alopecia

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Alopecia

 

Definition

Alopecia simply means hair loss (baldness).

Description

Hair loss occurs for a great many reasons, from conditions that make people literally pull it out to complete hair loss caused by the toxicity of cancer chemotherapy. Some causes are considered natural, while others signal serious health problems. Some conditions are confined to the scalp. Others reflect disease throughout the body. Being plainly visible, the skin and its components can provide early signs of disease elsewhere in the body.
Oftentimes, conditions affecting the skin of the scalp will result in hair loss. The first clue to the specific cause is the pattern of hair loss, whether it be complete baldness (alopecia totalis), patchy bald spots, thinning, or hair loss confined to certain areas. Also a factor is the condition of the hair and the scalp beneath it. Sometimes only the hair is affected; sometimes the skin is visibly diseased as well.

Causes and symptoms

  • Male pattern baldness (androgenic alopecia) is considered normal in adult males. It is easily recognized by the distribution of hair loss over the top and front of the head and by the healthy condition of the scalp.
Top of balding male's head.
Top of balding male's head.
(Photograph by Kelly A. Quin. Reproduced by permission.)
  • Alopecia areata is a hair loss condition of unknown cause that can be patchy or extend to complete baldness.
  • Fungal infections of the scalp usually cause patchy hair loss. The fungus, similar to the ones that cause athlete's foot and ringworm, often glows under ultraviolet light.
  • Trichotillomania is the name of a mental disorder that causes a person to pull out his or her own hair.
  • Complete hair loss is a common result of cancer chemotherapy, due to the toxicity of the drugs used.
  • Systemic diseases often affect hair growth either selectively or by altering the skin of the scalp. One example is thyroid disorders. Hyperthyroidism (too much thyroid hormone) causes hair to become thin and fine. Hypothyroidism (too little thyroid hormone) thickens both hair and skin.
  • Several autoimmune diseases (when protective cells begin to attack self cells within the body) affect the skin, notably lupus erythemematosus.
  • In 2004, a report a the annual meeting of the American Academy of Dermatology said that alopecia was becoming nearly epidemic among black women as a result of some hairstyles that pull too tightly on the scalp and harsh chemical treatments that damage the hair shaft and follicles.

Diagnosis

Dermatologists are skilled in diagnosis by sight alone. For more obscure diseases, they may have to resort to a skin biopsy, removing a tiny bit of skin using a local anesthetic so that it can be examined under a microscope. Systemic diseases will require a complete evaluation by a physician, including specific tests to identify and characterize the problem.

Treatment

Successful treatment of underlying causes is most likely to restore hair growth, be it the completion of chemotherapy, effective cure of a scalp fungus, or control of a systemic disease. Two relatively new drugs—minoxidil (Rogaine) and finasteride (Proscar)—promote hair growth in a significant minority of patients, especially those with male pattern baldness and alopecia areata. While both drugs have so far proved to be quite safe when used for this purpose, minoxidil is a liquid that is applied to the scalp and finasteride is the first and only approved treatment in a pill form.

Key terms

Athlete's foot — A fungal infection between the toes, officially known as tinea pedis.
Autoimmune disease — Certain diseases caused by the body's development of an immune reaction to its own tissues.
Chemotherapy — The treatment of diseases, usually cancer, with drugs (chemicals).
Hair follicles — Tiny organs in the skin, each one of which grows a single hair.
Lupus erythematosus — An autoimmune disease that can damage skin, joints, kidneys, and other organs.
Ringworm — A fungal infection of the skin, usually known as tinea corporis.
Systemic — Affecting all or most parts of the body.
Minoxidil was approved for over-the-counter sales in 1996. When used continuously for long periods of time, minoxidil produces satisfactory results in about one-fourth of patients with androgenic alopecia and as many as half the patients with alopecia areata. There is also an over-the-counter extra-strength version of minoxidil (5% concentration) approved for use by men only. The treatment often results in new hair that is thinner and lighter in color. It is important to note that new hair stops growing soon after the use of minoxidil is discontinued.
Over the past few decades a multitude of hair replacement methods have been performed by physicians and non-physicians. They range from simply weaving someone else's hair in with the remains of one's own to surgically transplanting thousands of hair follicles one at a time.
Hair transplantation is completed by taking tiny plugs of skin, each containing one to several hairs, from the back side of the scalp. The bald sections are then implanted with the plugs. Research completed in 2000 looked at the new technique of hair grafting, and found that micrografts (one or two hairs transplanted per follicle) resulted in fewer complications and the best results.
Another surgical procedure used to treat androgenic alopecia is scalp reduction. By stretching skin, the hairless scalp can be removed and the area of bald skin decreased by closing the space with hair-covered scalp. Hair-bearing skin can also be folded over an area of bald skin with a technique called a flap.
Stem cell research is generating new hope for baldness. Scientists know that a part of the hair follicle called the bulge contains stem cells that can give rise to new hair and help heal skin wounds. Early research with mice in 2004 showed promise for identifying the genes that cause baldness and to identify drugs that can reverse the process.

Prognosis

The prognosis varies with the cause. It is generally much easier to lose hair than to regrow it. Even when it returns, it is often thin and less attractive than the original.

Resources

Periodicals

Cohen, Philip. "Stem Cells Generate Hair and Hope for the Bald." New Scientist (March 20, 2004): 17.
Lohr, Elizabeth. "Alopecia Nearly Epidemic Among Black Women." Clinical Psychiatry News (March 2004): 96.
Nielsen, Timothy A., and Martin Reichel. "Alopecia: Diagnosis and Management." American Family Physician.

Other

Androgenetic Alopecia.com. "How can minoxidil be used to treat baldness?" May1, 2001. http://androgenetic-alopecia.com/baldnesstreatments/minoxidil/002minoxidilbaldnessusee.shtml.
Mayo Clinic. "Alopecia" January 26, 2001. [cited May 1, 2001]. http://www.mayohealth.org.
WebMD Medical News. "Hair Today, Gone Tomorrow, Hair Again" 2000. [cited May 1, 2001]. http://my.webmd.com/content/article/1728.53923.

alopecia

 [al″o-pe´shah]
loss of hair; baldness. The cause of simple baldness is not yet fully understood, although it is known that the tendency to become bald is limited almost entirely to males, runs in certain families, and is more common in certain racial groups than in others. Baldness is often associated with aging, but it can occur in younger men. minoxidil has been approved as a topical treatment for male pattern baldness. Approximately one-third of the men undergoing this therapy have experienced hair regrowth. The effects of the drug take several months to develop and new hair growth may be limited; the hair is lost if treatment is discontinued. Hair transplants are also available to selected patients. Many men opt for no treatment.

Alopecia as an outcome of chemotherapy for a malignancy can be very distressing. The loss of hair usually is temporary and the hair will grow back after the course of treatment is completed. Male patients may feel more comfortable wearing a hat or cap when out in public. Female patients who wish to wear a wig are encouraged to obtain one that is lightweight and the same color as their hair. Having a hairdresser cut the wig to the patient's usual hair style can increase self-esteem. A kerchief or head scarf can be worn around the house if it is more comfortable than a wig. Receipts for wigs, hairpieces, and other headcovering should be saved; they are tax-deductible medical expenses when related to chemotherapy.
androgenetic alopecia (alopecia androgene´tica) a progressive, diffuse, symmetric loss of scalp hair. In men it begins in the twenties or early thirties with hair loss from the crown and the frontal and temple regions, ultimately leaving only a sparse peripheral rim of scalp hair (male pattern alopecia or male pattern baldness). In females it begins later, with less severe hair loss in the front area of the scalp. In affected areas, the follicles produce finer and lighter terminal hairs until terminal hair production ceases, with lengthening of the anagen phase and shortening of the telogen phase of hair growth. The cause is unknown but is believed to be a combination of genetic factors and increased response of hair follicles to androgens.
alopecia area´ta hair loss in sharply defined areas, usually the scalp or beard.
alopecia ca´pitis tota´lis loss of all the hair from the scalp.
cicatricial alopecia (alopecia cicatrisa´ta) irreversible loss of hair associated with scarring, usually on the scalp.
congenital alopecia (alopecia congenita´lis) congenital absence of the scalp hair, which may occur alone or be part of a more widespread disorder.
alopecia limina´ris hair loss at the hairline along the front and back edges of the scalp.
male pattern alopecia see androgenetic a.
moth-eaten alopecia syphilitic alopecia involving the scalp and beard and occurring in small, irregular scattered patches, resulting in a moth-eaten appearance.
symptomatic alopecia (alopecia symptoma´tica) loss of hair due to systemic or psychogenic causes, such as general ill health, infections of the scalp or skin, nervousness, or a specific disease such as typhoid fever, or to stress. The hair may fall out in patches, or there may be diffuse loss of hair instead of complete baldness in one area.
alopecia tota´lis loss of hair from the entire scalp.
alopecia universa´lis loss of hair from the entire body.

al·o·pe·ci·a

(al'ō-pē'shē-ă),
Absence or loss of hair.
Synonym(s): baldness, calvities, pelade
[G. alōpekia, a disease resembling fox mange, fr. alōpēx, a fox]

alopecia

(ăl′ə-pē′shə, -shē-ə)
n.
Complete or partial loss of hair from the head or other parts of the body.

al′o·pe′cic (-pē′sĭk) adj.

alopecia

(1) Loss or absence of hair on the scalp.
(2) Baldness, see there.

Alopecia types 
• Male pattern—On the front and top (maternal recessive). 
• Patchy—Alopecia areata (maternal recessive). 
• Permanent—Related to radiation therapy. 
• Post traumatic (i.e., pulled out). 
• Total—Alopecia capitis totalis (maternal recessive). 
• Transient—Due to chemotherapy-cyclophosphamide, cytosine arabinoside, doxorubicin.

alopecia

Baldness Dermatology
1. Loss or absence of hair on the scalp.
2. Baldness, see there See Hair replacement, Hot comb alopecia, Moth-eaten alopecia.
Alopecia types
Male pattern
On the front and top–blame mother
Patchy
Alopecia areata–blame mother, angry lover
Permanent
Related to RT–blame radiation oncologist
Total
Alopecia capitis totalis–blame mother
Transient
Due to chemotherapy—cyclophosphamide, cytosine arabinoside, doxorubicin–blame oncologist
.
.

al·o·pe·ci·a

(al-ō-pē'shē-ă)
Complete or partial absence or loss of hair. Results from normal aging, endocrine disorders, skin disease, or drug reactions (especially various forms of chemotherapy).
Synonym(s): baldness.
[G. alōpekia, a disease resembling fox mange, fr. alōpēx, a fox]

alopecia

(al?o-pe'sh(e-)a ) [Gr. alopekia, fox mange]
Absence or loss of hair, esp. of the head.

Etiology

Alopecia may result from serious illness, drugs, endocrine disorders, dermatitis, hereditary factors, radiation, or physiological changes during aging.

Treatment

Treatments include drugs, such as minoxidil or finasteride; surgeries, such as hair transplantation; or prostheses (wigs).

Enlarge picture
ALOPECIA AREATA OF SCALP

alopecia areata

Loss of hair in sharply defined patches usually involving the scalp or beard.
See: illustrationillustration
Enlarge picture
ALOPECIA CAPITIS TOTALIS

alopecia capitis totalis

Complete or near complete loss of hair on the scalp. See: illustration
illustration

cicatricial alopecia

Loss of hair due to formation of scar tissue.

alopecia congenitalis

Baldness due to absence of hair bulbs at birth.

alopecia follicularis

Baldness due to inflammation of the hair follicles of the scalp.

alopecia liminaris

Loss of hair along the hairline, both front and back, of the scalp.

male-pattern alopecia

Male-pattern baldness.

alopecia medicamentosa

Loss of hair as a result of medical treatment, esp. treatment with drugs used in chemotherapy for cancer.

alopecia pityroides

Loss of both scalp and body hair accompanied by desquamation of branlike scales.

alopecia prematura

Premature baldness.

alopecia symptomatica

Loss of hair after prolonged fevers or during the course of a disease. This baldness may be due to systemic or psychogenic factors.

alopecia totalis

Alopecia capitis totalis.

alopecia toxica

Loss of hair thought to be due to toxins of infectious disease.

alopecia universalis

Loss of hair from the entire body.

alopecia

Baldness. The commonest form is hereditary and affects males, but baldness may also be caused by old age, disease, chemotherapy or radiation for cancer and treatment with thallium compounds, vitamin A or retinoids. Alopecia areata features localized patches of complete baldness, usually with regrowth of hair within 9 months. The new hair is often white at first. The cause is unknown. The condition is currently treated with local steroids, MINOXIDIL, PUVA or immunotherapy. Early in 2004 it was reported that implanted stem cells from hair follicles could promote growth of hair and other skin elements.

alopecia

partial or complete loss of hair in humans. The cause is unknown but the condition may be a response to stress. Frequently occurs in patients undergoing CHEMOTHERAPY for CANCER or other diseases.

al·o·pe·ci·a

(al-ō-pē'shē-ă)
Absence or loss of hair.
[G. alōpekia, a disease resembling fox mange, fr. alōpēx, a fox]

Patient discussion about alopecia

Q. What medications cause hair loss? I have RA, high blood pressure, high cholesterol, allergies and depression for which I take medication. Which of these cause hair loss?

A. any one of them can, you need to ask your pharmacist about it

Q. Will my hair fall off if I have leukemia? I was diagnosed with ALL and I have to pass on a series of chemotherapy treatments, will my hair fall off? What are the side effects of chemotherapy?

A. Sorry but Yes. Most chemotherapy drugs that will be used do have the side effect of hair loss. However, this will only be temporary and your hair will grow back, probably even better than before! This is just a minor setback, not to be concerned about it..

Q. Do you know if Propecia can truly stop hair loss and even grow back hair. do you have any statistics about it? do you know if there are any side effects to this medication?

A. it does work but there is some side affects, as in E.D. while you are on the med.

More discussions about alopecia
References in periodicals archive ?
Early research in male pattern hair loss found that men with AGA have elevated levels of PGD2 in the balding scalp area.
Grade I, II and IIa in Hamilton-Norwood classification were defined as normal for male pattern alopecia.
Emin Tuncay Ustuner, a plastic surgeon in Ankara, Turkey said that the "force of downward pull caused by the gravity on the scalp skin" is the key contributor to the events leading to progressive hair loss in male pattern baldness.
The researchers from University of Tokyo trawled the Medline and the Cochrane Library databases for research published on male pattern baldness and coronary heart disease, and came up with 850 possible studies, published between 1950 and 2012.
Male pattern hair loss affects a large portion of the male population according to The International Society of Hair Restoration Surgery.
Androgens (testosterone, dihydrotestosterone) are responsible for male pattern baldness.
Men with male pattern baldness have higher levels of a molecule called prostaglandin D2 in the bald parts of their scalps than in parts still covered in hair, a new study shows.
Men with male pattern baldness still have stem cells in follicle roots but these stem cells lose the ability to jumpstart hair regeneration.
Male pattern baldness and the risk of prostate cancer.
Male pattern baldness, also known as androgenic alopecia, affects around half of all men in their lifetime.
Androgenic alopecia, also known as male pattern baldness, is a common disorder affecting almost 50 per cent of men.
There are many different reasons for hair loss, the most common being male pattern baldness, which can be inherited.