before they change.

And that is a characteristic of hereditary hair loss: the hair becomes thinner and the hair loss is permanent.

Another possibility is that you lose a lot of your long hair so that the number of short hairs is relatively overrepresented. This is not likely because you would notice the excessive loss of long hair.

There is a hair disorder in which the hair breaks off at "knots" in the hair. You can sometimes feel these knots when you let a hair slide between your fingers. It is a very rare hair disorder.

Hair is almost never permanently damaged by chemotherapy. A hair changes once every five years. Normally, 20% of the hair changes every year, which means that changes occur very slowly, especially due to aging and hereditary hair loss. In the case of chemotherapy, 100% of the hairs change, after which all hairs that would have disappeared or reduced in size over the course of five years now undergo these processes over the course of six months.

Under normal circumstances, a head of hair changes very gradually. Thinning of the hair is an example of this. A hair does not thin during the growth phase. In the case of hereditary baldness (androgenetic alopecia), a hair that changes at the end of a growth phase is succeeded by a hair that is slightly thinner than its predecessor, and its successor is also thinner and shorter.

Due to the anagen effluvium, and therefore due to the chemotherapy, the growth phase of all hairs is abruptly interrupted, after which the successors, if hereditary predisposed to this, can all become thinner at the same time. In other words, if you had not been treated with chemotherapy, your hair would also have become thin (and/or gray), but only over a period of five to seven years. It is quite possible that there is androgenetic alopecia. You can have this investigated.

After chemotherapy, the hair can disappear completely while it is still in the growth phase. This is called an anagen effluvium. The growth phase is interrupted and the hairs are shed.

After chemotherapy ends, the hair follicles will start producing hair again and in principle you will get back the same hair that you had before chemotherapy. However, depending on heredity, the hair can also return differently.

Under normal circumstances, a head of hair changes very gradually. Graying and balding/thinning of the hair are examples of this. A hair does not turn gray during the growth phase. When a hair changes at the end of a growth phase, the successor is slightly grayer than the predecessor, and the successor is also grayer. This also applies to thinning and balding hair due to hereditary baldness (androgenetic alopecia). At the end of the growth phase, a hair is followed by a hair that is thinner and grows shorter, and this in turn is followed by a hair that is even thinner and grows even shorter.

Due to the anagen effluvium, and therefore due to the chemotherapy, the growth phase of all hairs is abruptly interrupted, after which the successors, if hereditary predisposed to this, all become grayer and thinner at the same time. In other words, if you had not been treated with chemotherapy, your hair would also have become thin and/or gray, but only over a period of five to seven years. It is quite possible that there is androgenetic alopecia. You can have this investigated.

The chance that a medicine will cause excessive hair loss is not high. There may be another cause. The disease itself for which you are using the medicine could already be a cause, but hereditary baldness (androgenetic alopecia) can also be the cause. Hair loss due to illness or stress leads to a homogeneous thinning of the hair (the same amount of hair loss in all places). Androgenetic alopecia leads to local thinning, especially on the center parting, sometimes above the ears and on the back of the head.

If the drug is successful you should not stop taking it unless it is absolutely certain that this is the cause of the hair loss. You can have it investigated to determine what the cause of your hair loss is.

A hair root can produce about 20 hairs, after which it is exhausted (no longer has stem cells) so that new hair can no longer grow. The hair root then disappears (and because it is no longer there, you cannot make the hair root return!).

AIf the hair root has not disappeared, but decreases in volume due to the DHT hormone, the successive hairs become thinner and shorter. This process can be reversed by the use of DHT inhibitors. The hair roots then become thicker and grow longer. This means that the hair changes less often and hair loss also decreases. The hairs become thicker and longer over three years of use.

If a hair root is already very small (and has migrated to just under the skin), only a few small, thin hairs emerge, after which the hair root is exhausted.

Microscopic photos are taken in the Intermedica Clinic on which counts and thickness measurements are made. This gives a good picture, the measurement is reliable, gives a realistic picture of the hair abnormality and can be carried out quickly. We can use the thickness measurements to predict what effect you can expect from a treatment and, during a check-up, to see whether the treatment is effective.

Hair pain can have various causes. First of all, it may be because hair follicles become massively smaller. The shrinkage then causes the pain. This is a common problem with hereditary baldness (androgenetic alopecia). Treatment with a DHT inhibitor, which stops the hair follicles from shrinking, can then solve the problem.

A second cause is superficial inflammation or irritation of the skin. This could be a yeast (seborrheic eczema, which causes dandruff) or a bacteria. The pain can be reduced by applying a corticosteroid cream.

To a lesser extent, hair pain occurs as a symptom of an autoimmune disease. This is an abnormality of the immune system that causes hair follicles to be attacked as if they were foreign substances. Treating this can reduce the pain.

You can have the cause of your hair pain examined at the Intermedica clinic.

Schilfering van de hoofdhuid kan diverse oorzaken hebben. Een daarvan is seborrhoisch eczeem (roos), dat wordt veroorzaakt door een gist (een soort schimmel). In dat geval zou ketoconazol een werkzaam middel moeten zijn. Maar schilfering kan bijvoorbeeld ook komen door psoriasis of eczeem. Schilfering van de hoofdhuid is vrijwel nooit een oorzaak van haarverlies. Als je duidelijkheid wilt over de oorzaak van de hoofdschilfers en over de behandeling ervan, is het raadzaam om een afspraak te maken voor een onderzoek door een van de dermatologen van de Intermedica Kliniek.

Dandruff is caused by a yeast, a type of fungus. Yeast particles try to penetrate the skin and the scalp reacts with flaking.

Ketoconazole removes the yeasts. You always combine this product with an anti-dandruff shampoo. After using the anti-dandruff shampoo, apply it to the scalp for ten minutes.

You use it three times during the first week.

The second week you use it twice and wash your hair once with an anti-dandruff shampoo

The third week you use it once and wash your hair twice with an anti-dandruff shampoo.

Then wash your hair three times a week with a good anti-dandruff shampoo. Make sure that the shampoo is on the scalp for at least five minutes. The longer the contact with the scalp, the better the effect against dandruff.

If even a few yeast particles remain, they can start to multiply again and the rose will return. That is why it is a good idea to wash your hair with the anti-dandruff shampoo for at least six months, preferably longer to remove all yeasts. There is also a risk of reinfection from caps, hats or other head coverings, combs, clips, etc.

Do you want more information? Make an appointment for an examination.

Hair loss due to stress is common in both women and men. This is called a telogen effluvium.

A telogen effluvium can be a result of physical or psychological stress, such as high fever, infections, anemia, surgery, an accident, emotional problems, a strict diet, alcohol abuse and staying in an extremely hot country. Many women go through a phase of telogen effluvium after giving birth.

With a telogen effluvium, hair stops growing and retreats more quickly into a resting phase. The hair falls out more and more easily than 'normal' when brushing or, for example, when running your hands through the hair.

The hair always grows back after about six months. In some cases, there is a chronic telogen effluvium and the excessive hair loss persists for many months or even years. If you lose more than the average 100 hairs per day, you may be dealing with a telogen effluvium. You can support the natural recovery of the hair by supplementing your healthy, daily diet with a nutritional supplement. Our experts are happy to help you with your choice.

Excessive hair loss can be a harmless and reversible process. However, it can also be caused by a medical problem. Please contact us if you have any doubts about the cause of your hair loss. Making the correct diagnosis is of great importance for choosing a treatment plan.

One of the most frequently asked questions at the Intermedica Clinic: “Is there anything that can be done about hair loss in men?”

About 70% of all men will experience some form of baldness or hair loss at some point, ranging from a mild form to complete baldness. A hereditary condition (androgenetic alopecia) causes excessive hair loss and can result in baldness. Extreme stress situations can lead to excessive hair loss. Another hair disease can also cause your body to shed hair.

A good diagnosis is essential for the choice of treatment and the prediction of the treatment result.

The dermatologists at the Intermedica Kliniek advise on hair loss and are happy to inform you about the treatment options available for men with hair loss.

If you would like a personal consultation with a dermatologist about your hair problem, make an appointment.

Elsewhere on this website you will find more information about the most common causes of hair loss in men.

A thinning head of hair on the crown can be a sign of androgenetic alopecia: a hereditary form of hair loss in which the hormone dihydrotestosterone (DHT) ensures that the growth phase of hair is shortened from three to five years to just a few months. The hair becomes thinner and the scalp becomes visible.

When androgenetic alopecia has been diagnosed, you can opt for treatment with a drug, for example finasteride or dutasteride, that prevents the formation of DHT. This normalizes hair loss and makes thin hair thicker, longer and darker again. This prevents further thinning on the crown.

Androgenetic alopecia often follows a predictable pattern and is classified using the so-called Norwood/Hamilton scale. The scale shows the pattern for 'male pattern hairloss'.

Good diagnosis is essential for the choice of treatment and the prediction of the treatment result.

If your hair is becoming thinner and you are concerned or would like to be personally informed, consult a doctor at the Intermedica clinic.

In women, the pattern of hair loss due to androgenetic alopecia is different than in men. They do not experience a thinning crown, but thinning hair distributed over the entire head. This is first visible in a widened center parting and can be noticed, for example, a thinning horsetail.

Baldness can be hereditary. A common form of hereditary baldness is androgenetic alopecia, also known as male and female pattern baldness.

Androgenetic alopecia is caused by a combination of genetic predisposition and hormonal influences. It is characterized by a progressive decrease in hair density in certain areas of the scalp, leading to hair thinning and ultimately hair loss.

In androgenetic alopecia, people inherit genes from both their father and mother that influence the sensitivity of the hair follicles to hormones such as dihydrotestosterone (DHT). DHT is produced from testosterone in the hair follicles and can lead to a shortened hair growth cycle and thinning hair.

The degree of heredity and pattern of hair loss can vary, but if there are close relatives with androgenetic alopecia, the risk of developing this form of baldness may be higher.

However, it is important to know that heredity is only one of many factors that can influence baldness. Other factors such as age, gender, hormonal changes, health status and lifestyle can also influence the development of baldness.

If you are concerned about your hair loss or thinning hair, make an appointment with our dermatologist for an accurate diagnosis and treatment options.

Cicatricial alopecia is an umbrella term that refers to hair loss that involves scarring of the hair follicles of the scalp. This can result in permanent hair loss as the hair follicles are replaced by scar tissue and are unable to produce new hair.

Cicatricile alopecia can have several causes, such as autoimmune diseases, inflammation, infections or injuries. Cicatricial alopecia can occur on different parts of the scalp.

Frontal fibrosing alopecia is a specific form of cicatricial alopecia in which hair loss is concentrated in the frontal hairline.

The treatment of cicatricial alopecia generally attempts to minimize scarring and manage symptoms.

Some possible treatment options for cicatricial alopecia include:

Medication: Topical corticosteroids or other medications (such as dutasteride) may be prescribed to reduce inflammation, relieve symptoms, and reduce scarring.

Symptomatic treatment: Symptoms such as itching, pain or burning on the scalp can be treated with topical remedies, such as soothing shampoos, lotions or other medicated products.

Treating underlying condition: If cicatricial alopecia is the result of an underlying condition, such as an infection or autoimmune disease, treating that condition can help stop or slow further hair loss.

Sun protection: UV radiation can worsen the inflammatory response in the skin and affect the immune system, which can contribute to the progression of cicatricile alopecia. Sun exposure can also age the skin and reduce its elasticity, which can worsen inflammation and scarring. A product with SPF 50 or higher and a head covering is recommended.

It is important to consult an expert dermatologist for an accurate diagnosis and treatment options, as the appropriate approach may vary depending on the specific situation and the patient's health.

From an early age, every person has approximately 150,000 hair follicles, also called follicles. Hair grows from it and remains in the scalp for an average of four years before falling out. Because each follicle can produce about 25 hairs, a person should be able to live to be 100 years old with a full head of hair. The fact that many men exhibit baldness at a young age has to do with the (hereditarily determined) degree of sensitivity of certain hair follicles to the hormone dihydrotestosterone (DHT).

This DHT is formed from the hormone testosterone under the influence of an enzyme (5-alpha-reductase, types I and II). The DHT binds to the androgen receptor (a 'biological magnet') of the hair follicle, which therefore has less blood flow. This shortens the growth phase of the hair from three to five years to just a few months and the hair follicle dies at an accelerated rate. If this process occurs in many hair follicles, the hair becomes thinner and eventually baldness will occur. The number of androgen receptors a person has is genetically determined and that partly explains why some people become bald and others do not.

To prevent progression of hereditary baldness (androgenetic alopecia), the conversion of testosterone to DHT must be inhibited. This normalizes hair loss and makes thin hair thicker, longer and darker again.

Dutasteride is the most powerful drug that can be prescribed for androgenetic alopecia.

This image illustrates the effect of inhibiting DHT with dutasteride (2 years of use) on hair loss due to hereditary baldness. Our doctors can advise you on this.

The most common form of alopecia areata is the patchy form (Fig. 1). Round or oval bald spots develop on the scalp, beard skin or arms. If there are many of these areas that are also connected, this is called alopecia areata subtotalis (fig. 2). This can progress into alopecia areata totalis if the entire scalp is hairless (fig. 3).

If hair has also disappeared from other parts of the skin (eyebrows, eyelashes, arms, legs, armpits, pubic area), this is called alopecia areata universalis. A special expression is the form in which the hair loss progresses from the neck upwards. This is an alopecia areata ophiasis (fig. 4).

If the process is limited to one or a few bald spots, the hair loss is not so noticeable. Characteristic of acute alopecia areata (sub)totalis (Fig. 5a) is the simultaneous loss of an extremely large number of hairs. Immediately after the hair falls, the skin under the microscope clearly shows the exit points of the hairs, often with so-called exclamation mark hairs. These are hairs with a length of a few millimeters that are thinner on the skin side than at the tip (fig. 5b).

The diameter of the exit sites is representative of the size of the hair follicles. The smaller the exit points, the smaller the underlying hair follicles. By monitoring the diameter of the exit points, insight can be gained into the speed of the process. If the hair follicle becomes smaller due to the autoimmune reaction, the exit site also becomes smaller. Reducing the diameter of the exit sites is important for the decision to start active treatment. Fig. 6 shows the complete recovery with unchanged hair follicle size. If the hair follicles are already reduced in size at the start of treatment, complete recovery is no longer possible. The hair follicles that are still present will only produce short, thin hairs (fig. 7).

Alopecia areata is caused by a change in the immune system, whereby the defense focuses on the body's own hair follicles, resulting in hair loss and the development of bald spots. Normally the immune system is directed against foreign substances and organisms, such as viruses and bacteria, but with alopecia areata there is a disruption in the immune system.

The exact cause of alopecia areata is not yet fully known, but it is believed that there are several causative factors. Possible factors include autoimmune thyroid disease, vitiligo, psychiatric disorders and stress. However, no scientific evidence has yet been provided for all the factors mentioned. Although stress is often mentioned as a possible cause, there is no conclusive evidence that stress actually causes alopecia areata.

Alopecia areata occurs in approximately one in 500 Dutch people, with a higher prevalence in women and a greater chance of the first attack at a young age. Despite extensive research, the exact cause of alopecia areata has not yet been fully elucidated and it remains a complex condition that requires more research.

There are options to treat alopecia areata. Make an appointment with our dermatologist for a personal consultation.

The treatment is initially aimed at framing the problem, reducing anxiety and stress and recording and monitoring the condition.

If the condition is not in remission after one year, active treatment can be considered. Active treatment can be considered more quickly if it appears that many hair follicles become substantially smaller during the first year.

To monitor the progress of the condition in the first year, overview images and microscopic images of the hairless areas are made. The diameter of the exit point of the hairs is determined on the microscopic images. When the diameter of the exit site decreases, the diameter of the hair follicle also decreases.

Although it is unclear exactly which causal factors play a role in alopecia areata, indications are found in the literature that supplementing the normal diet can be helpful in recovery from the condition. This involves vitamins B5, B6, B8 and B12, iron (divalent) and zinc to stop the process of alopecia areata and positively condition recovery. During recovery, the skin suddenly has to produce a lot of hair that requires specific substances. To prevent a deficiency of these substances, the diet is supplemented with isoflavone, betasitosterol and L-cysteine.

The activity of the condition is assessed: progression, stabilization or remission is expected. If progression or stabilization of the abnormality is expected, treatment can be chosen. The age of the patient is important when choosing the treatment(s).

The treatment of alopecia areata depends on several factors. You will see a schematic representation on this page (click). A personal treatment plan is always discussed with one of our dermatologists and may deviate from this schedule.

Each hair follicle can produce a hair approximately 20 times per lifetime, after which it dies. Because each hair remains in the hair follicle for three to five years, a person would only experience baldness after 60 to 90 years. Baldness at a young age with a hereditary cause is caused by the degree of sensitivity of certain hair follicles to the hormone dihydrotestosterone (DHT).

This DHT is formed from the hormone testosterone under the influence of an enzyme (5-alpha-reductase, types I and II). The DHT binds to the androgen receptor (a 'biological magnet') of the hair follicle, which therefore has less blood flow.

The growth phase of the hair is therefore shortened from three to five years to just a few months. The affected hairs become finer and shorter with each hair cycle and the hair follicle eventually dies at an accelerated rate. If this process occurs in many hair follicles, the hair becomes thinner.

The number of androgen receptors a person has is genetically determined and that explains why some people go bald and others do not.

There are quite a few products and treatments that claim to have an effect on stopping hair loss due to androgenetic alopecia (hereditary baldness). Every two months a new shampoo, lotion or nutritional supplement comes onto the market with claimed effectiveness. Unfortunately, these claims are usually empty promises and the effect cannot be scientifically proven. However, there are also plenty of options whose effectiveness has been proven in scientific studies.

Below is an overview of the treatment options used at Intermedica.

The effectiveness of the products can be expressed as a percentage of full effectiveness, where hair loss is completely normalized. The effectiveness of the products for which scientific evidence is available is as follows (estimates):

Minoxidil lotion: 25%

Diane pill, Yasmin pill or Yaz pill: 25%

Trix Basic Alpha + Trix Basic Beta: 25%

Aminexil: 20%

Androcur: 20%

Other nutritional supplements: 0-10%

Shampoos with Aminexil: 5%

Other shampoos and lotions: 0-2%

The effectiveness of the various products should not be added together. However, the effectiveness of one product can be improved slightly if another product is used.

In addition, treatments are offered for which there is also only weak evidence that they inhibit the process of hair loss due to androgenetic alopecia. Examples of such treatments are light and laser treatments and the injection of vitamins and minerals into the scalp (PRP, mesotherapy). These are not carried out at Intermedica.

The drugs finasteride and dutasteride have been prescribed for a long time and with good clinical results to women with hair loss due to androgenetic alopecia by the dermatologists of the Intermedica Clinic. These medicines are prescribed off-label. Off-label use of medicines means that they are prescribed for a purpose or in a different way than that for which they were approved. This is done based on a doctor's professional assessment. This is legally permitted.

Finasteride and dutasteride were originally approved and prescribed for the treatment of prostate problems, but in low doses they also appear to be effective in preventing hair loss due to androgenetic alopecia, a so-called positive side effect.

Finasteride and dutasteride affect the amount of dihydrotestosterone (DHT) in your blood. DHT is an important substance in the development of the male genitalia. This development starts in the womb and continues in men until the end of puberty.

To prevent any risk (however small it may be!) of a genital abnormality in a male fetus, the prescription of finasteride and dutasteride is subject to strict rules.*

The Intermedica clinic can prescribe finasteride or dutasteride to women under certain conditions.

These conditions are:

there is infertility (post-menopausal, sterilization) or

finasteride or dutasteride is the only possible treatment in your situation (other treatments have proven to be ineffective or insufficiently effective) and

you have been fully informed about the advantages and disadvantages of finasteride/dutasteride and you sign a statement about this (“informed consent”) and

consultation has taken place with the pharmacy that supplies the medicine.

It is solely the dermatologist who assesses and decides on each patient and circumstance.

By the dermatologists of the Intermedica Clinic in 2013 in collaboration with internationally renowned

trichologists conducted a retrospective study on the effectiveness of finasteride and dutasteride when used by women with androgenetic alopecia. You can read the results of this research here or download it in PDF format below.

PDF scientific publication: “The effectiveness of finasteride and dutasteride used for 3 years in women with androgenetic alopecia”.

Ids H. Boersma, Arnold P. Oranje, Ramon Grimalt, Matilde Iorizzo, Bianca M. Piraccini, Emiel H. Verdonschot

*The Lareb side effects center received ten reports of possible side effects of finasteride/dutasteride in women in the period between 2005 and 2014. Two of these reports concerned the use of finasteride during pregnancy. On this basis, pharmacies are advised not to supply finasteride and dutasteride to fertile women. You can find Lareb's full message here.

Telogen effluvium is a form of hair loss in which an increased number of hair follicles are in the telogen phase*, resulting in temporary hair loss. It can be caused by various factors such as physical or emotional stress, hormonal changes, nutritional deficiencies, medications, pregnancy, childbirth or illness.

The telogen phase is one of the three phases of the hair growth cycle, along with the anagen (growth phase) and the catagen (transition phase) phase. During the telogen phase, the hair is at rest and does not grow. About 10-15% of the hair on the scalp is normally in the telogen phase at any given time.

The telogen phase usually lasts about 2-4 months, but this can vary depending on the individual. After the telogen phase, the old hair falls out and is replaced by new hair that begins to grow from the hair follicles in the anagen phase.

It is normal for hair to naturally enter the telogen phase and fall out as part of the natural hair growth cycle. The hair loss that occurs during the telogen phase is usually evenly distributed over the scalp and does not result in obvious bald spots.

In certain conditions, such as telogen effluvium (as previously discussed), a greater number of hair follicles may be in the telogen phase, resulting in increased hair loss. It is important to consult a doctor or dermatologist if you notice excessive hair loss to determine the underlying cause and consider appropriate treatment options.

Treatment for telogen effluvium usually focuses on identifying and addressing the underlying cause. You can support the natural recovery of your hair by supplementing a healthy daily diet with a nutritional supplement, such as Trix Basic Beta, which was specially developed for this purpose.

Frontal fibrosing alopecia is an autoimmune disease in which inflammation occurs around the hair follicles that can be observed as red dots on the scalp. This causes scarring.

It mainly affects women after menopause and is characterized by the gradual receding of the hairline at the front and sides of the scalp, often accompanied by redness, itching and a burning sensation.

The treatment is based on controlling the inflammation as quickly as possible, as well as maintaining and improving the quality of the remaining hair.

With a hair transplant, hairs, including a small piece of skin, are removed from the scalp and implanted in another place on the scalp. The place where the hair is harvested, the donor site, is almost always the lower edge of the hairy scalp at the back.

In most cases, a hair transplant is performed because bald or sparsely hairy areas on the head have arisen due to hereditary baldness (androgenetic alopecia). The choice of the lower edge at the back as a donor site is the best choice for men because this edge, the so-called corona, only contains hairs that cannot be lost due to androgenetic alopecia. When transplanted, this genetic property is preserved so that the transplanted hairs are retained, even if they are in a place where the hairs were previously lost. The situation is different for women. They do not know corona with hair that is resistant to androgenetic alopecia. The hairs on the lower edge of the back can also be sensitive to hair loss due to hereditary baldness. If these hairs are transplanted, they may still be lost over time.

There are two methods commonly used for hair transplantation. The oldest is the method in which a strip of skin with hair is removed from the corona. The tissue parts are brought together and stitched together. The skin strip is cut into small pieces, so-called grafts. Each graft contains one to three hair follicles (hair follicles) with a hair. In the bald or thin area, an incision is made in the scalp with a small knife and a graft is placed in it. In general terms, this method of hair transplantation is also referred to as the FUT method (“Follicular Unit Transplantation”).

It has been fashionable for some time to make the holes in the scalp, into which the grafts are placed, with a laser. This method has been abandoned because the energy from the laser can cauterize the blood vessels, making it difficult for the graft to adhere to the scalp.

With the FUE method (“Follicular Unit Extraction”), follicles or groups of follicles are removed one by one from the scalp of the donor area. This is done with a hollow needle attached to a rotating angle piece ("dental drill"). The grafts are stored in a liquid. With the same needle, holes are “drilled” in the thin/bare places. The grafts are placed in these holes.

Each graft contains a piece of skin containing one or more hair follicles. The skin part grows into the scalp within a few days. During the first month after the hair transplant, the transplanted hairs accelerate from the anagen to the telogen phase and fall out. A new hair follicle with new hair is built from the matrix of the hair follicle. This new hair sees the light of day after three months. The effect of the treatment can be assessed for the first time four months after the hair transplant. Typically, 90% of transplanted grafts develop new hairs.

Whether there will be a visible improvement in the hair after a hair transplant depends on the number of grafts that can be placed per unit area. This number is determined by the diameter of the grafts and the density of the hairs in which the new hairs must be placed.

Each graft must be completely surrounded by healthy and well-vascularized skin tissue, so grafts are preferably not against each other. The smaller the diameter of a graft, the more grafts can be placed per unit area and the greater the possible improvement in the hair.

Typically, 30-50 grafts can be placed per square centimeter, resulting in a density of 100-120 hairs per square centimeter.

The technique of harvesting and placing grafts using thin, hollow needles is superior to other methods from this point of view. An additional aesthetic benefit of this method is that the harvested grafts fit precisely into the prepared holes, allowing the scalp to recover evenly. If a graft is larger or smaller than the prepared hole, the scalp may show irregularities after repair.

If hairs are placed in an area where the density of healthy hairs is approximately 100 hairs per square centimeter, relatively few grafts can be added. As a result, there will be hardly any visible improvement as a result of the hair transplant. This situation is common in women with androgenetic alopecia.

With a hair transplant, it is often decided to compact the hairline at the front or to bring forward several rows of grafts to improve the frontal appearance. This is a common wish of people with hair loss.

There are some important differences between men and women that affect the success of a hair transplant.

Firstly, the hairs harvested from the corona of men are not susceptible to hereditary baldness, so they are preserved after transplantation to another part of the scalp. This is different in women, where all hair on the scalp, including those at the back of the lower edge, can be lost due to hereditary baldness, even after transplantation.

Another important difference between men and women when considering a hair transplant is that women with androgenetic alopecia rarely develop completely bald spots. This means that transplanted hairs must be placed between the existing hairs, which is a challenging task because the existing hairs must not be damaged when making the transplant holes. In addition, there are limited options for placing the grafts between existing hairs, making it difficult to systematically arrange the hairs and fewer grafts can be placed.

Does this mean that there are no disadvantages at all to hair transplantation for men? No, yes.

In men, the non-transplanted hairs will eventually disappear and the transplanted hairs will be retained, which may eventually cause hair thinning to occur again in the transplant area. This can be solved by undergoing a hair transplant again, or by thinking in time about ways to keep the non-transplanted hair. Our experts are happy to advise you on this.

In women, both the transplanted hair and the non-transplanted hair will disappear more or less equally, because the process of hair loss due to hereditary baldness continues.

Most hair transplant clinics give a lifetime guarantee on the effect of hair transplantation in men. Women generally do not receive this guarantee because their transplanted hairs can also be sensitive to loss due to hereditary baldness. Depending on the speed at which this process takes place, the result of the hair transplant will be preserved for a shorter or longer period.

Hair loss of non-transplanted hair can be slowed down with substances such as Minoxidil, cyproterone acetate and saw palmetto. The medicines finasteride and dutasteride stop hair loss almost completely and are recommended if you want to maintain the effect of a hair transplant for as long as possible.

Our dermatologist can advise you on all options.

There are several hair transplant clinics in the Netherlands. The quality and service of these clinics is generally high, but there are also differences. A good consultation involving examination by a specialized doctor with good information is a requirement. All clinics will carry out these consultations free of charge and without obligation.

Hair transplants are also offered in clinics in Poland and Turkey via websites in the Netherlands. This option seems attractive because the costs of the hair transplant are relatively low and a hair transplant can be combined with a nice holiday. However, if complications arise upon return to the Netherlands, these patients are referred back to clinics abroad to claim the guarantee or undergo retreatment. This entails additional costs.

A hair transplant is not covered by insured care. Sometimes a health insurer can provide (partial) reimbursement if a hair transplant is considered essential for a person's health. There are no set rates for a hair transplant. Hair transplant clinics determine the actual costs of the treatment and add a surcharge to create a margin for business operations and profit. This margin is available to the patient for negotiation. It is very common to visit multiple clinics and obtain multiple quotes. In order to make the quotations comparable, a treatment result defined in advance by the patient must be assumed on which all clinics must base their quotation.

Hair transplants with the FUT method are cheaper than hair transplants with the FUE method. Hair transplant rates range from €1,500 for a small addition to €10,000 for a major correction.

We are happy to inform you personally based on a questionnaire. Please contact an expert for advice by e-mail: info@intermedica.nl.

The term mesotherapy indicates that "active" substances are injected into the skin with the aim of improving the quality of the skin. This is done with many small injections. If mesotherapy is used for androgenetic alopecia, an active substance must be injected. Vitamins don't help. The injected substances enter the rest of the body through the skin and their effectiveness has not been scientifically proven.

If the active substance is finasteride or dutasteride, it is better to take it. These substances then enter the scalp through the body and this has a proven effect.

With normal hair growth, where no hair abnormalities are present, it can be challenging to promote hair growth. Nevertheless, there are two possible approaches: the use of the natural hormone melatonin and the application of the blood vessel dilating fluid minoxidil.

In cases of abnormal hair growth, nutritional supplements and medication can be used to stimulate hair growth. It is essential to first determine whether there is a hair abnormality.

There is no specific shampoo that can prevent hair loss. However, it is important to wash your hair with a mild shampoo that is suitable for your hair type. To effectively tackle hair loss, it is wiser to look at remedies that address the underlying cause of the hair problem, such as nutritional supplements or medication.

Yes, scientific research has shown that biotin has an effect on the hair. Biotin, also known as vitamin B8, plays an essential role in the process of growing new hair. A deficiency of biotin can lead to thinning hair and the development of shorter hairs. By supplementing this deficiency with nutritional supplements, you can promote hair growth.

Hair supplements are products that can make a positive contribution to the growth and health of your hair. These supplements are usually available in the form of tablets or ointments. TRIX Basic hair supplements are specially formulated with vitamins and building blocks that have been shown to support healthy hair growth and promote the recovery of damaged hair.

With normal hair growth, where no hair abnormalities are present, it can be challenging to accelerate hair growth. Nevertheless, there are two possible approaches: the use of the natural hormone melatonin and the application of the blood vessel dilating fluid minoxidil.

In cases of abnormal hair growth, such as hair loss, promoting faster hair growth can be achieved through the use of nutritional supplements or medicines. It is essential to first determine whether there is a hair abnormality.

Yes, hair growth pills refer to nutritional supplements and medicines.

There are numerous products available on the market that claim to promote hair growth. However, the effectiveness of many of these products has not been scientifically proven. However, this does not automatically mean that these products do not work. Scientific research is often expensive and time-consuming, and is therefore not carried out for every product.

For a clear explanation with supporting illustrations about how hair growth works, we invite you to scroll down.

Haaruitval: hoe het werkt

1. Growth phase: A healthy hair grows from a hair follicle. The hair remains in this phase for four to five years. After this, the exchange process begins.

2. Exchange phase: The hair follicle with old hair is shed. The blood supply to this hair decreases because a new hair follicle with hair is formed. The old hair is now less deeply embedded in the scalp and is therefore easier to pull out.

3. Shedding phase: The old hair is no longer nourished and is more or less loose in the scalp as 'dead material'. The new hair is now nourished and growing. The old hair moves further and further to the surface.

3. Shedding phase: The old hair falls out. The new hair is firmly and deeply rooted and grows for four to five years - just like its predecessor. After this period, this hair is also replaced by a new hair.

​

*This hair cycle takes place approximately 20 times in a human life.

Yes, it is possible to experience new hair growth after hair loss. Under your scalp there are hair follicles from which your hair grows. Normally, a hair falls out after about five years. At the same time, the hair follicle has already produced a new hair. This cycle repeats approximately 20 times during the life of a hair follicle. After these 20 cycles of hair growth and loss, the hair follicle becomes exhausted and can no longer produce new hairs.

Yes, it is possible to experience hair loss due to severe stress. This phenomenon is known as telogen effluvium in medical terms.

Are you wondering if you suffer from telogen effluvium? Our experts are ready to help you. Schedule a consultation today to gain more insight into your situation.

Veel mensen voelen zich onzeker wanneer ze haaruitval ervaren en weten niet meteen wat ze moeten doen. Het eerste wat je wilt weten, is de oorzaak van je haaruitval. In de meeste gevallen kan het gaan om een telogeen effluvium of erfelijke kaalheid. Gelukkig zijn er voor beide soorten haarafwijkingen oplossingen beschikbaar.

Wil je meer weten over hoe je haaruitval kunt aanpakken? Onze experts staan klaar om je te adviseren. Maak vandaag nog een afspraak voor een consult.

Many people feel insecure when they experience hair loss and do not immediately know how to act. The first thing you want to find out is the cause of your hair loss. This is often a telogen effluvium or hereditary baldness. Fortunately, there are solutions available for both types of hair loss.

Would you like to know more about how to tackle hair loss? Our experts are ready to provide advice and solutions. Make an appointment for a consultation today.

Yes, if there is a biotin deficiency, it can accelerate hair growth. Biotin, also known as vitamin B8, is obtained through diet. It is mainly found in beans, bread, fish, meat and dairy products. If your diet is not rich in these foods, you run the risk of a biotin deficiency. Fortunately, you can supplement this shortage with TRIX Basic nutritional supplements.

Using a shampoo is not likely to cause hair loss. However, using certain shampoos can affect the quality of your hair. Frequent use of a low-quality shampoo can affect the structure of the hair, which can lead to its damage.

Yes, it is possible to stimulate hair growth after hair loss. The nutritional supplement TRIX Basic Beta is particularly suitable for telogen effluvium. The nutritional supplement TRIX Basic Alpha, on the other hand, is very suitable for hereditary baldness.

To take optimal care of your hair, it is essential to know which habits are good for your hair. Here are some key points:

1. A balanced diet is crucial to get the right nutrients for healthy hair.

2. Avoid prolonged exposure to heat, such as the sun and hairdryer, as this can be harmful to your hair.

3. Try to reduce stress, as intense stress can cause hair loss.

4. Avoid pulling your hair back too tightly and choose a mild shampoo that suits your hair type when washing your hair.

There is a link between zinc and hair loss, but it is important to emphasize that hair loss due to a severe zinc deficiency is rare in people with a normal diet. Although a severe zinc deficiency can cause hair loss, this rarely occurs in practice. Therefore, zinc deficiency is generally not a common cause of hair loss.

If you don't know how many hairs you normally lose per day, it can be quite shocking if you suddenly remove 50 hairs from your brush. Don't panic, it is normal to lose between 50-100 hairs on average every day. However, if you start to lose more than 150 hairs per day, you may have a hair disorder and it would be wise to investigate this further.

No, accelerating hair growth by using shampoo is not possible. Shampoo is designed to clean your hair and scalp, not to promote hair growth. Hair growth takes place inside your body, under your scalp, where hair follicles are located. These hair follicles produce hair. If you have healthy hair follicles, they will produce healthy and strong hair. The health of a hair follicle is determined by factors such as good blood flow to the hair follicle and the correct supply of building materials and vitamins.

Yes, if there is a hair disorder, nutritional supplements can help to promote hair growth. The three different TRIX Basic nutritional supplements have been specially developed for three types of hair disorders: androgenetic alopecia, telogen effluvium and alopecia areata.

For more personal advice and guidance, we also offer a consultation with our experts.

There is no specific shampoo that can treat hair loss. A possible exception to this are shampoos with Aminexil. However, to tackle hair loss effectively, it is better to look at remedies that tackle the hair problem at the root, such as nutritional supplements or medicines.