Slideshow: Hair Loss - Causes, Treatments and Solutions for Men & Women

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.



Alopecia Areata

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.



Traction Alopecia

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.



Trichotillomania

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.



Telogen Effluvium

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

• childbirth,
  
• high fever,
  

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.)



Male-Pattern Baldness

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.
  

Female-Pattern Baldness

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)
  

Minoxidil (Rogaine)
Men

• 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.
  

Women

• 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.
  

Finasteride (Propecia)

Men

• 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.
  

Women

• 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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