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Alopecia
all information

Alopecia

(Hair Loss)

En Español (Spanish Version)

Definition

Alopecia refers to hair loss in areas of skin that normally have hair. There are two forms of alopecia:

  • Scarring—This is the loss of hair follicles, causing permanent hair loss. Cutaneous lupus erythematous and fungal kerions are the most prevalent forms of scarring alopecia.
  • Nonscarring—In this case, the hair shaft is gone, but the follicles are still present. Because the hair follicles still exist, it often is reversible. It can, however, develop into the scarring type. Alopecia areata is a type of non-scarring alopecia. It is an autoimmune process and the cause is not known. Hair loss lasts approximately six months.

Hair Loss

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Causes

Many things can cause alopecia, including:

  • Stress that prompts growing hairs to rest and shed
    • Illness or surgery
    • Prolonged fever
    • Childbirth
    • Emotional/psychological stress
    • Crash dieting
  • Hormonal problems
    • Overactive or underactive thyroid gland
  • Medications
    • Blood thinners
    • Drugs for gout
    • Chemotherapy for cancer treatment
    • Vitamin A
    • Birth control pills
    • Antidepressants
    • Blood pressure and heart medications
  • Allergic reaction to medications
  • Radiation therapy
  • Infections
  • Autoimmune disorders
  • Systemic and discoid lupus erythematosus
  • Anemia
  • Hair pulled too tightly by:
    • Hair rollers
    • Pigtails
    • Cornrows
  • Hot oil treatments (can inflame the hair follicle and cause scarring)
  • Twisting and pulling hair out due to psychiatric problems
  • Genes
    • Male-pattern baldness is usually inherited.
    • Birth defects can include problems with the hair shaft.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

  • Family history of baldness or hair loss
  • Advancing age (for male-pattern baldness only)
  • Pregnancy
  • Stress
  • Poor nutrition

Symptoms

Alopecia symptoms depend on the type of hair loss. Some of the more common symptoms include:

Male-pattern baldness:

  • Hair recedes
  • Hair falls out at the top of the head
  • Affects men and women

Female-pattern baldness:

  • Hair thins over the entire head
  • Hair comes out when brushing

Alopecia areata:

  • Rapid hair loss
  • Round or oval patches of hair loss
  • Sometimes tiny hairs are visible in the patches
  • Brittle and discolored fingernails and toenails with ridges

Stress-related:

  • Gradual shedding
  • Hairs come out with gentle pulling

Fungal infections:

  • Patches of hair loss
  • Black dots in the patches
  • Itching
  • Scaling
  • Inflammation (such as redness)

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor will examine the area(s) of hair loss, noting the pattern of hair loss and condition of the scalp.

This physical exam may include:

  • Gentle pulling on the hair
  • Taking samples of scalp areas with inflammation and examining them under a microscope
  • Analyzing samples of hair
  • Checking for hair loss on other parts of the body

The doctor will ask questions about:

  • Diet
  • Hair care
  • Medication use
  • Your personal and family medical history
  • Pregnancies, menopause, and monthly menstrual cycles

Other tests may include:

  • Blood tests to help identify underlying conditions that may be causing the hair loss
  • Biopsy of the scalp—removal of a small tissue sample to be analyzed under the microscope

Treatment

Alopecia treatment depends on the cause of the condition. Treatments include:

Medications

  • Drugs to correct a hormonal imbalance or deficiency
  • Switching to a different medication if a drug you are taking is contributing to the hair loss
  • Antifungal shampoos and pills to treat fungal infections
  • For baldness in men, a prescription drug taken in pill form (finasteride) Note: Pregnant women should not even handle this medication. Even a small amount absorbed through the skin of the hands can cause birth defects in baby boys.
  • Over-the-counter medication (minoxidil) that is applied to the scalp daily (must be used on a regular basis) Note: If you have heart problems, discuss this drug with the doctor before using it.
  • To help speed-up hair re-growth in alopecia areata, your doctor may inject a steroid preparation into your scalp.
  • For some patients, not responding to other therapies, topical immunotherapy (usually administered by a dermatologist) may be helpful. It involves applying an allergen to scalp that causes local reaction like redness, itching and also induces hair growth.
  • Phototherapy is another potential treatment for patients with alopecia areata. Therapy is usually administered for 4 to 6 months.

Lifestyle Changes

Be gentle with your hair. Avoid pulling it tightly. If pulled over a long period of time, scarring can occur resulting in permanent hair loss. If treatment does not correct the hair loss, you may opt for a wig, hairpiece, or hair weaving. If emotional stress is the cause, learn and practice stress-management techniques.

Surgery

This can involve:

  • Hair transplant—taking hair from the back and sides of the head and transplanting it in bald areas. As many as 300 grafts may be needed. You must return multiple times for the grafts.
  • Scalp reduction with flaps—cutting the scalp and pulling the areas with hair closer together.

Chemotherapy Induced

  • It could be minimal, moderate or severe.
  • It is transient and completely reversible after discontinuation of chemotherapy.
  • Currently, there are no medications available that were shown to reduce the risk of alopecia associated with cancer treatments.

Prevention

There are no prevention guidelines for the most common type of hair loss, male-pattern baldness. However, the following tips may help you avoid other types of hair loss:

  • Do not pull your hair tightly into a ponytail, cornrows, or curlers.
  • Learn and practice stress-management techniques.
  • Obtain medical care for acute illnesses and to manage chronic conditions.
  • Eat healthy, well-balanced meals.

RESOURCES:

American Academy of Dermatology
http://www.aad.org

National Alopecia Areata Foundation
http://www.alopeciaareata.com

CANADIAN RESOURCES:

BC Health Guide
http://www.bchealthguide.org/

Derm Web
http://www.dermatology.org/

References:

American Academy of Dermatology website. Available at: http://www.aad.org/default.htm .

American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .

Cecil Textbook of Medicine . 21st ed. WB Saunders Co;2000.

Dorr VJ. A practitioner's guide to cancer-related alopecia. Semin Oncol. 1998;25:562.

Griffith's 5-Minute Clinical Consult . Lippincott, Williams, and Wilkins;1999.

Harrison's Principles of Internal Medicine . The McGraw-Hill Co;1999.

Hussein, AM. Chemotherapy-induced alopecia: New developments. South Med J. 1993;86:489.

Mitchell, AJ, Douglass, MC. Topical photochemotherapy for alopecia areata. J Am Acad Dermatol. 1985; 12:644.

Price, VH. Treatment of hair loss. N Engl J Med. 1999; 341:964.

Primary Care Medicine . 4th ed. Lippincott, Williams, and Wilkins;2000.

Taylor, CR, Hawk, JL. PUVA treatment of alopecia areata partialis, totalis and universalis: audit of 10 years' experience at St John's Institute of Dermatology. Br J Dermatol. 1995; 133:914.



Last reviewed November 2007 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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