Hair Loss

Index
Causes
Frequelently Asked Questions About Hair Loss
Debunking Hair Loss Myths

Loss of hair at a very tender age has become a common disorder. Hair is formed in minute pockets in the skin, called follicles. An up growth at the base of the folic, called the papilla, actually produces hair; when a special group of cells turn amino acids into keratin, a type of protein of which hair is made. The rate of production of this protein "building blocks." determines hair growth. The average growth rate is about 1.2 cm per month, growing faster on women between the ages 15 and 30.

Causes
There are many potential causes of hair loss. It is important to determine the cause of your hair loss because the cause will usually determine the type of treatment you should have.

Male pattern baldness: Male pattern baldness, also known as androgenetic alopecia, is a hereditary form of hair loss. Male pattern baldness is by far the most common cause of hair loss, affecting over 20 million men in the United States. To fully understand what goes on in male pattern baldness, let's briefly revisit the hair cycle. Over time, some hair follicles begin to shrink, producing finer, shorter hairs (“peach fuzz”). This is what accounts for thinning of the scalp. These changes usually start at the temples, appearing as the classic “receding hairline.” It also occurs on the crown of the scalp. Eventually, hair follicles may begin to die, leading to hair loss. Bald spots may increase in size until the entire top of the head is bald with hair remaining only on the sides. (Fortunately, there are several medical and surgical treatments for androgenetic alopecia.)

Medication: An annoying side effect of certain medications may be temporary hair loss in a small percentage of patients. Examples of the more common drugs known to have this effect include certain blood pressure medications (beta blockers such as Inderal®), blood thinners (warfarin and heparin), as well as some of the medications used to treat gout, arthritis, and heart problems. Also, high doses of vitamin A may also cause hair loss which is reversible.

Chemotherapy: Many agents used to treat cancer will cause hair cells to stop dividing, stopping hair growth. Up to 90% of the hairs may fall out 1 to 3 weeks after cancer treatment. Fortunately, the hair does regrow in most cases when the treatment is completed. Cancer patients should be warned of this side effect so that they have the opportunity to prepare for any possible hair loss, such as getting a wig or hairpiece, if desired, prior to treatment.

Tinea Capitis: Tinea capitis, or ringworm, is a fungal skin infection that can cause a patchy form of hair loss when the scalp is infected.  A ringworm scalp infection results in hairs breaking off at the surface of the scalp. There may be redness, flaking, scaling, swelling, and even oozing at the affected areas on the scalp. And there is often itching and pain as well. Severe cases of ringworm may lead to swollen glands in the neck or back of the head.

Ringworm: A contagious form of hair loss, most common in children. It is spread by contact, such as sharing brushes, towels, and hats, and is commonly spread from child to child at daycare centers or schools. Some strains of tinea capitis can also be contracted from pets, particularly cats. Fortunately, this infection is curable with oral antifungal medication, and it is important that all affected family members, classmates, and pets be treated to prevent reinfection.

Alopecia Areata: Alopecia areata appears as discrete, smooth, round patches of hair loss about the size of a coin or larger. There may be one or several of these coin-sized patches of hair loss. This condition is most often limited to one area of the body but can affect the scalp, beard, eyebrows, eyelashes, or any hair on the body.  A severe form of this disease, known as alopecia universalis, results in total loss of all scalp and body hair. Fortunately, this is rare.

The cause of alopecia areata remains a mystery. It is not uncommon, affecting approximately 2% of the population. It may occur at any age and is equally common among women and men. Besides the hair loss, affected persons are usually otherwise healthy. In some cases, the bald area(s) will spontaneously regrow hair over several months without treatment. In other cases, the bald spots may progressively enlarge.

There are various topical treatments available for alopecia areata, which may be beneficial in some cases. In my practice, I have found that the most effective treatment for localized bald spots is the injection of a steroid solution directly into the involved areas. The steroid solution remains localized to the injected areas and is not absorbed in the body in large enough amounts to cause any side effects. These injections can be repeated at monthly intervals until there is a cosmetically acceptable regrowth of hair.

Telogen Effluvium: Telogen effluvium is a condition characterized by a generalized, diffuse hair loss that occurs 2 to 3 months after a significant stress on the body, such as major surgery, severe illness, or even crash dieting. Any severe shock to the system can cause more than 20% of our hair follicles to enter into the resting phase of the hair cycle, rather than the normal 10%, as previously discussed. As a result, more hairs are shed than usual, which leads to significant thinning of hair. The good news is that in most cases, these hairs will return to their growing phase within a few months, but it will take longer for the thin areas to fill in. I counsel my patients not to expect a return to their normal head of hair for at least 6 months.

Other Causes: Iron deficiency (anemia) as well as thyroid disease (either an under active or overactive thyroid) can result in hair loss. Your doctor may order specific laboratory tests to check for these conditions. Hair loss that is associated with either anemia or thyroid disease is reversible with proper treatment.

Hair loss can be broken down into several different types, including alopecia areata (temporary hair loss in a coin-shaped patch), telogen effluvium (temporary hair loss secondary to a stressor on the system), and androgenetic alopecia (male-pattern hair loss). For the purposes of our discussion, we will focus on male-pattern hair loss. It generally shows itself in the 20s or early 30s by gradual loss of hair, chiefly on the top of the head and in the angles at the frontal hairline. There are several different patterns to this hair loss, but male-pattern hair loss is the most frequently encountered type. The exact mechanisms are still unknown. We have no doubt, however, that inherited factors and the effect of androgens (male hormones) on the hair are most responsible.

Is stress a factor in hair loss?
Stress does not cause hair loss—it simply makes a bad situation worse. Telogen effluvium, for example, occurs after an assault to the system. The most common cause is pregnancy. This can result in extensive and worrisome hair loss in women in the first few months after the birth of a baby. It is, however, temporary and returns completely.

What is DHT and how is it involved in hair loss?
DHT stands for dihydrotestosterone. This is the active form of the male hormone testosterone. It has been suggested that high DHT levels in genetically predisposed hair follicles initiate baldness. It is this chemical conversion from testosterone to dihydrotestosterone that is blocked by hair restoration products, such as finasteride, which is a prescription medicine and the active ingredient in Propecia, another prescription medication to treat hair loss. Finasteride blocks the formation of active testosterone and allows those hairs predisposed to inactivity to become active again and make new hairs. 

What is the relationship between genetics and hair loss?
Although not the primary cause of male-pattern hair loss, genetics does have a significant role in male-pattern hair loss. It is, however, polygenic, in that there is more than one factor at work. It is unclear whether having an affected mother or an affected father predisposes descendants to greater risks.

Can hair loss occur in young adults?
Male-pattern hair loss can occur as early as 15, although it typically begins anywhere from the 20s and early 30s. Familiy history may help determine if this is going to occur, as parents with a history of early-onset male-pattern hair loss may increase the risk for this to occur in descendants. Alopecia areata and telogen effluvium, two other forms of temporary hair loss, can occur in children as young as one year of age. Other precipitating factors may also be involved.

What can be the cause of a sudden loss of a large mass of hair?
Stressors to your system, such as illness, high fever, pregnancy, extreme weight loss or gain, and drug use, can cause temporary hair loss. This occurs when the ratio of growing to resting hairs is upset and more of the growing hair shifts into a resting phase. A greater quantity of normally sleeping hairs falls out, prompting a visit to the dermatologist. This type of hair loss is temporary and full regrowth should be expected.

Do shampoos and other hair products cause hair loss?
An allergic reaction to any constituent in shampoo or hair products can cause hair loss. Shampoos are designed to be as safe as possible, although there are always someone who will react to them. Caustic hair dyes, straighteners, and other products can certainly cause inflammation of the scalp and result in hair loss.

Can my hairstyle cause my hair to fall out?
Certain hairstyles can contribute to hair loss, most notably styles involving tight braids or pull-backs. This form of hair loss is called traction alopecia. This occurs when the hair is pulled tightly back and fastened at the base of the skull, or braided into tight braids or rows. Exposure to this type of hairstyle over long periods can result in a scarring alopecia, with no potential for regrowth. 

How effective is hair transplantation?
Hair transplantation is a surgical office procedure for the treatment of hair loss. This is accomplished by actually transferring grafts or small sections of hair bearing skin from the back of his scalp to bold areas on the top of the head. Micro grafts, containing one hair, and mini grafts, containing two to seven hairs, are usually used. This technique is very effective in most types of hair loss, including male and female pattern loss. It is also effective when concealing scar injury and complications from disease. It is especially effective in concealing the scars from facial plastic surgical procedures (face lifts, brow lifts, etc.). Even eyebrows can be reconstructed with excellent cosmetic appearance. Women in particular are excellent candidates, as their hair loss tends to be diffuse and can afford them full coverage of the area while undergoing healing. Best of all, your results are permanent.

 
Debunking Hair Loss Myths

You might be surprised to learn that many people are unable to untangle fact from fiction when it comes to hair loss. Some of the blame lies with the many companies and individuals exploiting hair loss myths in order to sell bogus hair products. Other myths may linger because people with hair loss, particularly women, are reluctant to talk about an issue that remains sensitive and sometimes emotional.

The following are some popular myths about hair loss to watch out for:

Myth: Pattern Baldness Comes From Your Mother's Side Only
For those of you secretly blaming your mother's grandfather for your male- or female- pattern baldness, it's time to let go. The hair loss gene does not get passed down from your mother, nor does it skip a generation. If fact, there isn't even a single hair loss gene; researchers think pattern baldness is probably due to the interaction of several genes inherited from both parents.

Myth: Only Men Experience Pattern Baldness
In reality, hair loss is just as common in women as it is in men, though the degree of loss tends to vary by gender. "By the age of 50, over 50 percent of men have significant hair loss," Dr. McAndrews says. "For women, about 25 percent have significant hair loss by the age of 50, though it may be less apparent because women are more conscientious about hiding it than men are." The timing and pattern of pattern baldness is also different in men and women. While men tend to start losing hair in the 30s and 40s, hair loss begins in the 40s or 50s in women, though it can occur as early as the 20s. And while men first lose hair in the front and at the top of the head, women's hair thins diffusely throughout the scalp.

Until recently, women have been reluctant to seek treatment, but hair restoration surgeons say that women make up more and more of their practices.

Myth: Poor Blood Flow Causes Pattern Baldness
This myth has been used to sell hair loss products as bizarre as a device that allows you hang upside down in your closet overnight in order to restore blood flow. But as Paul McAndrews, MD, a board-certified dermatologist and hair restoration surgeon and a clinical professor at the University of California School of Medicine, explains, "Blood supply is excellent in the balding region, which is why hair transplant works so well."

Myth: Pattern Baldness is Caused By Hair Mites, Plugged Follicles, Vitamin Deficiencies
Other manufacturers claim that pattern hair loss is due to a hair mite called the demodex mite that can be removed with certain shampoos, or to plugged hair follicles, which can be unplugged with a shampoo or laser comb.

Dr. McAndrews says there's no evidence to support either of those theories. "The dermodex mite has been seen for centuries on hair follicles on face and scalp. If the mite contributed to hair loss, my beard hair would be gone."

As for plugged hair follicles, they simply lead to ingrown hairs, he says.

Other manufacturers claim that vitamin deficiencies cause pattern baldness. Although some studies have linked crash diets to temporary hair loss, malnutrition is rarely a cause of hair loss in the United States. And consuming more of a given vitamin, such biotin or zinc, than required will not have an impact on hair re-growth.

So why are people so willing to buy into these myth-based products? "Hair loss can be devastating," says Gregory Pistone, MD, a board-certified dermatologist and hair restoration surgeon practicing in Marton, New Jersey. "I think anytime you're dealing with an issue that concerns self-esteem, you will find a lot of people trying to make a quick buck by playing on people's weaknesses."

Myth: Hair Transplant Can Only Produce a "Pluggy Look"
Older approaches to hair transplantation involved grafts containing 8 to 20 hairs. Such large grafts made the scalp look as if it had "plugs" of hair. Today's techniques, if performed by a qualified hair transplant surgery, allow the surgeon to transplant tiny grafts of one to four hairs, creating a very natural look.

"These days, unless hair transplant is done improperly, it's undetectable," Dr. Pistone says. One reason this myth persists may be because the people in whom a transplant is visible are usually those who've had older surgical techniques. That's why it's still important to ensure you see a hair qualified transplant surgeon; research their education and ask to meet patients who had their hair transplant performed by them.

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