Ok, as I was strolling through some of Blogs last night I noticed a number of people asking questions about hair loss, symptoms, treatments and things of that nature. Now I have been working in dermatology on and off for approximately 10 years now and have seen ALOT. I also know patients that are going through all types of hair loss and then only to add to it....I too was diagnosed with a form of hair loss- Androgenetic Alopecia- in 2007 and boy did this give me a whole new understanding! Since then I have accumulated various bits of information and would like to share it with all you guys on here simply because I know how confusing this can all be and unfortunately the information that some doctors are willing to give (perhaps due to their OWN limited understanding) is not enough. Also please remember that although I work for Specialists with over 50 years of experience (they shall remain nameless) and that the facts of today may become one of many theory's at later date.

According to the American Academy of Dermatology(AAD):
*About 90% of the hair is growing at any one time, and the growth phase lasts between 2 and 6 years.
*10% of the hair is in a resting phase that lasts 2-3 months, and at the end of its resting stage the hair is shed.
*When a hair is shed, a new hair from the same follicle replaces it and the growing cycle starts again.
*Scalp hair grows about one-half inch per month, but as people age their rate of hair growth slows.
*Most hair shedding is due to the normal hair cycle, and losing 50 to 100 hairs per day is expected and is no cause for alarm. (I don’t quiet agree with this one)

SO BELOW I HAVE TYPED OUT SOME OF THE CAUSES OF EXCESSIVE HAIR LOSS ALONG WITH SOME (NOT ALL) TREATMENT OPTIONS THAT ARE AVAILABLE. IT IS VERY IMPORTANT FOR ME TO RESTATE THAT THESE ARE ONLY SOME OF THE REASONS AND THAT I KNOW THERE ARE PLENTY OF DISORDERS OUT THERE THAT CAN BE A CONTRIBUTING FACTOR FOR HAIR LOSS- AMONG THESE ARE LUPUS-PLEASE REMEMBER THAT I AM NOT A MEDICAL DOCTOR SO THEREFORE THAT MAKES MY LEVEL OF EXPERTISE LIMITED. METAPHORICALLY SPEAKING, I KNOW THAT THIS IS ONLY THE TIP OF A VERY BIG MOUNTAIN:

1.Improper Chemical Treatments like the use of dyes, tints, bleaches, straighteners, and permanent waves. The hair can become weak and break if used too often and it is best to stop until the hair grows out.

2.Androgenetic Alopecia=Inherited from either mother’s of father’s side of the family. Women with this trait develop thinning hair, but do not become completely bald. Hereditary hair loss can start in one’s teens, twenties or thirties.
A) Minoxidil, a lotion applied to the scalp twice a day, which can be used by men or women.
B) Finasteride, an oral prescription med (brand name Propecia) which blocks the formation of the active male hormone in the hair follicle.

Another option I later found out by my endocrinologist was Spironolactone (among other oral tabs available) to help stop the increased level of androgens on my scalp.

It began for me in the latter part of 2007 right after being promoted Supervisor at my job.
Two new doctors had just joined the other two doctors that were already within the Practice and the level of stress was SUPERHIGH (I always thought this was a contributing factor even though some studies say that it does not which to me is absolutely absurd. I mean how can sleep deprivation and constant pressure to over perform not be) That when I began to notice a lot of shedding and an extremely uncomfortable feeling on my scalp that made my scalp very, very sensitive to the touch. Some on this site have described it as the feeling you feel after you let out your hair from a ponytail you’ve worn all day.
A few days later an itch set in. I hesitated to do the next step but knew it was the only way to get a scientific diagnosis and that was to have a Biopsy. I did not want speculation or guesses; I needed to know which form of hair loss I was experiencing in order to use the best treatment option available, if any. My specimen was obtained using a uni-punch so as to get to the root of the scalp for the most definitive diagnosis. However some dermatologist’s use a less invasive approach and use a scalpel #11 or 15 to scrape only a small piece on top of the scalp. So my biopsy was done, 2-3 stitches were put in its place with some antibiotic ointment to prevent infection. I was then given a corticosteroid prescription to slow the shedding and to help control the itch and inflammation called Clobex Shampoo .05%=(clobetasol propionate) and its foam to leave in.

After about 3 uses (within 7 days) I had a horrible burning sensation. I mean I felt like my scalp was on fire and that only stressed me out even more. I voiced my complaints to one of the nurses at the practice and was told to discontinue it and once I stopped it I had immediate relief. I am now aware of the fact that I am irritated by products that contain alcohol or sulfites in its ingredient panel. I happen to know that this is a wonderful option for many of our clients and help with many different scalp disorders.

I then had a series of blood tests requested to eliminate the possibility of other medical conditions that could be contributing to the hair loss like deficiencies or increased levels of certain hormones in my system. I can not stress the importance of having a doctor request the proper panel only because some imbalances within the body can be adjusted with oral medications and/or vitamins like anemia for instance, one of the causes for hair shed, increasing ones intake of iron would correct this imbalance hence stopping the shed. Another reason among many would be due to an elevated count on the thyroid panel suggesting hyperthyroidism, also treatable with oral meds today. My X husband had this one! The panel is as follows:

DHEA Sulfate
Chem-Screen Panel
TSH, 3rd Generation
Iron and Iron Binding Capacity
Thyroid Panel
CBC (Includes Diff/Plat)
ESR, Westergren
ANA Screen EIA w/rfl Titer IFA
Cholesterol, Total
FSH
LH
T4, Total
T3, Total
Testosterone, Total & Free
ANA Screen EIA w/rfl Titer IFA

Approximately 1 week later all my results were in and I was told to see an endocrinologist because of the comment under the diagnosis that suggested an early stage of androgenetic hair loss. Unfortunately endoconologist are the go to peple for these kind of diagnosis's. The prescription written for me in that appt. was Spironolactone 50 mg and I was to take it twice a day. The shedding slowed down for about a year then began to increase again. I realized that my potassium levels had to be monitored every 3 months due to this med. but failed to follow up with my endocrinologist which was a vital step because when I later saw him in March 2009 he told me that I was overdue for an adjustment on the mg of the Spironolactone. I am now on 100mg twice a day. That’s enough about me for now.

Now getting back to the different types of Hair Loss according to the ADA:

3.Alopecia Areata= the cause is unknown, but it is thought to be an autoimmune condition (the body makes antibodies to its own hair). The spots are smooth, round patches about the size of a coin or larger. Among the treatments are Corticosteroids (anti-inflammatory drugs that suppress the immune system like:
A) Injections in the scalp where the hair loss occurred every 3-6 weeks. Hair growth usually begins after 4 weeks.(I read that atrophy is a side effect)
B) Topical medications like Minoxidil 5% solution applied twice a day to the scalp, brow and beard. Hair growth may appear in 12 weeks.
C) Anthralin- Is a synthetic tar-like substance that alters the immune function in the affected skin. It is applied for 20 to 60 minutes (“short contact therapy”) and then washed off to avoid skin irritation.
D) A special kind of light treatment
E) Pills
Nearly 2% of the U.S. population (about 4 million people) will develop AA in their lifetime. Some people with AA (about 5%) may loose all scalp hair (alopecia totalis) or all scalp & body hair (alopecia universalis) AA is not contagious and a person’s particular genetic makeup combined with other factors triggers AA. It is likely that the hair may regrow, but it may fall out again. Hair could regrow white or fine, but the original hair color and texture may return later. Wigs, caps, hats, or scarves are also options and wearing a head covering does not interfere with regrowth.
Immunomodulators and other therapies are being explored.

4.Telogen Effluvium= Illness, stress and other factors can cause too many hairs to enter the resting (telogen) phase of the hair growth cycle, and it produces a dramatic increase in the amount of hair shed (effluvium), usually without bald patches. In many cases it usually resolves in a few months on its own. Causes include:
A) High Fever, Severe Infections, Severe Flu
B) Major Surgery/ Chronic Illness
C) Thyroid Disease
D) Inadequate Protein in Diet
E) Low Serum Iron
F) Medications
G) Birth Control Pills H) Cancer Treatments

5.Trichotillomania (Hair Pulling)=Children, and sometimes adults, will twist or pull their hair, brows, or lashes until they come out. Oftentimes this is just a bad habit that gets better when the harmful effects of the habit are explained. Sometimes hair pulling can be a coping response to unpleasant stresses and occationally is a sign of a serious psychological problem.

6.Cicatricial (Scarring) Alopecia= This rare disorder can cause patchy hair loss and associated itching and/or pain. Inflammation around the hair follicle causes damage, scaring and permanent hair loss in the affected area. The cause or trigger is unknown. Treatment focuses on stopping the spread of inflammation.

7.Scalp Ringworm (Tinea Capitis)=This disorder that results in scaling and patchy hair loss. Fungal infections are contagious and can be picked up by touching and infected pet or item contaminated with the fungus. Fungus thrive in warm, moist areas. A comb, clothing, shower surface, or pool area can harbor tinea. Poor hygiene and prolonged wet skin increase the risk of developing a fungal infection.

8.Scalp Seborrhea= These patches are red and itchy and most commonly develops on the scalp, sides of the nose, eyebrows, ears, eyelids and mid chest. This is not to be confused with Dandruff witch causes scaling on the scalp but no redness.
A yeast like organism may be involved in causing this. Gentle shampooing with a mild shampoo is helpful for infants with cradle. Adults often need to use a preparation (shampoo, foam, gel or spray) containing one or more of the following ingredients:
A) Tar Shampoos
B) Zinc pyrithione
C) Selenium sulfide
D) Ketoconazole
E) Salicylic acid.

9.Scalp Psoriasis=A condition in which skin cells grow too quickly, causing red, crusty, scaly lesions to appear. For mild cases treatment options are:
A) Tar Shampoos
B) Steroid Solutions and Foams
C) Salicylic Acid
D) 10% sulfur
E) Intralesional corticosteroid injections will clear isolated plaques.
According to the Manuel of Dermatologic Therapeutics more severe cases where scaling is thick, it is necessary to first remove the scales by applying a keratolytic gel to a hydrated scalp and then covering the scalp with an occlusive plastic cap for several hours or overnight. You can then try to inhibit their reformation by applying one of the above solutions

October 24, 2009