Monthly Article: The Angst of Hair Loss
April 17, 2007
Hair often defines and frames one’s face. Therefore, loosing hair can be a devastating condition for both men and women. There are many factors that contribute to hair loss such as family history, hormonal changes, nutrition, medications, and hair care practices. While many reasons exist for hair loss, options for treatment are limited. However, preventive measures can be taken to decrease the risk for hair loss. Most important, seeking treatment by a dermatologist early can aid in diagnosing the problem and, depending on the reason for loss, increases the likelihood for recovery.
Alopecia Areata
Alopeica areata occurs when the body’s immune system attacks the hair follicles. The exact mechanism of how alopecia areata occurs remains elusive. The disease may manifest itself as a bald spot or sudden hair loss. Round or oval areas of hair loss usually occur on the scalp; although, hair loss can occur on the entire body. This can be a cyclical process. In individuals with less than 25% of hair loss, the hair may return spontaneously. However, loss may reoccur.
Familial history of alopecia areata can be a risk factor for the disease. Other associated conditions include thyroid disease, diabetes, anemia, and vitiligo. Steroids are a common form of treatment. Other medications for localized hair loss, such as anthralin and minoxidil, are also used for treatment while many other medications available for extensive disease.
Female and Male Pattern Hair Loss (Androgenetic Alopecia)
This form of hair loss is commonly inherited, occurring in both men and women. Thinning of the hair will usually be the first sign of hair loss. The pattern varies amongst men and women. Men typically loose hair around the front hairline, temples, and back of the head whereas it is more common for women to loose hair on the top of the head. Women usually do not develop baldness. Treatment includes finasteride for men and minoxidil for both sexes. Hair transplant is also an option for treatment.
Scarring alopecia (Cicatricial alopecia)
Hair loss from scarring alopecia results in loss of the hair follicle. Several causes include infections, autoimmune disease, cancer, and burns. In addition to hair loss, redness, scales, itching, and bogginess may also be present. Treatment is aimed at decreasing the symptoms of the disease and stopping its progression. After a biopsy, treatment can be tailored appropriately. Treatment varies but can include steroid, antibiotics, or antimalarial drugs.
Telogen effluvium
Multiple factors may contribute to this form of hair loss. Medications, childbirth, major surgery, thyroid disease, poor nutrition, or any condition that generates severe stress are common causes of this disorder. Contributing nutritional deficits include iron deficiency or crash diets. Anticancer, antithyroid, Beta-blockers (a type of blood pressure medication), and oral contraceptives have been known to lead to telogen effluvium. Typically, sudden hair loss occurs but thinning is not extensive. This disease is self limited as long as the offending cause is eliminated. Treatment is usually not warranted and hair loss naturally ceases within six months.
Hair Care Practices
Insult to the hair from hair care practices can result in hair loss. Bleaching, relaxers, permanent waving, and coloring are common triggers. These products lead to permanent damage of the hair. Hair loss characteristically manifests as hair breakage. Methods to reduce hair loss from these products include proper application. Assistance when applying these products at home also decreases the risk for application error. Proper technique will hopefully decrease the risk of scarring alopecia that can occur from relaxer burns. Correct storage of these products is also important as the products’ properties change over time.
Some common hairstyles, such as ponytails or braids, can lead to permanent hair loss due to the force placed upon the hair to maintain the style. This can be avoided by avoiding the hairstyle or decreasing the force used when styling the hair. If permanent damage has not occurred, the hair often returns with cessation of the insult.
In conclusion, there are multiple factors that can contribute to hair loss. Some of these factors can be avoided with appropriate hair care, but often loss cannot be prevented. Regardless of the cause, treatment is available for most triggers of hair loss and a dermatologist can facilitate the management of the disorder.
References
Gummer CL. Cosmetics and hair loss. Clin Exp Dermatol. 2002 Jul;27(5):418-21.
Han A, Mirmirani P. Clinical approach to the patient with alopecia. Semin Cutan Med Surg. 2006 Mar;25(1):11-23.
Hordinsky MK. Medical treatment of noncicatricial alopecia. Semin Cutan Med Surg. 2006 Mar;25(1):51-5.
Price VH. The medical treatment of cicatricial alopecia. Semin Cutan Med Surg. 2006 Mar;25(1):56-9.
Ross EK, Tan E, Shapiro J. Update on primary cicatricial alopecias. J Am Acad Dermatol. 2005 Jul;53(1):1-37.
