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Why Hair Loss Should be Taken Seriously

By Debra Jaliman, MDFebruary 8, 2012
From the WebMD Archives

Hair loss can affect men and women alike, and it is just as distressing for men as it is for women. Yes, more men suffer from it, but a surprising number of women do, too. In men, male pattern baldness is mostly genetic. In women, the causes can be far more complicated.

When a patient comes in depressed by her thinning hair, the first thing a good dermatologist does is take a comprehensive history. Medications are sometimes the culprit: hair loss is a known side effect of some anti-depressants, cholesterol-lowering drugs, and blood pressure medications. Patients are always surprised when I also order a battery of tests, but hair loss is often a sign of a serious underlying condition, such as lupus, hypothyroidism, iron-deficient anemia, or polycystic ovarian syndrome (PCOS). This week alone I’ve diagnosed one woman with iron deficiency anemia after she came in complaining of hair constantly clogging her shower drain.

“Doctor, I’m losing my hair because of stress,” patients keep telling me. And stress can indeed cause hair loss. So can sudden illness, surgery, or giving birth, because all of these stress the body and disrupt the hair growth cycle. Poor diet is another cause; one that I often see in models and actresses. They diet so strenuously to keep their figures that they don’t take in enough protein, and when that happens, the hair is the first to go. Thinning hair is also, unfortunately, a common complaint of menopause. Hormone replacement therapy can reverse the trend, but carries its own risks.

Scalp conditions – fungal infections and seborrheic dermatitis, for example – can also be a factor. If you have hair loss accompanied by persistent itching, flaking, or crusting, your doctor may opt for a scalp biopsy.

And finally there is alopecia areata, an autoimmune disorder where the body literally attacks itself. I cannot stress this enough: if you suddenly develop bald patches, run, don’t walk, to a dermatologist. The sooner you get steroid injections to stop the destructive autoimmune process, the better your chances of being able to grow your hair back.

Male or female, if you have hair loss, take heart: you are lucky to be living in this day and age, when an increasing number of options is available:

  • Minoxidil, the active ingredient in Rogaine, works quite well when used regularly. Oddly, even though it is mostly marketed towards men, it is even more effective in women. The down side is that it does leave hair sticky. Some people also find that minoxidil solutions make their scalp itch and burn; I recommend they try the foam or unscented solutions.
  • Propecia (finasteride), a pill that the FDA has only approved for men. Most men who use it experience significant hair growth. The earlier you start these pills the better, as they prevent further hair loss. The side effects that have been reported, such as depression and sexual dysfunction, are very rare and seen in less than one percent of patients. They are reversible when you stop taking the drug.
  • Latisse (bimatoprost), the same product that results in stunningly long and thick lashes, is now in clinical trials to see if it also works to regrow hair. One potential drawback: cost. Latisse is an expensive product, even when used in very small quantities on eyelashes.
  • Laser combs, approved by the FDA. From what I’ve seen, consistent use may result in thicker hair, but I am less convinced that they can actually regrow hair in bald areas.
  • Hair transplants is an area where amazing advances have been made. Years ago, hair transplants were not only expensive, but gave some fairly artificial-looking results. New techniques have made hair transplants not only easier, but so natural-looking that even your hairdresser will never know. They are still expensive, but most people are delighted with what they get.

Bottom line: Hair loss should always be investigated to see if there is an underlying cause.

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