American Academy of Dermatology: Unraveling the Mystery of Hair Loss: Dermatologists Can Help Provide Answers


SAN FRANCISCO, March 24 /PRNewswire/ -- Does it seem like lately when you brush your hair, more strands seem to collect on the bristles? Well, it may not be your imagination.  Each year, millions of men and women suffer from unexplained hair loss.  Oftentimes, this visible problem may be a sign of an internal medical problem that is even more serious than the hair loss itself. Fortunately, your dermatologist can help you get to the root of the problem.

Speaking today at the American Academy of Dermatology's 2003 Annual Meeting in San Francisco, dermatologist Amy J. McMichael, MD, Associate Professor, Department of Dermatology, Wake Forest University, Winston-Salem, NC, discussed some of the serious internal diseases as well as drug side effects that are linked to hair disorders.

Eating Disorders  

While millions of Americans at any given time are on a quest to lose weight, some end up going to extremes to lose these extra pounds.  Anorexia and bulimia are two common eating disorders that can have devastating effects on a person's overall health and self-esteem -- and, as dermatologists point out, hair.

"People with serious eating disorders often try their best to hide their condition, but often it will affect aspects of their personal appearance that they can't hide, such as their hair," said Dr. McMichael.

People with eating disorders often develop calorie and/or protein malnutrition, which forces the body to save protein by shifting growing hairs into the resting phase.  This shift causes shedding of the hair spread out over the entire scalp.  This type of hair loss, known as telogen effluvium, is slow and not noticeable until close to half the hair is lost.  There may also be increased loss when combing, brushing, and washing the hair.  Oftentimes, patients may experience an increase in the baby fine hairs known as lanugo hairs that grow on the face over the cheeks and forehead.

Once the underlying eating disorder is diagnosed and treated, the hair loss can be reversed and prevented as long as the patient maintains a proper nutritionally-sound diet.  Even individuals who are losing weight in a physician-monitored program may experience some hair loss three to six months after losing more than 15 pounds.  This hair loss is common and will return to normal.

"This same pattern of hair loss experienced in individuals with an eating disorder is nearly identical to people who are anemic or have an iron deficiency," added Dr. McMichael.  "Since there are at least 30 diseases that can cause permanent or long-term hair loss, such as thyroid disease or lupus erythematosus, it is crucial for anyone with unexplained hair loss to talk to their dermatologist for the correct diagnosis and treatment based on their condition.  Your dermatologist can also determine whether or not the hair loss is a specific type of hair condition including, for example, androgenetic alopecia, characterized by thinning hair, or alopecia areata, marked by patches of hair loss or complete hair loss on the scalp."

Thyroid Disease  

Hair loss can also be a sign of both hyperthyroidism, an overactive thyroid, and hypothyroidism, an underactive thyroid.  In hyperthyroidism, scalp hair may become fine and soft with scattered hair loss.  In hypothyroidism, head and body hair can become dry and coarse with scattered partial hair loss, madarosis (or loss of the lateral one-third of the eyebrows), or an increased percentage of telogen hairs, or shedding hairs.

"Since laboratory tests are needed to diagnose a thyroid problem, it is important for patients who notice these types of changes in their hair to see a dermatologist," explained Dr. McMichael.  "In most cases, hair loss caused by thyroid disease can be reversed with the proper treatment."

Hormonal Imbalances  

Oftentimes, a dramatic change in hormones can cause unexplained hair loss -- especially in women.  If, for example, the hormonal imbalance is associated with increased androgens (or male hormones), women will experience increased thinning over the crown of the scalp while still maintaining the frontal hair line.  Since with this type of condition the hair is not as noticeable as it falls out because it becomes so thin, the scalp will become increasingly more noticeable as the condition worsens.

"Patients with this type of hair loss may require specific testing to measure abnormal hormones if we suspect that this is the culprit based on a patient's symptoms and hair loss pattern," said Dr. McMichael.  "If a woman tests positive for ovarian overproduction of androgens, hormonal supplements may be required to regulate these hormones.  However, this type of hair loss is harder to treat than the form of hair loss that occurs in patients with an eating disorder, iron deficiency and thyroid disease.  Once the underlying hormonal problem is treated, the hair loss may not improve or only improve minimally."

Chemotherapeutic Agents  

Although hair loss is usually transient and not permanent, it can often be the most traumatic part of chemotherapy.  Hair loss is a noticeable side effect of cancer treatment and can cause changes in self-esteem and body image.  Chemotherapeutic agents can cause hair cells to stop dividing.  In some cases, patients can lose up to 90 percent of their scalp hair.  When the cancer treatment ends, the hair will usually regrow.  Common chemotherapy drugs that cause hair loss include methotrexate, cyclophosphamide, bleomycin, doxorubicin, mitomycin, cytarabine, vinblastine, and vincristine.

Psychosocial Impact of Hair Loss  

While the physical symptoms of hair loss can be traumatic for patients, the psychosocial impact of the hair loss can be just as severe.  There is very little social acceptance of hair loss, especially in women and children whose appearance is so dependant on their hairstyle.

In quality-of-life studies of people with androgenetic alopecia (AGA), also known as male- or female-patterned hair loss, the research finds that there is an increased prevalence of personality disorders in patients experiencing this type of hair loss when compared to the general population.

"While both men and women with hair loss reported psychosocial problems as a result of their condition, women reported a higher incidence of behavior that interfered with their daily lives -- including a significant loss of self-esteem, being introverted, feeling less attractive, and tense feelings in public places with even complaints of neck cramps from holding their head in a certain way to prevent others from discovering their hair loss," explained Dr. McMichael.  "It's important to note these clinical trial studies show that treatment alone does not address all quality-of-life and psychosocial issues for patients with hair loss.  That's why patients with hair loss should see their dermatologist for the correct diagnosis and treatment before the hair loss manifests into other problems."

The American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations.  With a membership of over 14,000 dermatologists worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical, and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; supporting and enhancing patient care for a lifetime of healthier skin.  For more information, contact the AAD at 1-888-462-DERM or www.aad.org .

SOURCE  American Academy of Dermatology  

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