|
|
|
Overview |
|
|
Definition |
|
Alopecia is the absence or thinning of hair in an area of the body where hair
formerly grew. It may be caused by physical damage to the hair itself or to the
hair follicles, but is most often the result of changes in the natural hair
growth cycle.
The average scalp has about 100,000 hairs. Most of these hairs are in the
anagen, or growing, phase, which may last as long as five years. In the catagen,
or transitional, phase, the hair stops growing and the follicle begins to
shrink. The hair then falls out and the follicle lies dormant in the telogen, or
resting, phase until a new anagen phase begins. About 10% of the hair follicles
on the normal scalp are in the transitional or resting phases, and about 100
hairs are lost every day. In some types of alopecia, the growth cycle is
disrupted by some temporary situation such as a chemical imbalance or stress;
often the problem may be resolved when the precipitating condition is
alleviated. However, 95% of cases of hair loss in both men (male pattern
baldness) and women (female diffuse baldness) are genetic in origin. This is
called androgenetic alopecia. |
|
|
Etiology |
|
Androgenetic alopecia is caused by a genetic predisposition for certain hair
follicles to produce the enzyme 5-alpha reductase, which combines with the
testosterone in the follicle and transforms it into dihydrotestosterone (DHT).
DHT accumulation eventually shuts down the follicle. In the interim, the hairs
produced by the follicle gradually become shorter and finer. Female diffuse
baldness progresses more slowly than male pattern baldness because of the small
amount of testosterone in a woman's body. Androgenetic alopecia may be
exacerbated by a hormone imbalance.
Many temporary forms of hair loss result from telogen effluvium, in which
approximately 30% of the hair follicles go into the resting phase at once. Any
shock to the body's systems, including starvation, systemic infection,
childbirth, thyroid or immunologic disorders, drugs, or stress may precipitate
such an episode. In anagen effluvium, the growth phase is suddenly halted and
all or most of the hair falls out in clumps within a few weeks. The most common
cause of this condition is chemotherapy for cancer.
In cicatricial, or scarring alopecia, hair follicles are destroyed by
scarring from burns or other trauma, severe scalp infections, X-ray therapy, or
skin disorders. Physical damage may also result from tight hairstyles maintained
over a long period of time, called traction alopecia. Chemical treatments such
as hair coloring or permanents can cause hair loss, as can trichotillomania, the
habitual pulling out of the hair. Tinea capitis, or "ringworm of the scalp," a
fungal condition, also results in hair loss. Except for scarring alopecia, these
conditions are generally temporary.
The causes of alopecia areata, or patchy hair loss, are not well understood.
There appears to be a genetic component, and it is sometimes associated with an
autoimmune disorder. Onset tends to occur in times of stress. Since white hairs
are less affected by alopecia areata than pigmented ones, a patient with this
condition may report that areas of hair appear to have
"turned gray overnight." |
|
|
Risk Factors |
|
- Male gender
- Advancing age
- Close family member with hair loss
- Hormone imbalance
- Stress
- Eczema, asthma or hay fever, thyroid disease, or vitiligo
- Autoimmune disorders such as lupus erythematosus
- Down's syndrome
|
|
|
Signs and Symptoms |
|
- In male pattern baldness—thinning or absence
of hair at the hairline and crown; normal hair growth remains in a "horseshoe"
pattern around the sides and back of the scalp.
- In female diffuse baldness—a gradual
thinning of hair, especially on the crown; hairline generally remains
intact
- Broken hairs, or hairs easily removed
- One or more round or oval bald
patches
|
|
|
Differential
Diagnosis |
|
Determine the type of alopecia and treat accordingly. |
|
|
Diagnosis |
|
|
Physical Examination |
|
Thin short hairs, tapering at their base ("exclamation point hairs"), easily
pulled out, are seen in and near the bald patch or among hairs which have shed.
Look for other patches of alopecia on eyebrows, eyelashes, beard or body hair.
In alopecia areata, nails may be pitted or deformed. |
|
|
Laboratory Tests |
|
Thyroid function tests and complete blood count to rule out immunologic
disorder |
|
|
Pathology/Pathophysiology |
|
Biopsy will support diagnosis of several forms of
alopecia. |
|
|
Treatment Options |
|
|
Treatment Strategy |
|
Appropriate treatment options depend upon the type of alopecia.
Aggressiveness of the treatment depends on the patient's attitude toward what is
fundamentally a cosmetic problem and must be weighed against potential side
effects. In many temporary forms of alopecia, the condition will begin to
normalize without treatment upon removal of the cause. Surgery may be indicated
for highly motivated patients with male pattern baldness for whom medical
therapies are contraindicated or ineffective. Options include hair transplants,
scalp reduction, and strip or flap grafts. |
|
|
Drug Therapies |
|
- Male pattern baldness—Topical minoxidil
(Rogaine), 2% to 5% applied bid. Alternatively, finasteride (Propecia), 1 mg/day
orally. Either drug must be used indefinitely to maintain regrown hair. Monitor
for potential side effects.
- Female diffuse baldness—Topical minoxidil
(Rogaine), 2% applied bid. Must be used indefinitely to maintain regrown hair.
Monitor for potential side effects.
- Alopecia areata—Intralesional injections of
aqueous corticosteroids, triamcinolone suspension 5 mg/ml, 0.05 to 0.1 ml at
intervals of 1 to 2 cm. Injections should not be repeated at the same site for
three months. Topical steroids (0.5% triamcinolone cream) may be used for
children.
- Tinea capitis—Antifungal such as
griseovulfin, orally for eight weeks, in combination with antifungal shampoo two
to three times per week for eight weeks. Complete entire course of treatment to
prevent relapse.
|
|
|
Complementary and Alternative
Therapies |
|
Alopecia is a multi-factorial condition. Correcting the underlying cause is
the primary goal of treatment. Complementary therapies have limited success in
treating male pattern baldness in men. |
|
|
Nutrition |
|
- Optimizing diet by reducing intake of pro-inflammatory foods
(saturated fats, dairy, and other animal products) and increasing fresh
vegetables, whole grains, essential fatty acids, and, in particular, protein
will help to provide essential nutrients for normal hair growth.
- Biotin (300 mcg/day) may be helpful in relieving alopecia. Trace
minerals, such as those found in blue green algae (2 to 6 tablets/day), are also
needed for hair growth.
- For androgenetic alopecia: Vitamin B6 (50 to 100 mg/day), zinc (30
mg/day), and GLA (1,000 mg bid) helps to inhibit 5-alpha reductase. Hormone
imbalance: Essential fatty acids (1,000 mg bid), B6 (50 to 100 mg/day), vitamin
E (400 IU/day) and magnesium (200 mg bid) enhance hormone
production.
|
|
|
Herbs |
|
Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water.
Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for
roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
noted.
- Herbs that support circulation may aid in bringing nutrients to the
scalp. Combine the following herbs in equal parts and use as tea (2 to 3
cups/day) or tincture (20 to 30 drops bid to tid).Ginkgo (Ginkgo biloba),
rosemary (Rosmarinus officinalis), prickly ash bark (Xanthoxylum
clava-herculis), black cohosh (Cimicifuga racemosa), yarrow
(Achillea millefolium), and horsetail (Equisetum arvense). Ginkgo
should be used with close supervision if pharmaceutical circulatory
(anticoagulation) agents are employed (e.g., coumadin or aspirin).
- Androgenetic alopecia: Green tea (Camelia sinensis), 2
cups/day, and saw palmetto (Serenoa repens), 100 mg bid, have
anti-androgenic effects.
- Hormone imbalance: Chaste tree (Vitex agnus cactus), 200 to
300 mg/day, has a normalizing effect on the pituitary and may help correct
hormonal imbalances.
- Viral or immune etiology: Herbs that support the immune function are
helpful to treat the underlying cause of this type of alopecia. Echinacea
(Echinacea angustifolia), astragalus (Astragalus membranaceus),
and Siberian ginseng (Eleutherococcus senticosus) may be
helpful.
|
|
|
Physical Medicine |
|
Effective stress reduction techniques are helpful to reduce stress, which
will lead to increased blood flow to the scalp. |
|
|
Massage |
|
Therapeutic massage increases circulation and reduces stress by enhancing
overall sense of well-being.
Scalp massage using essential oils of rosemary, lavender, sage, thyme, and
cedarwood may be helpful in increasing circulation. Add 3 to 6 drops of
essential oil to 1 tbsp. of jojoba and/or grapeseed oils. Massage into scalp
daily. Essential oils may also alleviate cases of tinea
capitis. |
|
|
Patient Monitoring |
|
Patients on minoxidil should be cautioned to use as directed, to prevent
possible side effects from systemic absorption (uncommon). More likely side
effects include irritation of the scalp. A small percentage of men using
finasteride may experience decreased libido, difficulty in achieving an
erection, or a decrease in ejaculate volume. Tinea capitis may be transmitted
among family members. Support groups may help patients deal with the emotional
effects of alopecia. |
|
|
Other
Considerations |
|
|
Complications/Sequelae |
|
Twenty four percent of adults and 54% of children diagnosed with alopecia
areata progress to alopecia totalis, the loss of all scalp hair. Alopecia
universalis, the loss of all body hair, is rare. |
|
|
Prognosis |
|
Minoxidil and finasteride result in reduced hair loss and/or new hair growth
within a few months if they are going to be effective in the patient with
androgenetic alopecia. In alopecia areata, the onset of the condition is
generally sudden. The more extensive the hair loss, the less likely that
recovery will be complete. However, in most cases, hair begins to regrow within
a few months to a few years. With corticosteroid injections hair regrowth should
occur in four to six weeks. New hair growth is fine and sometimes unpigmented,
but normalizes over time. |
|
|
Pregnancy |
|
Treatment should be delayed until after
pregnancy. |
|
|
References |
|
Guendert DV. Management of Alopecia. February 1, 1995. Department of
Otolaryngology, UTMB. Accessed at Neuropathy Research at the Medical College of
Georgia, www.npntserver.mcg.edu/html/alopecia/documents/BALDNESS_95.html on
January 13, 1999.
Hay IC, Jamieson M, Ormerod AD. Randomized trial of aromatherapy: successful
treatment for alopecia areata. Arch Dermatol. 1998;134:1349-1352.
Lebwohl M. New treatments for alopecia areata. Lancet.
1997;349:222-223.
Whiting DA. The Diagnosis of Alopecia. Dallas, Tex: University of Texas.
Baylor Hair Research and Treatment Center. Accessed at Neuropathy Research at
the Medical College of Georgia,
www.npntserver.mcg.edu/html/alopecia/documents/DiagnosisAA.html on January 13,
1999. |
|
Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. | |