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The Bare Skinny
by Dr. Coco Toledo, MD, FPDS
Chairperson, PDS Committee on Publications and Library (2007-2008)
Alopecia (a-lo-PEE-sha) is the medical term for hair loss anywhere in the skin.
The most common area for hair loss is the scalp. Not a few who have this problem presume it is all a matter of the choice of shampoo. Many shampoos later, they are at the dermatologist's doorstep seeking advice. Invariably, they are pleased to be enlightened by the medical approach to their problem.
Consider these possibilities:
- A ndrogenetic alopecia , more commonly known as male-pattern baldness, is the loss of hair due to (1) genetic factors and (2) the excessive response of the hair “root” to male hormones (a.k.a. androgens ) - hence the name.
What is not common knowledge, however, is that it also occurs in women, differing only in the pattern of hair loss. Men usually experience a receding hairline along the forehead while women have a more diffuse loss at the scalp's center.
- Alopecia areata is the patchy loss of scalp hair, eyebrows, eyelashes, beard hair or hair in any other part of the body.
On the scalp, it can begin as a single round or oval bald spot that a patient with long hair may not notice at all. Multiple patches can coalesce to form a larger, more noticeable bald area.
Many patients come to know of their problem only when pointed out by others examining their scalp – like family members, hairdressers or barbers. Children are not spared and their bald patches are initially noticed by parents who groom them.
It is important to note that alopecia areata may be a sign of internal diseases such as thyroid problems or systemic lupus erythematosus. It is also associated with other skin diseases such as atopic dermatitis and vitiligo.
Remember as well this rule of thumb: The greater the area of involvement and the longer it has gone untreated, chances for recovery from alopecia areata are less.
- Out of the 100,000 hairs on our scalp, we normally lose up to 150 hairs a day.
In telogen effluvium , up to three times that number can be shed!
Hair loss is diffuse and the patient usually notices increased hair loss before the alopecia is perceptible. So people shouldn't take the patient's claims lightly just because it isn't physically evident early on!
Telogen effluvium is usually triggered by stressful events such as childbirth, surgery and high fever. It can occur weeks or months after these events. After childbirth, it can occur up to 6 months later. Or one may be surprised to find out that his hair loss was triggered by a bad bout of influenza or typhoid fever months before.
It may also result from medications such as beta blockers (for hypertension), propylthiouracil (for hyperthyroidism), and lithium (for manic-depressive disorders).
- Mechanical factors can cause scalp hair loss. If hair is tugged tightly and repeatedly - as in braids, ponytails and curlers, traction alopecia can result. Pressure alopecia , on the other hand, may occur among sleeping infants or bedridden persons maintaining a steady position for prolonged periods of time.
- Alopecia can be a sign of an infection. Patchy hair loss or a generalized thinning of scalp hair may be the first sign of a syphilis infection, for example ( alopecia syphilitica ).
- Alopecia can indicate endocrine problems ( endocrinologic alopecia ). Hypothyroidism can cause hair to become coarse, brittle, and sparse. In hyperthyroidism, hair becomes extremely fine and sparse.
- Women taking contraceptive pills containing male hormones may experience scalp hair loss. The problem can be solved by switching to an estrogen-based substitute.
Hair is a product and element of skin. And so hair problems can be discussed with a dermatologist. Depending on the diagnosis, the skin doctor can guide one to proper therapy - or even further investigations for other diseases if these are suspected.
For most, one's tresses are deemed most precious, so consulting early regarding hair loss can spare one much distress.
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