Condition Care Guide

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Hair Loss

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What is hair loss?
Alopecia, commonly known as baldness, typically refers to excessive loss of hair from the scalp, and is experienced by more than half of men and women in the U.S. at some point in their lives. In addition, nearly 30 percent of people suffer some kind of hair loss by age 30 and about 50 percent have it by age 50. In fact, hair loss is so common that it is often considered a normal sign of aging and not a disease.

What are the symptoms and how is it diagnosed?
Hair loss can be separated into two categories based on re-growth. Permanent hair loss typically falls under the classification of “pattern” or androgenetic alopecia, and occurs in both males and females. Male pattern baldness can begin quite early - sometimes even in the teens and early twenties - but more often develops after age 50. It is often characterized by balding at the top of the head with or without a receding hairline at the temples, the end result being partial or complete baldness. And hair loss isn't just a male problem. Many women experience female-pattern baldness, which manifests as progressive, thinning hair at the front, sides or top of the head. Complete hair loss is rarely experienced in women, who usually maintain their frontal hairline. Other permanent baldness can occur due to scarring or inflammation that damages follicles, causing hair to stop growing. This is rare, but if it does occur, it most often causes patchy hair loss that can itch and burn.

Other types of alopecia are temporary, and can involve the scalp or other parts of the body. Alopecia areata is an autoimmune condition that attacks hair follicles causing hair on the head to fall out, usually in small patches about the size of a quarter. Most people don't lose all their hair, but some can. Essentially, this condition can cause baldness anywhere that hair grows, including eyebrows, eyelashes, the face, back, extremities and genitals. In a more severe form of the disease, people lose all the hair on their heads and everywhere else on their bodies (alopecia universalis). Unfortunately, autoimmune alopecia is unpredictable. Hair might come back, but if it does, it can fall out again. Some people continue to lose and re-grow hair for many years. Even among those who lose all their hair though, there's always a possibility that it can completely return.

Patchy hair loss can also occur as a result of certain hair styles that maintain pressure on hair or pull it tightly. This traction alopecia can come from wearing hair in braids, pigtails, cornrows, or using tight hair rollers. Hair loss occurs typically at the site where hair is pulled. With continued pulling, scarring and damage to hair roots can occur over time. This can cause hair loss to become permanent. Telogen effluvium is stress-related temporary condition that occurs suddenly and involves the loss of large amounts of hair after combing, washing or gentle pulling. This type of hair loss creates an overall thinning of the scalp as opposed to bald spots or patches.

What are the causes?
A number of things can cause excessive hair loss. A severe illness or major surgery may suddenly cause the loss of a large amount of hair. This is usually temporary and is often related to physical or emotional stress (Telogen effluvium).

Nutritional deficiencies and hormonal problems may also contribute to hair loss. If your thyroid gland is overactive or underactive, your hair may fall out. This hair loss usually can be reversed by normalizing levels of thyroid hormone. Hair loss may also occur if male or female hormones are out of balance. Many women notice hair loss about 3 months after they've had a baby. It usually grows back, but can oftentimes be a different thickness or texture. Male pattern baldness develops when hair follicles are destroyed as a result of being exposed to too much dihydrotestosterone (DHT), a metabolite of the male sex hormone, testosterone. This is especially true when it runs in families.

Over-the-counter and prescription drugs can cause hair loss that most often improves when medications are stopped. These include blood thinners, birth control pills and some antidepressants, as well as medications used for gout, seizures, arthritis, heart problems, and high blood pressure. Undergoing chemotherapy or radiation may cause temporary hair loss that typically re-grows when treatments are finished. Certain fungal infections of the scalp can cause patchy hair loss, especially in children. Hair loss may also occur as part of an underlying disease, such as lupus, diabetes or iron deficiency anemia.

Finally, certain hair treatments that use chemical dyes, bleaches, and straightening or curling agents, can damage hair and cause it to break off if used incorrectly or too often. Excessive brushing, combing or styling of hair can damage the hair shaft or roots, also causing it to fall out or break. Extreme twisting or pulling of hair can ultimately leave patches of baldness, especially when it becomes obsessive and uncontrolled.

What is the conventional treatment?
Conventional treatments focus on promoting hair growth or hiding hair loss. First priority should be to recognize and treat identifiable causes of hair loss, such as medications, infections, nutritional deficiencies, medical conditions or hormonal imbalances.

Certain drug treatments may help to slow or prevent the development of pattern baldness in men or women. Minoxidil (brand name: Rogaine), is available without a prescription and is used for pattern baldness and alopecia areata. It is directly applied as a liquid or foam to the scalp. New hair growth may be shorter and thinner than normal but sufficient enough to hide bald spots or blend with existing hair. It may take several weeks to notice an effect, and new hair growth slows down soon after you stop taking it. Another drug, finasteride (brand name: Propecia), is available by prescription only. It comes in pill form and is only indicated for men, as it poses a serious danger to women of child-bearing age - even skin contact can result in absorption of the drug and lead to birth defects in pregnant women. It works by stopping the conversion of testosterone into DHT.

Steroid injections are sometimes used as a suppressive treatment for patches of alopecia areata. Ointments and creams can also be used, but aren't as effective. Another topical treatment consists of using Anthralin ointment, a synthetic substance made from tar used to treat skin conditions such as psoriasis, that may stimulate hair growth in those with autoimmune hair loss. Surgical treatments involving hair transplantation or scalp reduction are often a last resort but may be effective in the right candidate, although they can be expensive.

What therapies does Dr. Weil recommend for hair loss?
The good news is there are some changes you can make that may help prevent further loss of hair and encourage re-growth. Try the following:

  • Dietary changes: Include omega-3 fatty acids in your diet. Try to eat salmon (preferable wild Alaskan salmon), sardines, herring or mackerel two or three times a week. Or, sprinkle two tablespoons of freshly ground flaxseeds per day on your cereal or salads, or eat walnuts.
  • Mind/Body: If the hair loss is autoimmune in nature, as several noted above are, mind-body treatments such as hypnosis, psychotherapy and guided imagery therapy may be useful.
  • Supplements: Try the essential fatty acid called GLA (gamma-linolenic acid) in the form of black currant oil or evening primrose oil, available in capsules or soft gels at health food stores. Take 500 mg of either twice a day. Be patient. You won't see results for six to eight weeks. Dr. Weil has also read a few reports that the herb saw palmetto (Serenoa repens) used to treat benign prostatic hyperplasia (BPH), can promote hair growth in men. He thinks the effect, if any, is modest. However, James A. Duke, Ph.D., a leading authority on healing herbs and author of The Green Pharmacy, explains that saw palmetto may indeed promote hair growth since it inhibits conversion of testosterone to dihydrotestosterone (DHT) not unlike Propecia. The recommended dose is 160 mg of an extract standardized to 85-95% total fatty acids twice daily.
  • Also: Handle your hair gently, allowing it to air-dry whenever possible. Avoid hairstyles that create unnecessary tension on hair such as braids, buns, ponytails or cornrows, as well as compulsively twisting or pulling your hair. If adequate treatment is not available, you may consider different hairstyles or wigs, hairpieces, hair weaves or artificial hair replacement that helps to minimize the effects of balding.

Or, ultimately, you can follow Dr. Weil's example after he began losing his own hair when he was 16 years old: Enjoy the beauty of being bald!

Read more of Dr. Weil's Condition Care Guide articles.

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