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TOPIC: Hair Loss -- The Fall of the Crown |
From the misadventures of Samson and Delilah to a certain notorious ' 60s Broadway rock musical to what can only be termed (kindly, if we must) the "creative flair" that has come out of some beauty salons through the ages, hair has been one of mankind’s most passionate and enduring obsessions. We comb it, brush it, color it, perm it, tweeze it, tease it, pluck it, shave it, and otherwise manipulate it into some magnificent (or on occasion, disastrous) works of art. In fact, the Victorians did go so far as to make works of art out of it; many examples of jewelry and pictures made with human hair still exist and are highly prized by some collectors.
I think most women would agree that at best hair can be fun, even glorifying, and at worst can cause us to want to hide from the world (with unshaven legs on "bad hair" days). And that most men would agree that even three-foot long strands on a woman’s head are not long enough. But for the most part, everyone would probably concur that hair isn’t something to concern one’s self with exclusively nor worry about too much. That is, until we start losing it. Hair loss can make even the bravest man weep and the most elegant woman don a ridiculous hat. Hair loss, even though it’s not life-threatening, is still serious business. At least that’s the conclusion I came too when combing through my 69-year-old mother’s head of once lustrous hair and realizing along with her that more and more of her scalp is starting to peek through. And being just as upset as she obviously was that this is happening to her. So, I’d like to talk about hair loss this month and what, if anything, can be done about it. And if you are too young or too naïve to think this will happen to you, think again. Hair loss affects approximately 20 million women in the United States alone. Yes, you, my dear -- even if you are female and thought balding only applied to men -- might be one of them someday.
ALOPECIA (or what we with not-so-loving-care call hair loss)
Hair loss typically begins somewhere between the ages of 25 and 40, long before middle or old age. Hair loss does not put anyone’s life at risk, but it can damage and destroy the ego and sense of self-esteem. Watching my mother deal with this and feel less attractive as a result has convinced me that hair loss is significant and damaging. Following is a short discussion of the various types of hair loss.
1. Alopecia Areata -- this is a medical condition and represents just a small portion (about 2%) of those suffering hair loss. Most researchers have concluded that alopecia areata is an autoimmune condition. There are three types:
Patchy Alopecia Areata: these are small, smooth, circular areas of hair loss mainly limited to the scalp. In most of these cases, hair grows back within six to 24 months.
Alopecia Totalis: this is complete and total loss of all scalp hair.
Alopecia Universalis: this is a complete and total loss of all body hair.
Other than hair (and occasionally nails), no other part of the body is involved in the condition known as alopecia areata. Heredity plays a role in perhaps 20% of these cases. It is not a life-threatening condition nor is there any known cure. The Patchy form responds well to some medical treatments (cortisone injections/pills, topical minoxidil, anthralin cream/ointment, topical immunotherapy) while Totalis and Universalis are difficult if not impossible to treat.
2. Traction Alopecia –- this is hair loss caused by the physical tension and/or the stress of hair styling techniques done on a prolonged basis such as hair weaving, corn rows, etc. If they are done too often or too tightly, especially on weak hair, these hair styling techniques can lead to permanent hair loss. However, most hair lost to these hairstyles will return when the pulling and manipulation is halted.
3. Telogen Effluvium –- this is a general term applied to most temporary hair loss. Telogen effluvium can have many different causes: physical stress, emotional stress, thyroid abnormalities, childbirth, fever, some medications, vitamin/mineral deficiency (inadequate protein or iron in the diet) and finally, hormone fluctuations. It is not serious and the hair loss is not permanent. It usually resolves itself once the underlying cause is identified and treated.
4. Anagen Effluvium –- this is the term applied to chemotherapy-related hair loss. Chemotherapy, of course, consists of the administration of powerful drugs that are designed to destroy rapidly producing cancer cells. Unfortunately, some other body cells – those responsible for the production of hair shafts and nails – are also rapidly producing. Therefore, the same drugs that are doing very important work by destroying cancer cells are also going to destroy those cells responsible for the normal production of hair and nails. The good news is that once the chemotherapy treatment has been completed, both hair and nail production will most likely return to normal.
5. Androgenetic Alopecia –- this is the medical term for what we have always called male-pattern hair loss or male-pattern baldness. However, applying it only to males is an error as this is what is responsible for a majority of female hair loss as well. In fact, androgenetic alopecia is responsible for close to 95% of all hair loss in both genders and is what is at the root of most of those terrible toupees and horrible hats. The term androgenetic alopecia can be broken down as follows: "andro," meaning any of the multiple hormones such as testosterone that control the appearance and development of male characteristics; "genetic," meaning the inheritance of genes responsible for hair loss from either the mother’s or the father’s side of the family; and finally, "alopecia," meaning hair loss.
Age must also be factored into the equation. There comes a time when some of our internal clocks will signal the hair follicle to produce an enzyme called 5 alpha reductase. This enzyme when combined with testosterone makes genetically pre-disposed, sensitive hair follicle receptors start the process of male-pattern baldness. The fluctuation of hormones during and after menopause, therefore, are big contributing factors. The hair follicles receive the signal, hair falls out at an increased rate, new hair production ceases, and sadly, we are left with not much protection against those cold, winter winds. Androgenetic alopecia cannot be cured. And since it is not life-threatening, there are precious few researchers solely devoted to finding a cure. We have management techniques, though, and I will discuss them in the following section.
TREATMENTS (or what to do if you’ve been snatched bald)
While doing research for this editorial, I was astounded by the thousands upon thousands of "miracle treatments" and "baldness cures." I would love to tell you that most or even some of them work. Unfortunately, this is simply untrue. Schemes to grow hair are among the most popular and prolific scams out there. Digital manipulation of photographs ("before’s and after’s") has only added to the problem. Most of these so-called "cures" are ineffective at best and dangerous at worst, as most avoid regulation by the U.S. Food and Drug Administration (FDA) because they are not considered drugs. If you are suffering from hair loss (of any type other than alopecia areata), the following are the only known effective treatment and management options, from least to most aggressive. Please be advised that anything else, either topical or ingested, is probably an empty promise and a waste of money, nothing more.
1. Simple Acceptance –- there’s a lot to be said for simply accepting what is happening to you. It also has the added benefit of no financial cost. And if you can afford to spend some money, professional counselors can be of assistance in learning to live with hair loss.
2. Cosmetic Techniques –- These can range from simple new hairstyling techniques and haircuts, to permanent waves (which make the hair that remains look fuller), coloring options (selecting a lighter shade will help hair blend with the scalp better since hair loss is more noticeable on dark hair; colored dyes also cause the hair shaft to swell, making remaining hair appear to be thicker), and scalp tattooing (the scalp is tattooed with dark ink to blend better with the remaining hair). Even non-surgical hair additions (wigs, toupees, weaves, extensions, etc.) are getting much better looking these days. Quite a few reputable manufacturers of wigs and toupees make products that compare extremely well to the real thing. And if all else fails, hats, scarves and turbans can be employed. Some can even be extremely beautiful.
3. Drug Alternatives –- Only two drugs, minoxodil and finasteride, have been approved by the FDA for the treatment of hair loss and/or the prevention of further balding.
Minoxodil -- marketed both in generic form and as the trademarked product, Rogaine. Minoxodil is sold as a liquid and is rubbed into the scalp twice a day. Its effectiveness varies; about 25% of men and 20% of women will experience some re-growth of hair. The recently approved (only for men) extra-strength version may generate as much as 45% more hair re-growth. Any new growth from either regular or extra-strength versions of minoxodil is often thinner and lighter. The cost for this drug ranges from about $200 to $350 a year. If the drug is discontinued, any re-growth will fall out.
Finasteride -- marketed as Propecia. This is the first and only approved treatment in pill form and requires a prescription. Like minoxodil, individual results will vary and positive benefits may not be seen for as long as several months. This drug works by inhibiting the conversion of testosterone into dihydrotes-tosterone (DHT), a hormone that shrinks hair follicles. About 80% of men may experience a retarding of hair loss, and about 60% may experience re-growth. Rare side effects include diminished libido and sexual function. It costs about $50 a month. Finasteride is not approved for use by women because it has not been proven to be effective in females. In fact, it poses significant danger to women of childbearing age as it may cause serious birth defects in male fetuses. Pregnant women should not even touch the tablets as it can be absorbed through the skin.
Neither minoxodil nor finasteride will help with hair loss that is nonhereditary nor hair loss due to illness or childbirth. Neither of these drugs should be given to children and adolescents.
4. Hair Replacement Surgery –- most commonly called hair grafting, punch grafting, plug grafting or hair transplantation. No new hair is added to the scalp; hair and skin are simply taken from where they are growing and transplanted to the bald areas. These can be done alone or in combination with a technique known as scalp reduction in which bald areas are completely removed and the scalp stretched. This is the most aggressive form of treatment available and may not be appropriate for everyone. The success of this technique depends on a combination of the appropriateness of the candidate and the skill of the surgeon. It can run into the thousands of dollars and require multiple surgeries. Hair replacement surgery should not be entered into lightly or without a good deal of research.
If the information I’ve provided is not enough, I direct you to the following resource:
American Hair Loss Council
At this site you will find more complete discussions of all the topics I have introduced, as well as assistance finding a specialist in your area who treats hair loss.
And if you have been blessed with the opposite problem (too much hair) and are thinking of cutting it off, there is an organization out there that could use it (10” minimum hair length):
Locks of Love
Locks of Love is a non-profit organization that provides hairpieces to financially disadvantaged children across the U.S. under age 18 suffering from long-term medical hair loss. They use donated hair to create the highest quality hair prosthetics. Most of the children helped by this organization have lost their hair due to alopecia areata.
I hope that by reading this, you have become more aware about the entire topic of hair loss and that you will know what to do should this happen to you or someone you know and/or love. My mother and I have decided that perms, color, and combing her hair in a different direction all work to disguise her hair loss enough so that she is more comfortable. Luckily, she looks terrific in hats too. As always, I wish you luck in this and in all your journeys.
Author’s Note: My thanks to the owners of the web sites I mentioned above where I found most of the information and statistics for this editorial.
Disclaimer: The information provided in this editorial is for informational purposes only and the author cannot make guarantees of accuracy or the application of this information to any specific individual, nor does she support nor discourage any particular treatment modality. Diagnoses and treatments should be obtained and/or be recommended only by a qualified healthcare practitioner. All patients are encouraged to speak to their doctors first before making any significant changes to their healthcare regimen.
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