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Hair Loss Overview
More than half of men and women in the United States experience hair loss. About 30% of people have hair loss by 30 years of age, and about 50% have hair loss by 50 years of age. Hair loss is so common that it is usually considered a normal variation and not a disease. Other animals closely related to humans, such as the chimpanzee, also lose their hair as they age.
What Are Causes of Hair Loss?
In general, most hair loss is not associated with systemic or internal disease, nor is poor diet a frequent factor. While thyroid disease can cause hair loss, thyroid tests on people who have ordinary hair loss are usually normal. Although many medications list "hair loss" among their potential side effects, overall drugs are also not common causes of thinning or lost hair. On the other hand, with cancer treatments and immune-suppression medications, hair loss is more common.
Types of Hair Loss
One useful way to classify hair loss is by whether the loss is localized and patchy or whether it affects large areas or the whole scalp. We'll take a look at some of the most common hair loss conditions on the following slides.
A common hair loss condition, alopecia areata, usually starts as a single quarter-sized circle of perfectly smooth baldness. Alopecia patches often regrow in three to six months without treatment. Sometimes, hair regrows in white coloration. In another variant, alopecia areata can produce two or three bald patches. When these grow back, they may be replaced by others. The most extensive form of hair loss is called alopecia totalis, in which the entire scalp becomes bald. It's important to emphasize that patients who have localized hair loss generally don't lose hair throughout the scalp. Alopecia can affect hair on other parts of the body, too (for example, the beard).
Alopecia Areata (Continued)
Alopecia areata is considered an autoimmune condition in which the immune system attacks the hair follicles. Most alopecia patients do not have systemic problems and need no medical tests. Alopecia is also often blamed on "stress," but in fact, it's usually the other way around. Having alopecia causes the stress, at least until people find out what it is.
Treatments for alopecia areata include injecting steroids into affected patches to stimulate hair growth. This is not practical for large areas. Other treatments, such as oral steroids or ultraviolet light therapy, are either toxic or impractical. In most mild situations, patients can comb over the affected areas. In more severe alopecia, patients may wear hairpieces. Some men shave their whole scalp as that this look has become fashionable.
Tight braids and ponytails can pull hard enough on hairs to make them fall out. If this happens, it's best to choose hairstyles that put less pressure on hair roots. The sooner this is done the better in order to avoid permanent damage.
This melodramatic name refers to the habit of pulling at hairs or twisting them, sometimes without realizing it. The scalp and eyelashes are often affected. Unlike alopecia areata patches, which are perfectly smooth, hair patches in trichotillomania show broken-off hairs. Treatment is entirely behavioral: You have to recognize that you're doing it and then stop!
Tinea Capitis (Fungal Infection)
Tinea capitis is also known as ringworm of the scalp. This fungal infection generally affects school-age children and may spread in schools. It appears as scalp scaling associated with bald spots usually showing broken-off hairs. Oral antibiotics are needed to penetrate the hair roots and cure the infection after which hair grows back.
Under normal conditions, scalp hairs live for about three years (the anagen, or growing, phase); they then enter the telogen, or resting, phase. During the three-month telogen period, the hair root shrivels up into a small white "club," then the hair falls out. It is, therefore, normal to lose about 100 hairs every day, more of them on days when shampooing loosens the hairs that are ready to fall out. The hairs are then replaced by natural regrowth.
Sometimes people worried about losing their hair start noticing hairs on their pillow or in the sink, not realizing that they've always been there. A close look at these will usually reveal the white "club" at the end, showing that these hairs were already dead. Normally, about 10% of scalp hairs are in the telogen phase.
Telogen Effluvium (Continued)
There are several circumstances that produce a "shock to the system" that alters the hair growth rhythm. As a result, as much as 30%-40% of the hairs can cycle into telogen. Three months later, hairs come out in a massive shedding (effluvium), especially near the front of the scalp. These include
- high fever,
- sudden weight loss (crash dieting),
None of these has to be life-threatening, nor does hair loss always follow them. Moreover, hair loss can happen after one pregnancy but not the next. But when the hair falls out, it's all over the place -- covering the pillow, clogging the drain, and so forth. Paradoxically, the more dramatic the hair loss, the better the prognosis, because when the body gets back into normal rhythm, most if not all of that hair comes back. No special treatment is needed. Normal shampooing can continue, because this only loosens hairs that were going to come out anyway.
Androgenetic Alopecia ("Male-Pattern Baldness," "Female-Pattern Baldness")
Everyone loses hair, but men do it better -- faster, earlier, and more extensively. Doctors refer to common baldness as "androgenetic alopecia," which implies that a combination of hormones and heredity (genetics) is needed to develop the condition. (The male hormones involved are present in both men and women.)
Even men who never go bald thin out over the years. Unlike those with reversible telogen shedding, those with common male-pattern hair loss don't notice much hair coming out; they just see that it's not there anymore. Adolescent boys notice some receding near the temples as their hairlines change from the straight-across boys' pattern to the more "M-shaped" pattern of adult men. This normal development does not mean they are losing hair.
Myths About Male-Pattern Baldness
- You inherit baldness through your mother's male relatives. Actually, baldness can come from either side of the family or both. Looking at your family can give you at best an educated guess about how you'll turn out.
- Longer hair puts a strain on roots. It doesn't. And hats don't choke off the circulation to the scalp to cause hair loss either.
- Shampooing does not accelerate balding.
- "Poor circulation" does not cause hair loss, and massaging doesn't stop it.
Women lose hair on an inherited (genetic) basis, too, but the female pattern is more diffuse, with less likelihood of the frontal hairline being lost. Although some women may notice hair thinning as early as their 20s, the pace of hair loss tends to be gradual, often taking years to become obvious to others. (It's common to hear women with what appear to have a full head of hair exclaim, "This is nothing...You should have seen how thick it used to be!").
Notions about baldness being inherited through the mother's family, just like stories about hats choking off follicles or long hair pulling on the roots, are just folklore.
Myths About Female-Pattern Baldness
- Longer hair does not put a strain on roots.
- Shampooing does not accelerate hair loss; it just removes those that were ready to fall out anyway.
- Coloring, getting a permanent, and conditioning the hair do not usually cause hair loss. Styles that pull tight may cause some loss, but hair coloring and "chemicals" don't cause hair loss.
Hair Loss Treatment
If hair loss is caused by another illness, treatment of the illness is the best treatment for hair loss. If hair loss is the only problem, then there are many ways to treat it depending on how severe the loss is. The most important consideration to make when deciding the type of treatment is how much your hair loss bothers you.
Treatment options include medications, surgery, grooming techniques, wigs, and hairpieces.
Medications for Hair Loss
Many conditioners, shampoos, vitamins, and other products claim to help hair grow in some unspecified way. These are harmless but useless for hair regrowth. To slow down hair loss, there are two basic options:
- Minoxidil (Rogaine)
- Finasteride (Propecia)
- This topical application is available over the counter, no prescription is required. It works best on the crown, less on the frontal region. Available as a 2% solution, Rogaine may grow a little hair, but it's better at holding onto what's still there. There are few side effects with Rogaine. One concern with this treatment is the need to keep applying it twice a day, and most men get tired of it after a while. In addition, minoxidil is not as effective on the front of the head, which is where baldness bothers most men. This drug also comes in a higher strength, 5%, which may be a bit more effective.
- Ask your doctor about minoxidil (Rogaine). This is available over- the- counter and available in 2% and 5% concentrations. It's something of a nuisance to apply, but it helps conserve hair and may even grow some.
- This is a lower-dose version of a drug that shrinks prostates in middle-aged men. Propecia is available by prescription and is taken once a day. Propecia does grow and thicken hair to some extent, but its main use is to keep hair that's still there. It's therefore best for men who still have enough hair to retain. One side effect is impotence, but this is no more common than it is in the general population and is reversible when the drug is stopped. Taking Propecia once a day is easier that applying Rogaine, but the prospect of taking a pill daily for years doesn't sit well with some men.
- Propecia is a drug that helps men retain their hair. It is unsafe for women of childbearing age to take this drug or even handle tablets. It is, however, safe for their husbands to take it while they are trying to become pregnant. Propecia is safe for older women but may not be very effective.
Surgery for Hair Loss
Surgical approaches include various versions of hair transplantation (taking hair from the back and putting it near the front) or scalp reduction (cutting away bald areas and stitching the rest together). Transplant procedures have improved greatly in recent years. They can produce much more attractive and natural-looking results than older methods that sometimes left a "checkerboard" look. Many transplant patients now take Propecia to keep what they've transplanted. When considering a hair transplant, check the surgeon's credentials and experience carefully.
Grooming Techniques, Wigs, Hairpieces, etc.
Styling hair to cover the areas with the most hair loss is effective for mild cases. Washing and styling the hair will not cause further hair loss. For more severe hair loss, wigs and hairpieces can provide good results if you are willing to try them. Hair weaving is a procedure in which a mesh is attached to your remaining hair and artificial or human hair of similar color and texture is woven with existing hair. Quality varies considerably with price; also, hairpieces and weaves stretch, oxidize, and loosen. Either of these options can be used in combination with medications or surgery if the results of styling or the hairpiece alone are not satisfying.
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