Hair loss: a vexing problem

Why should I care about hair loss?

While the physical symptoms of hair loss can be dramatic for patients, the psychosocial impact can be just as severe. In quality-of-life studies of people with androgenetic alopecia, also known as male or female pattern hair loss, researchers found that men and women both report a significant loss of self-esteem, being introverted, and feeling less attractive with hair loss. It really is a self-esteem issue.

What causes hair loss?

The most common cause of excessive hair loss is hereditary thinning or baldness. Many other conditions or diseases and improper hair care can result in excessive hair loss. While daily shedding is normal, people who notice their hair shedding in large amounts after combing or brushing, or whose hair becomes thinner or falls out, should consult a dermatologist for proper diagnosis and treatment

Other causes of hair loss, some of which are temporary, include:

• Some cancer treatments, such as radiation therapy and chemotherapy;

• Alopecia areata, a type of hair loss that affects all ages, which causes hair to fall out in round patches;

• Excessive or improper use of styling products, such as burns, dyes, gels, relaxers and sprays that can cause weathering or hair breakage;

• Hairstyles that pull on the hair, like tight braids and ponytails;

• Shampooing, combing, or brushing hair too much or too hard or pulling it out;

• A variety of diseases, such as thyroid disease or anemia;

• After-effects of childbirth, major surgery, a high fever, or severe infection, even the flu;

• Inadequate protein in the diet or eating disorders such as anorexia and bulimia;

• Certain prescription drugs including blood centers, high-dose vitamin A, medicines for arthritis, depression, gout, heart problems and high blood pressure in some people;

• Use of birth-control pills, usually in women with an inherited tendency for hair thinning or a few months after the discontinuation of oral contraceptives;

• Hormonal imbalances, especially in women;

• Ringworm of the scalp, contagious fungal infection seen most commonly in children.

How common is hair loss?

Hair loss has been reported to occur in 60 percent or more of all people.

How is hair loss diagnosed?

Because there are many causes of hair loss, it is important to get the appropriate diagnoses of your hair loss to successfully be treated; see your dermatologist for the successful diagnosis and treatment of hair loss. This may include blood work and a skin/scalp biopsy in addition to a clinical examination.

Can hair loss be prevented?

If not genetic hair loss, avoid such triggers as tight braiding and strong relaxers. A well balanced diet is important, too. A review of medications is advisable to make sure they are not contributing to hair loss.

How is hair loss treated?

Treatments for hair loss, such as topical minoxidil for men and women and oral finasteride for men only, have been shown to help in re-growth or to slow hair loss. Hair loss caused by diseases such as thyroid disease and anemia can be reversed with the adequate treatment of the underlying disease process.

Topical or injectable cortisone medications have been shown to accelerate the re-growth of hair in some types of hair loss. Topical or oral estrogen, or other female-specific hormones, is sometimes prescribed for women experiencing hair loss.

Hair transplantation is a permanent form of hair replacement utilizing dermatologic surgery that involves moving some existing scalp hair to areas that are bald or thinning. It may benefit men with male pattern baldness, some women with thinning hair, and people with loss of some but not all hair from burns or other scarring injuries to the scalp, eyebrows or eyelashes.

Newer treatments include topical laser treatments and injecting agents like natural cytokines and growth factors from the patient’s own blood. Additionally, some medications that have been FDA-approved to make eyelashes grow are showing promising results on existing scalp hair to make it longer and thicker.

What action steps can be taken now for anyone with unwanted hair loss?

• Avoid behavior that can cause hair loss.

• Review medications to make sure they are not causing hair loss.

• Get a general medical examination from your primary care doctor.

See a board-certified dermatologist for hair loss evaluation and treatment options.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine, one of the top 21 African-American physicians in the U.S. by the Atlanta Post, and is an active member of the Minnesota Association of Black Physicians, MABP.org.