MEDICAL CAUSES OF HAIR LOSS
Drugs and Ointments Minoxidil
There are generally
two types of hair loss:
effluvium - Permanent hair loss caused by the destruction of hair follicles
effluvium - Temporary hair loss due to transitory damage to the follicles
effluvium is generally due to internally administered medications, such as chemotherapy
agents, that poison the growing hair follicles. Telogen effluvium is due to an
increased number of hair follicles entering the resting stage.
The most common causes of telogen effluvium are:
stress - Surgery, illness, anemia, rapid weight change
stress - Mental illness, death of a family member
- High doses of vitamin A (sometimes present in diet supplements), blood pressure
medications, gout medications
changes - Pregnancy, birth control pills, menopause
to 95 percent of permanent hair loss is due to androgenetic alopecia, a hereditary
condition that affects millions of men, women and children. This condition is
characterized by what we call pattern baldness. Male
pattern baldness generally starts with a receding hairline at the front or
thinning of the crown hair and gradually progresses until, in extreme cases, only
a thin horseshoe-shaped rim of hair remains at the back and sides of the head.
pattern baldness, which has received more attention in recent years, refers to
general thinning of hair all over the scalp, usually beginning at around age 30
and becoming more noticeable after 40 and particularly after menopause.
with advancing age and an inherited tendency to bald early (a more complex link
than researchers originally thought), androgenetic alopecia is sped up by an over-abundance
of the male hormone dihydrotestosterone (DHT) within the hair follicle. DHT is
a highly active form of testosterone, which influences certain aspects of masculine
behavior, from aggression to sex drive.
is converted to DHT by an enzyme called 5-alpha reductase, which is produced in
the prostate, the scalp and various adrenal glands. Over time, DHT causes hair
follicles to degrade and shortens their anagen, or active, phase.
the follicle is still alive and connected to a good blood supply (that's why it
can nurture a transplanted follicle that is immune to the effects of DHT), but
it will grow smaller and smaller. Some follicles will die, but most will simply
shrink in size and produce weaker hairs. The progressively shorter anagen growing
cycle means more hairs are shed and remaining hairs become so thin that they cannot
survive daily wear and tear, experts say. Hairs in balding areas gradually change
from long, coarse, thick, colored hairs into fine, unpigmented, fuzzy hairs.
As we mentioned earlier, chemotherapy is the administration of
drugs that are poisonous to rapidly reproducing cancer cells (see How Cancer Works).
Cancer cells are some of the most rapidly reproducing cells in the body (see How
Cells Work). Other cells, such as those that contribute to the formation of hair
shafts and nails, also reproduce quickly. So while chemotherapy drugs preferentially
destroy cancer cells, the drugs also can destroy cells responsible for normal
growth of hair and nails. That's why cancer patients sometimes shed their hair
and nails during treatment. No hair growth stimulants, shampoos, conditioners
or other cosmetic treatments can prevent or retard the hair loss. The good news
is that once chemotherapy is completed, the hair usually grows back within six
months to a year.
Pharmaceutical hair restoration treatments use manufactured
chemical substances to affect the structure or function of the hair follicles
in an effort to stop hair loss and promote hair growth. Some hair loss medications
work by causing hair follicles that have shrunk or shut down to enlarge and grow
hair again. Hair restoration medications are used to treat both sudden, temporary
hair loss and chronic hair loss that starts slowly and becomes progressively more
extreme over time.
medications may be applied to the skin, taken by mouth or injected, and they include
both prescription and non-prescription drugs. Prescription drugs are typically
powerful and have the potential for some serious undesirable side effects if not
used as directed and for their intended purpose.
medications, like prescription drugs, contain active ingredients that affect the
body's structure or function in order to treat a medical condition. These medications
are intended for conditions that do not generally require skilled medical diagnosis.
They are usually less powerful than prescription drugs and less likely to cause
harmful side effects.
(the generic name) is in a class of drugs called hair growth stimulants. Oral
minoxidil, a prescription drug originally used to treat high blood pressure, was
found to increase body hair growth in the majority of patients taking it daily.
This led to the
development of topical minoxidil, sold over-the-counter and marketed in its 2
percent form under the brand name HealthGuard (Bausch & Lomb Pharmaceuticals),
and in its 5 percent form under the brand name Rogaine (Pharmacia & Upjohn).
These formulas have been shown to stimulate hair growth in men with pattern baldness.
In women, these ointments can help increase growth in the forehead area, according
or nursing women should avoid minoxidil in either form and be cautioned that the
use of extra-strength formulas are not designed for women and can cause facial
hair growth and other problems.
is what pharmacists call dose-dependent. This means that treatment must be continued
in order to maintain or increase hair growth benefits. Regular-strength Rogaine
must applied on a dry scalp at least twice daily (and left in place for at least
four hours) and for at least four months to see results. Extra strength formulas
work much more quickly (in about 45 days), manufacturers say.
minoxidil can cause a fall in blood pressure, an increase in the heart rate, and
weight gain (fluid retention). An increase in the absorption of topical minoxidil
from the scalp can occur in users with inflamed or abnormal scalps and can lead
to the same side effects as those of the oral minoxidil. This means that people
with heart failure or major coronary heart disease should avoid the drug in either
form, and those with high blood pressure should consult their doctors. In addition,
topical minoxidil should not be used with other ointments or topical creams. Skin
side effects might include irritation, itching, hives, swelling and sensitivity.
a prescription drug marketed in a 1-mg tablet as
Propecia (Merck Pharmaceutical), was approved by the FDA in 1998 for the treatment
of androgenetic alopecia. (Finasteride, in a 5-mg tablet, was manufactured and
marketed earlier as Proscar, which is still used to treat prostrate abnormalities.)
works by decreasing the concentration of the male hormone DHT by about 60 percent
in people taking one tablet per day. Since finasteride inhibits this hormone,
which is a key factor in the miniaturization of scalp hair follicles, this allows
for a reversal of the balding process. Results are usually seen in about three
months, and this drug is also dose-dependent. Generally, finasteride is not beneficial
in the treatment of female pattern baldness.
researchers say that a combination of minoxidil and finasteride provides hair
growth that is superior to that resulting from the use of either single drug.
Talk to your doctor about this. Side effects that have been attributed to finasteride
include decreased libido and groin aches.
Other less familiar options include using Retin-A (brand name,
Ortho Pharmaceutical) alone and in combination with minoxidil to treat male pattern
baldness. It is thought that the combination works because the increased absorption
caused by Retin-A increases the amount of minoxidil reaching the hair follicle
cells. (Since Retin-A is degraded by strong light, you should only use it at night.
If you're using a combination formula, wear a hat or stay in the shade.)
solutions, which are alternatives to Rogaine, come in formulas with varying amounts
of minoxidil, Retin-A and azelaic acids. Ask your doctor or pharmacist to help
you choose the right formula.
If the shampoo bottles marked "for thicker hair" grab
your attention in the store, you might want to think again before tossing one
into your cart. According to the FDA, none of the shampoos or hair products that
claim to give you thicker, fuller hair can actually do that. What these products
do, instead, is to create the appearance of greater fullness by plumping up hair
another interesting product on the market -- make-up that colors your scalp the
same color as your hair. It's cheap, it's fast and it's safe. (Manufacturers say
it won't run when wet but easily washes off with normal shampooing.) You can't
create a frontal hair line with this product, but if you can't afford surgery
or a new wig, why not check it out?
For thousands of years, wigs have been called wigs. Today,
wigs are called many different things, and they've come a long way in terms of
offering a more natural appearance. Temporary usage of hair additions while undergoing
lengthy hair transplant sessions is becoming more popular among men and women
who don't want to advertise their work-in-progress, especially since many transplants
take one or two years to complete.
non-surgical hair addition is any external hair-bearing device added to existing
hair or scalp to give the appearance of a fuller head of hair. In this category
are hair weaves, hair extensions, hairpieces, toupees, non-surgical hair replacements
and partial hair prostheses. Devices may consist of human hair, synthetic fiber
or a combination of both.
hair additions -- now more popular than wigs -- are attached in a variety
of ways. All techniques use either the existing hair or the skin as anchor sites.
Weaving, fusion, bonding and cabling generally describe the techniques used to
attach the new hair to the existing hair. All are used to provide more security
for the active lifestyle, and they are all dependent on the growing existing hair
and therefore must be reattached or tightened as the existing hair grows. (Techniques
that stress your existing hair, such as weaves, can cause permanent damage if
done incorrectly or on an inappropriate candidate. Even temporary clips attached
too tightly can cause permanent hair loss.)
that use the skin as the anchor site include adhesives such as two-sided tapes
and water-proof liquids. Most adhesives are safe, but it's a good idea to have
your dermatologist do a patch test to check for skin allergies.
your hair loss is due to illness or chemotherapy or physical abnormalities, these
devices are your best solution (you should probably opt for a full wig).
insurance generally does not cover male or female pattern hair loss, it may cover
the cost of a hair addition when hair loss is caused by disease or other abnormalities.
is seeing a growing number of people using wigs and hair systems to cover the
results of a bad hair transplant, and to combine partial transplantation with
a partial hair addition. The Hair Loss Council offers this example: An individual
with severe baldness who wants to wear his hair straight back may opt for a transplanted
hairline only (due to lack of donor hair available). Behind the newly transplanted
front hairline, this person might have a hair addition designed so that he can
now comb his own hair straight back.