Hair Loss

Alopecia is the official name of this often emotionally charged problem. It has a multitude of causes, not all of which are irreversible, so managing the problem is definitely worth an in-depth evaluation of the sufferer's situation. Bear in mind that growing scalp hair is not a continuous process. Hair follicles have a growth phase (anagen) and a resting, non-growth phase (telogen). A loss of up to 50 hairs a day can be normal and does not necessarily mean that the follicles have forever ceased to produce hair.

True hair loss, whether partial or complete, is traditionally divided into two kinds: scarring and non-scarring. The scarring forms are less likely to allow for regained growth. However, early diagnosis is important, because some loss may still be at least partially reversed. Scarring forms usually involve infections that cause inflammatory reactions around hair follicles, which eventually are replaced by scar tissue; deep bacterial and fungal outbreaks or the herpes zoster (shingles) virus can all be responsible. If treatment comes early enough, residual follicular activity may return. Serious physical trauma, such as abrasive, chemical or thermal burns, can also cause scarring hair loss.

The most common form of non-scarring hair loss is male pattern baldness (androgenic alopecia), which may start at the peak of the skull or at the sides of the frontal region. Though not all the contributing causes are known, we know the sex hormones are involved. However, female pattern baldness is not at all uncommon, though it's not nearly as widespread as in men. Stopping female pattern baldness is more likely than stopping male pattern baldness.

Severe illnesses (usually with high fever) and medications can both cause temporary loss of hair, known as telogen effluvium. In some cases the loss can be delayed, so before panicking, thoroughly re-evaluate your recent history and discuss possibilities with your doctor. The drugs that may promote this temporary hair loss include birth control pills, other hormones, anticoagulants, allopurinol, some anti-inflammatory drugs and some blood pressure medications, plus, of course, cancer-therapy drugs. Vitamin A is sometimes mentioned as causing hair loss, but that requires far higher doses than most people would normally take. (Incidentally, vitamin A is actually necessary for proper skin and hair formation.)

A striking, and not uncommon, loss of hair comes in the form of alopecia areata: the rapid loss of patches of hair, usually coin-sized, while surrounding areas of hair appear normal. The cause is still basically unknown, though the prevailing theory implicates an immune-system problem. The hair tends to return at intervals, but recurrences are common. The worst case is total loss (areata totalis), which can even include eye and body hair.

If scaling is present, though, it is possible that ringworm is causing the patchy hair loss, masquerading as alopecia areata. Here again, careful analysis is needed. Ringworm is readily treatable with antifungal agents.

Other reversible causes of hair loss include traction alopecia, which is the loss of hair due to its continually being pulled by certain hairstyles, such as tight braiding or ponytails, or by the unconscious habit of twisting the hair. Take care in your choice of fashion and in how hard your hair is pulled.

Excessively strong or frequent dyes, permanents and bleaching can do a considerable amount of damage that may result in hair loss. Long-term swimming and hot tub use can also have an adverse effect. Though those are not common causes, they are something to watch out for.

Obviously, female hair loss is a multifaceted problem. Attack the situation in an equally multifaceted manner and the outcome may be better than you think. Treatment of any underlying causes of hair loss is, of course, mandatory.

The only approved substance for hair loss today is the drug minoxidil (Rogaine). In pattern baldness, regrowth from minoxidil is usually minimal, and the drug must be taken perpetually or even that growth will be lost. Other conventional solutions include hair transplants, skin irritants (to stimulate new growth) and steroid injections. Results vary.

Some nutritional ideas to consider in non-scarring cases:

Additional protein, in the form of fish, cheese, some meat and especially egg yolk, which is high in the sulfur needed for healthy hair
Avoid refined carbohydrates and starchy foods
A good multivitamin and mineral supplement
A full-spectrum digestive enzyme immediately after meals
The lesser-known B-vitamin inositol, 500 milligrams a day
Choline, an adjunct to inositol, in a dose equal to the inositol
If the skin is dry and flaky, flax oil, six capsules a day
Vitamin E, 400 international units a day, preferably as mixed tocopherols
Selenium, 100-200 micrograms a day
For generalized, non-specific hair loss, consider topical application of polysorbate 60 or polysorbate 80, which have been shown to break up the impacted sebum that can help choke off new hair growth. Many products are available along this line, but a good one is promoted by the Life Extension Foundation, Box 229120, Hollywood, Fla. 33022, 1-800-544-4440. (These are the Peter Proctor, M.D. hair-loss formulas.)

For more information on certain forms of hair loss, consider the National Alopecia Areata Foundation at (415) 456-4644.

Good health,
A.N. Spreen, M.D.