Causes and treatment of hair loss in men and women

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E. Ronald Finger

The most common cause of alopecia (hair loss) is hereditary. This is called male pattern (MPB) and female pattern baldness (FPB). Alopecia affects about 35 million men and 21 million women in the United States alone.

More than 40% of men have noticeable hair loss by age 35, and 65% of women have significant hair loss by age 60.

Typically, MPB starts in the crown and temples and may expand to complete baldness, except for the sides and back of the scalp, according to family history. The age can vary from the 20s to 70s.

FPB looks more like an oval-shaped area of baldness in the center of the scalp, including the hairline. It's typically generalized thinning.

Common causes of alopecia in women include menopause, pregnancy, childbirth and thyroid problems (too much or too little thyroid hormone).

In men, the most common cause is too much testosterone being converted to DHT (dihydrotestosterone).

Smoking is another cause, regardless of gender.

Alopecia areota is a medical condition in which patches of hair are lost. The diagnosis is made with a small scalp biopsy.

Other medical conditions that cause alopecia include infections such as ringworm, dermatological skin conditions, a psychological condition called trichotillomania (pulling one's own hair out), diabetes and autoimmune disorders.

Taking anabolic steroids causes an elevation of DHT, which in turn causes permanent hair loss in many cases. Other common causes are chemotherapy, general anesthesia, and excess thyroid hormone medication.

Anorexia nervosa, the eating disorder in which a person denies oneself enough food to maintain a normal weight, commonly causes alopecia.

Stress, such as loss of a loved one or any long-term emotion or physical stressful event might also cause hair loss.

Even certain hairstyles can cause traction alopecia, which leads to permanent hair loss, the most common being braids, which is seen in my office virtually weekly. Other styles include pigtails and buns - and other hairstyles that constantly pull on the hair follicles.

Heavy metals, such as mercury and lead, can cause hair loss. Chlorine is another offender, along with smog and smoke.

Treatment should be oriented toward finding the cause of the alopecia. Here are some options:

• Topical therapy. Minoxidil 5% for both men and women. Many patients prefer the foam.

• PRP (platelet rich plasma). This is the injection of your own growth factors into your scalp. The benefit is temporary, and after the initial series requires an injection every 10 to 12 months. This is helpful in people with early hair loss.

• Finasteride is a medication taken by mouth that prevents testosterone conversion to DHT. Possible adverse side effects must be fully understood by patients before taking this medication.

• Hair transplantation: This involves taking hair follicles from the back of the scalp and transplanting them to balding areas. Success and longevity are dependent upon proper assessment by the hair transplant specialist and experience and skill of those performing the procedure. When properly done, the transplanted hair looks natural and lasts for decades.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com

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