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Women's hair loss: Getting to the root of the problem

By VIKKI CONWELL
NY TIMES NEWS SERVICE, ATLANTA, GEORGIA
Tuesday, Oct 02, 2007, Page 16

PHOTO: NY TIMES NEWS SERVICE

Long, brunet locks were a crown of glory for Nancy Black. But underneath her flowing tresses, the Atlanta woman concealed a veil of shame.

Quarter-sized bald patches covered the top and back of her scalp and, at one time, grew to the size of oranges at the front of her head.

"It was traumatic at the time," says Black, who purchased a hairpiece, wore a baseball cap for six months, and only confided in co-workers so they wouldn't think she had cancer. What she suffered from was alopecia areata, an autoimmune deficiency that causes balding.

"This was benign and it would get better," she says. "(But) it's not a pretty sight to walk around with the front of my hair gone."

From strands shedding in the comb or sink, thinning around the edges or balding spots, more women are experiencing hair loss at younger ages. Many of the conditions are temporary and can be reversed, but others are permanent and often lead to a loss of self-esteem.

"It's a very neglected epidemic," says Spencer Kobren, founder of the American Hair Loss Association, a nonprofit education and consumer advocacy organization. "We call it a disease of the spirit because it tears away at the very fabric of a woman's being."

According to the American Academy of Dermatology, more than 30 million women in the US suffer from hair loss. Many never regrow the hair. The condition, referred to as androgenetic alopecia or female-pattern baldness, affects 25 percent of pre-menopausal women and 38 percent of post-menopausal women. Visible hair loss symptoms appear in 40 percent of women by age 40.

Usually, a woman loses about 100 hairs a day, with the hair regenerating at a rate of about 1.3cm each month. But if she suffers from female-pattern baldness, her hair grows back thinner, shorter and finer until there is little or no growth at all. When she parts her hair in the center, there is a much broader path; the part will continue to grow wider in the front and back. The edges of the hair may remain thick and full, but the hair behind it thins.

Unlike male-pattern baldness, female-pattern baldness occurs around the entire top of the head.

Seventy percent of thinning hair can be attributed to heredity - from one or both parents - but other factors play a role, such as medication, diet, stress, illness and pregnancy. Iron deficiency, hormonal imbalance, and poor hair care also attribute to hair loss.

Kobren says that one of the largest factors is the widespread use of birth control pills, especially by women at an earlier age.

"Women are screwing with their hormones younger in life and besides the other problems, it's causing hair loss," he says. If women who are predisposed to hair loss knew that there was a strong possibility that they could lose their hair, they would choose another form of birth control, he says.

Successful treatment requires getting to the root of the problem with early diagnosis.

Once you recognize that you are losing your hair, go to someone who can do a hair loss work-up, says Edmond Griffin, an Atlanta dermatologist. The sooner the treatment, the greater the chances of good results, he says.

"(Women) hear about hair weaves and hair extensions from their stylists, but they don't hear about hair work-ups," says Griffin. A work-up includes a thorough examination of the head, scalp, nails and skin (checking for acne or excess hair ) and blood work that includes hormone, iron and thyroid evaluations, he says. As a last resort, a biopsy may be ordered to detect medical conditions such as lupus, scarring problems or immune problems.

Diet may reverse problems such as iron or hormonal imbalances, but in most cases, medication is required to help stop the shedding and balding.

FACTORS CONTRIBUTING TO HAIR LOSS

The majority of female-pattern baldness is due to genes, but other causes of hair loss include:

* Disease. Illnesses such as diabetes, lupus and thyroid disorders can cause hair loss.

* Poor nutrition. Having inadequate protein or iron in your diet or poor nourishment in other ways can cause you to experience hair loss. Fad diets, crash diets and certain illnesses, such as eating disorders, can cause poor nutrition.

* Medications. Certain drugs used to treat gout, arthritis, depression, heart problems and high blood pressure may cause hair loss in some people. Also, the acne medication Accutane contributes to hair loss. Taking birth control pills also may result in hair loss for some women.

* Medical treatments. Undergoing chemotherapy or radiation therapy may cause you to develop alopecia. After your treatment ends, your hair typically begins to regrow.

* Recent high fever, severe flu or surgery. You may notice you have less hair three to four months after events such as an illness or surgery. These conditions cause hair to shift rapidly into a resting phase, meaning you'll see less new hair growth. A normal amount of hair typically will appear after the growth phase resumes.

* Childbirth. Some women experience an increase in hair loss several months after delivering a baby. This is because during pregnancy the hair is shifted into an active growth state that then goes back to base line soon after delivery. This increased hair loss usually corrects itself.

* Hair treatments. Chemicals used for dyeing, tinting, bleaching, straightening or perming can cause hair to become damaged and break off if they are overused or used incorrectly. Excessive hairstyling or hairstyles that pull your hair too tightly also can cause some hair loss.

* Scalp infection. Infections such as ringworm can invade the hair and skin of your scalp, leading to hair loss. Once infections are treated, hair generally regrows. Ringworm, a fungal infection, can usually be treated with a topical or oral antifungal medication.

Source: Mayo Clinic

MYTHS AND REALITY

Myth: Hereditary hair loss is passed only from the mother's side of the family.

Fact: Men and women should look at both sides of their family tree for relatives with hereditary hair loss. The condition can be inherited from their mother, their father or from both parents.

Myth: Hereditary hair loss is rare among women.

Fact: In the US, 30 million women - or one in four - experience hereditary hair loss. Less frequent causes for hair loss in women include stress, illness, medication, diet and pregnancy. But 70 percent of women with thinning hair can attribute it to hereditary hair loss.

Myth: Prevalence of hereditary hair loss varies by ethnic or racial background.

Fact: Ethnicity neither increases nor decreases a person's likelihood of experiencing hereditary hair loss. Hereditary hair loss affects all ethnicities.

Myth: Blow-drying hair with heat gives the hair body.

Fact: While blow-drying is a quick, convenient way to dry and style hair, it damages hair as the high heat from a blow-dryer can actually boil the water in the hair shaft, leaving it brittle. In addition, vigorous towel rubbing or combing of wet hair also can cause hair loss, since wet hair is more elastic and more vulnerable to breakage than dry hair.

Myth: Dandruff (and subsequent scratching) does not contribute to hair loss.

Fact: Dandruff is caused by a fungus known as Malassezia globosa. This fungus is commonly found floating in the air, which is why dandruff can be treated, but not cured. In addition to the scaling that characterizes dandruff, the condition also can lead to hair loss. Studies have shown that with only 90 minutes of continuous scratching by the fingernails, it is possible to remove all of the cuticular scale, a protective covering on individual hairs, off of a hair shaft. This loss leaves the hair shaft weakened and permanently damaged, making it easily susceptible to breakage and hair loss.

Myth: Prescription shampoos treat scalp diseases, but also damage hair.

Fact: The two most common scalp diseases are dandruff and seborrheic dermatitis, which is characterized by both redness and scaling. Technological advances now allow prescription shampoos to have the necessary medication to treat dandruff and seborrheic dermatitis while also containing the same mild cleansers found in cosmetic shampoos.

Myth: As hair turns gray, perms and color treatments should be stronger.

Fact: As people age, they lose melanin, the pigment that gives the hair color. To retain a youthful look, many people dye their hair. Hair dye interacts with the melanin already present in hair to produce the final hair color, but gray hair is less likely to dye as dark as hair that contains more melanin. Also, as hair ages, the hair shaft becomes finer, and thinner hair shafts are more susceptible to chemical damage from permanent waves and coloring.

Source: American Academy of Dermatology.

TIPS TO HELP YOU COPE WITH THINNING HAIR

Discovering that your hair is thinning and possibly balding can be a frightening experience.

Don't panic. Hair loss is often temporary and reversible. There is hope.

Don't suffer in silence. The most common complaint is that women feel they are being ignored by their physician. If you feel that you're losing your hair, you probably are and should seek treatment. It can also be very empowering to be in contact with other women who have experience dealing with hair loss. The American Hair Loss Association recommends online support at www.womenshairlossproject.com.

Get professional help. To determine the cause of the condition, women experiencing hair loss should see a gynecologist, dermatologist and endocrinologist.

Don't believe the hype. Most of what you're going to be presented with is a scam. Don't buy any hair loss product or service advertised through late-night infomercials, radio, Internet or in the back of magazines. Unless the product is officially approved, stay clear.

Be wary of false prophets. Stay away from nonmedical practitioners such as trichologists who claim to have the ability to diagnose and successfully treat hair loss. These trade-school-trained individuals also charge the consumer large fees for their full range of "trichologically formulated" products, none of which have been proved effective to treat hair loss.

Source: American Hair Loss Association.
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