Understanding Female Hair Loss

The most common type of hair loss seen in women is androgenetic alopecia, also known as female pattern alopecia or baldness. This is seen as hair thinning predominantly over the top and sides of the head. It affects approximately one-third of all susceptible women, but is most commonly seen after menopause, although it may begin as early as puberty. Normal hair fall is approximately 100-125 hairs per day. Fortunately, these hairs are replaced. True hair loss occurs when lost hairs are not regrown or when the daily hair shed exceeds 125 hairs. Genetically, hair loss can come from either parents side of the family.

There are two different types of hair loss, medically known as anagen effluvium and Telogen effluvium. Anagen effluvium is generally due to internally administered medications, such as chemotherapy agents, that poison the growing hair follicle. Telogen effluvium, is due to an increased number of hair follicles entering the resting stage.

The most common causes of telogen effluvium are:

Physical stress: surgery, illness, anemia, rapid weight change.
Emotional stress: mental illness, death of a family member.
Thyroid abnormalities.
Medications: High doses of Vitamin A, Blood pressure and Gout medications.
Hormonal causes: pregnancy, birth control pills, menopause.

When the above causes of telogen effluvium are reversed or altered you should see the return of normal hair growth.

DIET CONSIDERATIONS
Hair loss may also occur due to dieting. Franchised diet programs which are designed or administered under the direction of a physician with prescribed meals, dietary supplements and vitamin ingestion have become popular. Sometimes the client is told that vitamins are a necessary part of the program to prevent hair loss associated with dieting. From a dermatologists's standpoint, however, the vitamins cannot prevent hair loss associated with rapid, significant weight loss. Furthermore, many of these supplements are high in vitamin A which can magnify the hair loss.

PHYSICAL AND EMOTIONAL STRESS
Surgeries, severe illnesses and emotional stress can cause hair loss. The body simply shuts down production of hair during periods of stress since it is not necessary for survival and instead devotes its energies toward repairing vital body structures. In many cases there is a three month delay between the actual event and the onset of hair loss. Furthermore, there may be another three month delay prior to the return of noticeable hair regrowth. This then means that the total hair loss and regrowth cycle can last 6 months or possibly longer when induced by physical or emotional stress. There are some health conditions which may go undetected that can contribute to hair loss. These include anemia or low blood count and thyroid abnormalities. Both of these conditions can be detected by a simple, inexpensive blood test.

HORMONAL CONSIDERATIONS
Hormonal changes are a common cause of female hair loss. Many women do not realize that hair loss can occur after pregnancy or following discontinuation of birth control pills. It is important to remember that the hair loss may be delayed by three months following the hormonal change and another three months will be required for new growth to be fully achieved.

MYTHS RELATED TO HAIR LOSS

• Frequent shampooing contributes to hair loss.
• Hats and wigs cause hair loss.
• 100 strokes of the hair brush daily will create healthier hair.
• Permanent hair loss is caused by perms, colors and other cosmetic treatments.
• Women are expected to develop significant hair loss if they are healthy.
• Shaving one's head will cause the hair to grow back thicker.
• Standing on one's head will cause increased circulation and thereby stimulate hair growth!
• Dandruff causes permanent hair loss.
• There are cosmetic products that will cause the hair to grow thicker and faster.
• Stress causes permanent hair loss.
• Hair loss does not occur in the late teens or early twenties.
• Hair loss affects only intellectuals.
• There is a cure for androgenetic Alopecia.

These are only a few of the common myths heard by physicians and other hair loss specialists on a daily basis. The AHLC suggests that you first have your hair loss diagnosed by a competent dermatologist who sees hair loss patients on a regular basis. Once you know the diagnosis you will have a better understanding of exactly which treatment option may be best for you.

Understanding Male Hair Loss

Dating as far back as history will take us, baldness has been a part of the aging process that many men fear the most. Before Rogaine, hair transplants and hair additions, men coped in various ways from magic ointments to the styling of their hair. Julius Caesar grew his hair long in the back and combed it all forward. Napoleon did the same thing. Somehow we often disregard history and the fact that this has been an age old condition. We can't imagine or accept the fact that there is not a cure.

Understanding the cause of male pattern hair loss may better indicate exactly why it presently has no cure.

ANDROGENETIC ALOPECIA - the modem medical term for either male or female pattern hair loss - can be broken down in two parts.

First, Androgenetic, consisting of ANDROGEN (Any of the various hormones that control the appearance and development of masculine characteristics such as testosterone). And GENETIC--the inheritance of genes from either the mother or the father's side of the family. Add AGE, which when coupled with genetics, represents a time clock that will signal the hair follicle to produce an enzyme named 5 alpha reductase. When the testosterone present in the follicle combines with the enzyme 5 alpha reductase, it produces dihydrotestosterone (DHT). Hair follicle receptors are sensitive to DHT and thereby start the process of male or female pattern hair loss.

Second, ALOPECIA meaning hair loss, of which there are many types.

Put simply, scientists are working against aging, hormones and genetics. This is no easy task. Add the fact that male or female pattern hair loss is not life threatening, and it is easy to see why many physicians do not view hair loss as a priority in scientific research.

What is working for you in terms of research is that large pharmaceutical firms now know that a cure for hair loss could mean a fortune in revenue for their companies and stockholders. This is fuel enough and the race HAS begun.

Although we may not see a cure in our lifetime, it is possible. Science is closer to understanding hair loss due to many recent advancements. To say the cure is around the corner would only be speculation but hope certainly is alive.

UNTIL THEN...
Since there are other causes of hair loss, it is advisable to consult with a dermatologist who is competent and experienced with diagnosing hair loss. Confirming the type of hair loss you have will make it possible for you to know which treatment options may be best for you.

OTHER CAUSES

• Alopecia areata: Generally thought to be an autoimmune disorder. Causes "patchy" hair loss, often in small circular areas in different areas of the scalp.
• Alopecia totalis: Total hair loss of the scalp, (an advanced form of alopecia areata).
• Alopecia universalis: Hair loss of the entire body, (also an advanced form of alopecia areata).
• Traction alopecia: Hair loss caused by physical stress and tension on the hair such as prolonged use of hair weaving, corn rows etc. Done too tightly on weak hair these can cause permanent hair loss.
• Telogen effiuvium: (usually temporary hair loss) Caused by Physical stress, emotional stress, thyroid abnormalities, medications and hormonal causes normally associated with females.
• Anagen effiuvium: Generally due to internally administered medications, such as chemotherapy agents, that poison the growing hair follicle.

All of these represent only a few of the different types of hair loss. Androgenetic alopecia represents close to 95% of all hair loss however.
 

Chemotherapy Related Hair Loss

Chemotherapy consists of the administration of drugs that destroy rapidly reproducing cancer cells. Cancer cells are some of the most rapidly reproducing cells in the body, but other cells, such as those which contribute to the formation of hair shafts and nails, are also rapidly reproducing. Unfortunately, while chemotherapy drugs preferentially destroy cancer cells, the drugs also can destroy those cells responsible for normal growth of hair and nails. Cancer patients sometimes shed the hair and nails during treatment. Chemotherapy drugs are poisonous to the cells of the hair root responsible for hair shaft formation. Usually, the hair is lost rapidly in large quantities during treatment.

NO HAIR GROWTH STIMULANTS, SHAMPOOS, CONDITIONERS OR OTHER COSMETIC TREATMENTS CAN PREVENT OR RETARD THE HAIR LOSS.

THE GOOD NEWS, however, is that once chemo­therapy is completed, the hair usually grows back.

HOW AND WHEN HAIR GROWTH OCCURS
Adequate hair growth may take six months to one year.

• Returning hair may be different from the hair that was lost. Due to the absence or alteration of pigment the hair may grow back white, gray or a different color. Eventually, as the pigment cells return to normal, the original color should return.

• It is common for the new hair returning to be finer in texture initially, but like color, the texture should return to its original thickness. It is sometimes difficult to be patient, but as the body is returning to normal and getting over the significant insult, time is a necessary ingredient.

HAIR CARE TIPS FOR NEW HAIR GROWTH

1. Shampoo hair twice weekly with a mild shampoo such as those intended for dry or damaged hair.
2. The scalp should also be thoroughly massaged to remove any scale.
3. Follow shampoo with a conditioner for fine or limp hair.
4. Avoid high heat from blow dryers to the hair and skin.
5. Keep hairstyling to a minimum due to the new hair being prone to breakage. Brushing, combing, hair pins and curling should all be minimized. Curling appliances should be avoided as the scalp is very tender following chemotherapy.
6. Hair styling aids such as mousse, hair spray, hair spritz, styling gel and sculpturing gel may be used in moderation. It is best to select products with normal to light holding ability as the high hold products may not be completely removed with mild shampoos. Hair styling aids can build up on the hair shaft resulting in dullness and possibly scalp disease.

CHEMICAL CURLING OR PERMANENT WAVING
Chemical treatment of the hair is best avoided until the hair is at least three inches long. It is difficult to get nice curls if the hair is much shorter even with a healthy head of hair. For best results use a mild body wave with short processing time.

The hair should be wrapped loosely on the largest size curling rod possible. Looser curls will be less damaging to the recovering hair shaft, and will thus minimize hair shaft breakage.

WARNING! Many patients cannot tolerate the permanent wave solution on their scalp for some times up to one year following chemotherapy. This extreme sensitivity of the scalp is not unusual during the regrowth period. In such cases perma­nents should not be attempted.

HAIR COLORING
Hair coloring may also be irritating to the sensitive scalp and should be avoided until the scalp sensation returns to normal. Once the scalp is healed, the hair may be colored.

PERMANENT HAIR COLORINGS ARE THE MOST DAMAGING TO THE HAIR SHAFT and should be minimized in favor of semi-perma­nent hair colorings which are gradually washed away with four to six shampooings.

BLEACHING to lighten the hair color should not be attempted at this time. Additionally, the hair should be altered only 3 shades from its regrowth color as more drastic color changes could increase hair shaft breakage.

The period of time following chemotherapy treatment is a time of healing and rebuilding for the body. Hair growth will gradually return, and with time most patients regain a healthy head of hair. Following some of the enclosed hair care tips will insure that the regrown hair looks and feels its very best!

CHILDREN
A word of caution to parents with children under­going chemotherapy. The absence of hair can be used in a positive manner. It can signal to others “handle with care.” While undergoing chemo­therapy the child has a low blood count and can be bruised easily.

The insistence of parents, although well meaning, for a child to wear a wig or prosthesis can signal the message “YOU’RE NOT O.K. THE WAY YOU ARE!” A child should have all of the options but the choice should be his or hers. Hugs and tender loving care along with your physician’s sugges­tions for care are all that is necessary from the parents.

Prepared for the American Hair Loss Council by Zoe Draelos, M.D. and Mike Mahoney, AHLC Executive Director.
 

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