Alopecia – Hair loss

Hair loss, also known as alopecia, is an agonizing skin condition that affects millions of young men in the prime of their life. The hair loss in most cases usually only affects the scalp. Even though hair loss may be due to hormonal alterations, use of certain medications, hereditary or part of a medial disorder, in the majority of men no cause is ever found. Hair loss occurs chiefly in men but can also be experienced by women and children. When hair starts to fall off, it creates anxiety, apprehension and depression in many men. A head full of hair reflects youth, machismo and sex appeal. Losing hair is simply unacceptable to most men. While a few men just let nature takes it course, most men try to hide the hair loss by wearing wigs, hats, changing their hairstyle, applying a dark polish to give an illusion of hair growth and seeking help from alternative healthcare practitioners for herbs, lotions and potions. Men with hair loss spend an extraordinary time on the internet trying to look for cures. Eventually almost all men use some type of medication to prevent hair loss and restore growth. While most men wish hair loss was temporary, unfortunately in most cases hair loss is permanent.

What are symptoms of hair loss?

Hair loss can present itself in many ways. In most men the first signs are an extraordinary amount of hair lost during combing or showering. The hair loss may be gradual or rapid. In some men the hair loss may be on the scalp and in others it may be a receding forehead. Hair loss can also be patchy and appear as coin-sized bald spots over the scalp. This type of hair loss may also occur on the eyebrows and beard. Loss of full body hair is often seen in medical disorders and after use of cancer drugs. This type of hair loss is reversible. In some cases, patchy hair loss with redness and itching may be associated with a fungal infection.

What causes hair loss?

In general most people shed about 50-100 strands of hair a day. This amount of hair loss is not noticeable because at the same time there is growth of new hair. Hair loss develops when this cycle of hair loss and hair growth is disrupted or the hair follicle is permanently damaged (eg burn to the skin). The precise reason why hair loss occurs is not well known but it is usually associated with one or more of the following:

  1. The most common cause of hair loss is a genetic condition referred to as male-pattern or female-pattern baldness. This type of hair loss occurs gradually and the pattern of hair loss is predictable — in men there is a gradual receding hairline with bald spots and in women there is generalized hair thinning. Individuals with a family history tend to develop hair loss early in life.
  2. Hormonal changes like excess levels of testosterone, pregnancy, childbirth or onset of menopause are associated with hair loss. Under activity of the thyroid gland can also cause hair loss.
  3. Medical conditions like psoriasis, lupus, sarcoidosis and lichen planus are known to cause hair loss with scarring (also known as scarring alopecia).
  4. Medications – such as the cancer drugs and use of prednisone is also associated with hair loss. However, when these medications are stopped the hair does grow back. Most people do not realize that excess consumption of vitamin A may cause hair loss as well.
  5. Scalp infections with the ringworm (a fungus), can lead to patchy hair loss with itching. Once the fungus is treated, hair generally grows back.
  6. Hair-pulling disorder or trichotillomania is a disorder where some females have an irresistible urge to pull their body hair. The condition is difficult to treat but may respond to some of the newer antidepressants.
  7. Certain hairstyles and hair treatments such as braids, tight pony tails, hot oil treatment, can result in pulling of the hair and lead to damage of the hair follicles. If the trauma results in scarring, then the hair loss may be permanent
  8. Patchy hair loss or non scarring hair loss is known as alopecia areata. In this condition there are patchy areas of sudden hair loss. When the stress is removed, the hair grows back.
  9. Radiation therapy to the head can thin hair.
  10. Some people lose hair as a result of emotional or physical shock. The shock may be high fever, loss of a loved one, extensive surgery or sudden weight loss. In most cases, this type of hair loss is reversible when the stressor is removed.
What are risk factors for hair loss?
How is a diagnosis of hair loss made?

In most cases, the diagnosis of hair loss is made after a physical exam and obtaining a family history. However, in some cases, the healthcare provider may perform the following tests:

What treatments are available for alopecia?

There are a few treatments for hair loss but it is important to know that when a person has a bald head, no treatment will bring back hair. In some cases of patchy hair loss, hair may regrow without any treatment within 9-12 months. If your hair loss is due to a medication or a medical disorder, then the drug may need to be discontinued if you no longer need it. When there is a medical condition causing hair loss, the treatment is directed at the medical disorder (eg treat under active thyroid with thyroid hormone). The treatment of hair loss includes use of medications, laser therapy, hair transplants and use of hairpieces and wigs. In most cases a combination approach achieves the best results. The aim of treatment is to hide the hair loss, slow down the loss of hair and promote new hair growth.

What medications are available for alopecia?

There are two medications currently available for treatment of hair loss.. Minoxidil is an over the counter foam or liquid that is rubbed into the scalp twice a day. In some men it does prevent hair loss but the rate of new hair growth is variable. The drug works very slowly and the maximum benefits are seen after 4-5 months. The medication must be applied regularly to obtain the benefits. Side effects of minoxidil include irritation of the scalp, fast heart rate and unwanted hair growth on the face and hands. Finasteride or propecia is a prescription drug for use in men only. It is taken daily as a pill, prevents hair loss and increases growth of new hair. Rare side effects include loss of sex drive and a slightly increased risk of prostate cancer.

What type of surgery can help hair loss?

Hair transplantation has been developed into a fine art. For people who can afford it, hair transplant can provide a head full of hair with pleasing results. The surgery essentially involves taking plugs of hair from the sides and re-implanting them in the front. The surgery is done as an outpatient and does take 4-6 hours. Several sessions may be required to complete the hair transplant. Most people are asked to take hair loss medications before and after surgery to obtain the maximum benefit from surgery. While the results are good, the downside is the cost which can easily run into thousands of dollars.

What is the role of Laser therapy for hair loss?

Recently a low level laser device was approved to treatment of hair loss. The initial studies indicate that the laser can help restore hair growth but the long term results are not known. Laser is also not cheap and can be painful.

Wigs and hairpieces

For the person who does not want to take medications or undergo surgery, the alternative is to wear a hair piece or a wig. These hair pieces can be used to cover hair loss and many of them are natural looking. When the hair loss is due to a medication or a medical condition, most insurance plans do cover the cost of a wig.

Are there any herbs or supplements for hair loss?

The internet is full of treatments for hair loss but most are scams. For patchy hair loss, there are anecdotal reports that use of lavender oil combined with oils from rosemary, thyme and cedar wood may help. Unfortunately there are no randomized studies to validate these claims.

Can I prevent alopecia?

If hair loss is genetic, then there is no way of preventing it. In some cases, hair loss can be prevented by adoption the following measures: