Increasing Hair Loss

Dear Dr. Spence,

I am a 52 year old female who has been having increasing hair loss. I’m afraid if I don’t do something at once, I’ll soon be completely bald. Help! What do you suggest I do?
Signed,
Imma Shining


-- Dear Imma,
There are many causes of hair loss. It is important to understand the principles of hair growth before one can understand the principles of hair loss. Hair grows in cycles of two to six years with an average growth of one centimeter per month during each cycle. It is normal to lose approximately 100 hairs per day which can be disconcerting for some people that are not aware of this. This, in part, may explain why hair growth can recuperate after a period of apparent loss.

As noted, there are numerous causes of hair loss, or alopecia. The most common is known as telogen effluvium (doctors always need fancy words to explain common conditions!). In telogen effluvium, an increased number of hairs enter the telogen, or resting phase and these hairs eventually fall out approximately three months later. The normal hair loss of 100 per day dramatically increases and may cause a loss of up to 30-50% of total body hair. Telogen effluvium is typically precipitated by some form of stressful event three months prior to the complaint. Stressful events may include surgery, childbirth, illness, injury or even severe psychologic stress. Other possible causes include thryoid disease (overactive or underactive) and iron deficiency. Medications may be the culprit and can include antiepileptics, hormones, blood thinners and some blood pressure medications.

Alopecia areata causes hair loss in circular patches and is typically a result of chronic illness like diabetes mellitus, thyroid disease or lupus. It can happen at any age and treatment usually consists of treating the underlying disease process. Other causes of hair loss include nutritional deficiencies, syphilis, medications and repeated trauma to the hair though braids, perms, use of hair curlers or twisting.

For physicians, the general evaluation revolves around a thorough history and physical. In some cases, bloodwork may be of some value and often includes thyroid testing as well as evaluation of iron stores and hormone levels (testosterone etc.). As noted, most cases are secondary to telogen effluvium and will resolve over time once the stressor has passed.

Finally, once all is said and done, many women are simply suffering from female pattern hair loss which is characterized by thinning over the central area of the scalp with widening of the midline part. Nearly 50% of women will experience female pattern hair loss in their lifetime. Treatment consists of over the counter minoxidil. It may take three to six months to see results. The higher concentration solutions (5%) do not offer any clear benefit and may be more likely to cause dryness, itching and possible skin irritation. I recommend the 2% solution.
 
Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.