Causes of Hair Loss

•Anagen effluvium – Permanent hair loss caused by the destruction of hair follicles
•Telogen effluvium – Temporary hair loss due to transitory damage to the follicles
•Anagen effluvium is generally due to internally administered medications, such as chemotherapy agents, that poison the growing hair follicles. 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 (sometimes present in diet supplements), blood pressure medications, gout medications
•Hormonal changes – Pregnancy, birth control pills, menopause

Androgenetic Alopecia – Male/Female Pattern Baldness
Up to 95 percent of permanent hair loss is due to androgenetic alopecia, a hereditary condition that affects millions of men, women and children. This condition is characterized by what we call pattern baldness. Male pattern baldness generally starts with a receding hairline at the front or thinning of the crown hair and gradually progresses until, in extreme cases, only a thin horseshoe-shaped rim of hair remains at the back and sides of the head. Female pattern baldness, which has received more attention in recent years, refers to general thinning of hair all over the scalp, usually beginning at around age 30 and becoming more noticeable after 40 and particularly after menopause.

Along with advancing age and an inherited tendency to bald early (a more complex link than researchers originally thought), androgenetic alopecia is sped up by an over-abundance of the male hormone dihydrotestosterone (DHT) within the hair follicle. DHT is a highly active form of testosterone, which influences certain aspects of masculine behavior, from aggression to sex drive.

Testosterone is converted to DHT by an enzyme called 5-alpha reductase, which is produced in the prostate, the scalp and various adrenal glands. Over time, DHT causes hair follicles to degrade and shortens their anagen, or active, phase.

Technically, the follicle is still alive and connected to a good blood supply (that’s why it can nurture a transplanted follicle that is immune to the effects of DHT), but it will grow smaller and smaller. Some follicles will die, but most will simply shrink in size and produce weaker hairs. The progressively shorter anagen growing cycle means more hairs are shed and remaining hairs become so thin that they cannot survive daily wear and tear, experts say. Hairs in balding areas gradually change from long, coarse, thick, colored hairs into fine, unpigmented, fuzzy hairs.

Treatment for Androgenetic Alopecia
The best treatment options for androgenetic alopecia include:

•Learning to live with hair loss (talking to a professional counselor can help)
•Using hair styles (a good cut can make a big difference) and cosmetic techniques to diffuse hair loss
•Some combination of hair additions (wigs, extensions) and hair replacement surgery
•Using one or a combination of the FDA approved drugs, Rogaine™ or Propecia™

Alopecia Areata
According to the American Hair Loss Council, alopecia areata also affects (to some degree) millions of men, women and children. This non-scarring, inflammatory condition is usually temporary — it’s experienced in episodes by almost 90 percent of those who have it. Alopecia areata is generally thought to be an autoimmune disease in which cells from an individual’s own immune system mistakenly prevent hair follicles from producing hair fiber. In many cases, the body will use its own management system to reverse the problem in time. However, those affected even temporarily by the disease can experience low self-esteem and depression and may need help from their families and friends.

The National Alopecia Areata Foundation says that approximately 20 percent of alopecia areata cases are related to heredity, as opposed to androgenic alopecia, in which heredity plays a more prominent role.

There is no diagnostic test for alopecia areata, but an experienced dermatologist can usually identify it. (For a more definitive diagnosis, doctors sometimes need to take a small skin biopsy for microscopic examination.) The disorder causes patchy hair loss, often appearing as small, smooth patches on different areas of the scalp (or, occasionally, on other parts of the body). These patches can appear suddenly, sometimes within 24 hours, and some people report feeling tingling and/or pain at the site. Other types of alopecia areata include:

•Alopecia totalis – An advanced form of alopecia areata that results in total hair loss of the scalp
•Alopecia universalis – Another form of advanced alopecia areata that causes hair loss over the entire body
•Traction alopecia – Hair loss caused by physical stress and tension on the hair, such as prolonged use of hair weaving or braiding (“Corn rows” or braids done too tightly on weak hair can cause permanent hair loss.)

Treatment for Alopecia Areata
There is no cure for alopecia areata, but its patchiness responds to medical treatment to varying degrees (less effectively in cases of alopecia totalis and universalis). Unfortunately, hair transplants do not work on alopecia areata because it’s what doctors call “recipient dominant.” In other words, the bald patch, which would receive transplanted hair, provides no potential for hair growth.

Patients whose conditions don’t respond to medical treatment might want to explore the use of wigs (some insurance companies pay for these — contact the American Hair Loss Council for a list of companies that do) or hair coverings such as turbans or scarves. Because of the unpredictability of alopecia areata, experts suggest that you avoid covering a patchy area with small hair additions. This is because the hair piece might be useless to you within a few weeks due to further advancement of the alopecia. A dermatologist can best tell you when your condition has stabilized — at that time, more options might be available to you.

Experts suggest that parents support their child’s choice when it comes to purchasing a wig or prosthesis for the child. Putting pressure on the child to wear a wig can send the wrong message and make the child feel self-conscious about the way he or she looks. There are support groups across the country for people of all ages. Contact the National Alopecia Areata Foundation to find a group in your area.

Chemotherapy Related Hair Loss
As we mentioned earlier, chemotherapy is the administration of drugs that are poisonous to rapidly reproducing cancer cells. Cancer cells are some of the most rapidly reproducing cells in the body. Other cells, such as those that contribute to the formation of hair shafts and nails, also reproduce quickly. So while chemotherapy drugs preferentially destroy cancer cells, the drugs also can destroy cells responsible for normal growth of hair and nails. That’s why cancer patients sometimes shed their hair and nails during treatment. No hair growth stimulants, shampoos, conditioners or other cosmetic treatments can prevent or retard the hair loss. The good news is that once chemotherapy is completed, the hair usually grows back within six months to a year.