Alopecia (Hair Loss)

Family history of baldness or hair lossAdvancing age (for male-pattern baldness only)PregnancyStressPoor nutrition SymptomsAlopecia symptoms depend on the type of hair loss. Some of the more common symptoms include: Male-pattern baldness: Hair recedesHair falls out at the top of the headAffects men and women Female-pattern baldness: Hair thins over the entire headHair comes out when brushing Alopecia areata: Rapid hair lossRound or oval patches of hair lossSometimes tiny hairs are visible in the patchesBrittle and discolored fingernails and toenails with ridges Stress-related: Gradual sheddingHairs come out with gentle pulling Fungal infections: Patches of hair lossBlack dots in the patchesItchingScalingInflammation (such as redness) DiagnosisThe doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor will examine the area(s) of hair loss, noting the pattern of hair loss and condition of the scalp. This physical exam may include: Gentle pulling on the hairTaking samples of scalp areas with inflammation and examining them under a microscopeAnalyzing samples of hairChecking for hair loss on other parts of the body The doctor will ask questions about:

DietHair careMedication useYour personal and family medical historyPregnancies, menopause, and monthly menstrual cycles Other tests may include: Blood tests to help identify underlying conditions that may be causing the hair lossBiopsy of the scalpremoval of a small tissue sample to be analyzed under the microscope TreatmentAlopecia treatment depends on the cause of the condition. Treatments include: MedicationsDrugs to correct a hormonal imbalance or deficiencySwitching to a different medication if a drug you are taking is contributing to the hair lossAntifungal shampoos and pills to treat fungal infectionsFor baldness in men, a prescription drug taken in pill form (finasteride) Note: Pregnant women should not even handle this medication. Even a small amount absorbed through the skin of the hands can cause birth defects in baby boys.Over-the-counter medication (minoxidil) that is applied to the scalp daily (must be used on a regular basis) Note: If you have heart problems, discuss this drug with the doctor before using it.To help speed-up hair re-growth in alopecia areata, your doctor may inject a steroid preparation into your scalp.For some patients, not responding to other therapies, topical immunotherapy (usually administered by a dermatologist) may be helpful. It involves applying an allergen to scalp that causes local reaction like redness, itching and also induces hair growth.Phototherapy is another potential treatment for patients with alopecia areata. Therapy is usually administered for 4 to 6 months. Lifestyle ChangesBe gentle with your hair. Avoid pulling it tightly. If pulled over a long period of time, scarring can occur resulting in permanent hair loss. If treatment does not correct the hair loss, you may opt for a wig, hairpiece, or hair weaving. If emotional stress is the cause, learn and practice stress-management techniques.

Surgery This can involve: Hair transplanttaking hair from the back and sides of the head and transplanting it in bald areas. As many as 300 grafts may be needed. You must return multiple times for the grafts.Scalp reduction with flapscutting the scalp and pulling the areas with hair closer together. Chemotherapy InducedIt could be minimal, moderate or severe.It is transient and completely reversible after discontinuation of chemotherapy.Currently, there are no medications available that were shown to reduce the risk of alopecia associated with cancer treatments. Prevention There are no prevention guidelines for the most common type of hair loss, male-pattern baldness. However, the following tips may help you avoid other types of hair loss: Do not pull your hair tightly into a ponytail, cornrows, or curlers.Learn and practice stress-management techniques.Obtain medical care for acute illnesses and to manage chronic conditions.Eat healthy, well-balanced meals. RESOURCES: American Academy of Dermatologyhttp://www.aad.org National Alopecia Areata Foundationhttp://www.alopeciaareata.com CANADIAN RESOURCES: BC Health Guidehttp://www.bchealthguide.org/ Derm Webhttp://www.dermatology.org/ References: American Academy of Dermatology website. Available at: http://www.aad.org/default.htm .

American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html . Cecil Textbook of Medicine . 21st ed. WB Saunders Co;2000. Dorr VJ. A practitioner's guide to cancer-related alopecia. Semin Oncol. 1998;25:562. Griffith's 5-Minute Clinical Consult . Lippincott, Williams, and Wilkins;1999. Harrison's Principles of Internal Medicine . The McGraw-Hill Co;1999. Hussein, AM. Chemotherapy-induced alopecia: New developments. South Med J. 1993;86:489. Mitchell, AJ, Douglass, MC. Topical photochemotherapy for alopecia areata. J Am Acad Dermatol. 1985; 12:644. Price, VH. Treatment of hair loss. N Engl J Med. 1999; 341:964. Primary Care Medicine . 4th ed. Lippincott, Williams, and Wilkins;2000. Taylor, CR, Hawk, JL. PUVA treatment of alopecia areata partialis, totalis and universalis: audit of 10 years' experience at St John's Institute of Dermatology. Br J Dermatol. 1995; 133:914. Last reviewed November 2007 by Marcin Chwistek, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.