Hair loss is a condition that affects a large percentage (1 in 4) of women in their lifetime, it can, however, be a difficult subject for women to broach. The subject of male hair loss is widely discussed and treatment for it can be found on pretty much on any website, television channel, or radio. Other than the occasional woman featured on a Hair Club© commercial, female hair loss is not at the forefront of our cultural rhetoric. July is International Women with Alopecia Awareness month, and it is important to know the causes, treatment, and prognosis for ladies currently affected by all kinds of hair loss.
What is normal hair loss? Everyone sheds hair on a daily basis; the average person should shed approximately 100 hairs. Medically, true “hair loss” occurs when shedding 125+ hairs per day.
There are several causes and types of female hair loss and can present at any age in life. Common causes of temporary hair loss include the use of oral contraceptive pills, pregnancy, weight loss, surgery, traumatic event or injury, and extreme stress. This type of hair loss is called Telogen Effluvium, and occurs when the hair growth and resting process is interrupted and goes directly into the shedding phase. Telogen Effluvium is typically temporary, and symptoms typically present three months after the event (as listed above). Hair re-growth can be expected usually after about six months; however, this can become a chronic condition for some women (although it is not understood why).
Alopecia is the most common type of hair loss, and is caused by an auto-immune disruption; specific T-cells invade the follicle (due to the loss of immune function), building up around it, and shrinking it so that it prevents hair growth. The hair follicle is not dead, and will re-grow hair when it is given the correct biological immune signal. There are two types of Alopecia: Alopecia Areata (Spot Baldness) and Androgenetic Alopecia (Female Pattern Hair Loss). Alopecia Areata is a condition characterized by “spot baldness”, which happens quickly, usually occurring on the scalp first. However, this can present on any part of the body. The underlying skin appears scarred (due to the secretion of T-cells), and pain or tingling may occur at the site of hair loss. Alopecia Areata tends to be cyclical, with hair loss and re-growth occurring several times. While this is an immune disorder, there are no other known sequelae associated with this condition, and it is not life threatening. The second, and most common type of hair loss in women (affecting 6% of women under the age of 50, and 38% of women aged 70 and older), is known as Androgenetic Alopecia, more commonly known as Female Pattern Hair Loss (FPHL). This condition is akin to Male Pattern Baldness (androgen excess), but the mechanism is not believed to be quite the same, as studies have shown less than 30% of female hair loss cases have androgen excess. Hair loss is more uniform and all over the scalp, usually thinning the most on the top of the head, but rarely leads to complete baldness.
The diagnosis for these various types of hair loss has become easier in recent years. Often Alopecia Areata can be diagnosed by visual inspection by a physician, because the characteristics of the condition are so blatant. A skin and hair test can be done for pathological diagnosis, and to do this, the doctor will take a small biopsy. Before these are done, there are serum blood tests that can be done to rule out other conditions that may cause hair loss, such as: thyroid disease, PCOS (polycystic ovarian syndrome), anemia. The link between Alopecia and heredity is not fully understood, but it does appear to be more common in people with other affected family members, as well as family members affected by other non-related autoimmune disorders. Environmental factors (and allergens) are also thought to affect these types of hair loss, and that a combination of both genetics/heredity and environmental factors are at the root of Alopecia. Genetic testing is available for Female Pattern Hair Loss (FPHL), however the implications of how to use this information for diagnosis and prognosis is unknown.
The treatment for hair loss is limited and has a wide range of results for individuals; however it is better than it has ever been! Individuals with Alopecia Areata often receive no treatment, and their hair will grow back on its own. This is not true for everyone, and is not as common for women who have FPHL.
-Steroid Injections – corticosteroid injections (Kenalog) into the affected area.
-Minoxidil (Rogaine) – the only FDA approved topical treatment for hair loss.
-Hair Replacement Surgery – Hair from a donor site (the back of the scalp, often) is grafted to the thinning or bald spot.
-Extensions/Additions –synthetic or real hair extensions that can be sown, glued, or clipped into existing hair.
Hair loss can be a very difficult and emotional condition to deal with, especially for women. There are increased reports of low-self esteem and depression in women with hair loss than men. Fortunately, hair loss is not life-threatening, and not physically limiting. Awareness of conditions like Alopecia is important to reduce stigma and allow those living with it to be better understood.
For more information please visit:
The American Hair Loss Council http://www.ahlc.org/
National Alopecia Areata Foundation https://www.naaf.org/
North American Hair Research Society http://nahrs.org/