Facts You Should Know About Hair Loss
by Beth G. Hodges, MD

Hair loss, also called alopecia, has many causes. It can be genetic or due to over processing of the hair. It can be due to stress, either physical stress on the body (from an illness) or emotional stress. Infections such as syphilis or a fungal infection like ringworm can cause hair loss. Most people know that chemotherapy and radiation therapy for cancer can cause hair loss, but most do not know it can also be due to accutane (a medication for severe acne), coumadin ( a medication that thins the blood), some cholesterol medications, some anti-seizure medications, some antidepressants, beta blockers ( medications for the heart and high blood pressure), oral contraceptive pills, glaucoma drops, anti-inflammatory drugs, and some ulcer medications.

Hair loss can also indicate another problem in the body, such as iron deficiency anemia or a thyroid problem. When evaluating hair loss, many things must be considered.

Diagnosing the cause for hair loss involves a careful history (information given to the doctor by the patient) and physical exam. Patchy hair loss is most likely due to a fungal infection or traction. Traction alopecia occurs when hair is braided too tightly and begins to be pulled out by the roots where it is pulled most tightly. Trichotillomania, on the other hand, occurs when someone suffering from obsessive compulsive disorder feels a constant compulsion to pull out his or her hair or eyelashes or eyebrows as a way of alleviating anxiety. Certain types of genetic hair loss, such as female pattern baldness, will be apparent on physical exam, such as symmetric hair loss at both temples.

If the history and physical exam do not reveal the cause of the hair loss, the next step is to do some blood tests. The tests should look for infection, iron deficiency, syphilis, and thyroid problems. Sometimes, the cause of the hair loss is not determined, but most of the time it is.

Treatment in Men

Treatment for hair loss varies by gender and the cause. Men, 85% of whom will suffer some degree of hair loss by age 50, unless there is an underlying correctable cause, have two main medication options. The first is Propecia (finasteride) which has a modest effect. Liver function tests should be monitored periodically during use of the medication, and the hair loss will return full force when it is stopped. Propecia has a teratogenic effect, meaning it can cause birth defects, so women who are or may be pregnant should not even handle the tablets. Rogaine, although not requiring monitoring of the liver, has a similar success rate as Propecia. Some men will elect to have hair plugs implanted and there are several other less conventional treatments available.

Treatment in Women

Treatment for hair loss in women is primarily focused on treating the underlying cause. If one cannot be found, a few available therapies do exist. One is Rogaine for women (minoxidil.) Spironolactone ( a medication for heart failure) and cimetidine (a medication for heartburn) have shown modest benefit. Estrogen and progesterone supplementation can be beneficial for women who lose hair due to menopause.

Although hair loss can signal a medical problem, it is more a social and psychological problem than a medical problem, and can have devastating effects on self-confidence for the person involved.

Published - January, 2010