WASHINGTON, D.C. (February 6, 2004) - Whether they suffer from rapidly thinning hair or a case of excessive hair growth, hair disorder patients often find themselves tangled in a significant amount of emotional distress. Fortunately for patients with these conditions, taking the first step on the road to recovery and renewed self-esteem is as easy as a trip to their dermatologist.
Speaking today at the 62nd Annual Meeting of the American Academy of Dermatology (AAD), dermatologist Jerry Shapiro, MD, Clinical Professor, Division of Dermatology, University of British Columbia, Vancouver, Canada, discussed the symptoms, treatments, and stigma surrounding three of the most common hair disorders -- pattern hair loss, alopecia areata, and hirsutism.
If you're a man, you have a 50 percent chance of experiencing pattern hair loss by your 50th birthday. The hereditary condition, clinically termed androgenetic alopecia, is characterized by a receding hairline, as well as a loss of hair on top of the scalp. While going bald isn't life-threatening, it can be life-altering to men.
"My experience indicates that men who are losing their hair typically consider themselves less happy in life and are more self-critical," said Dr. Shapiro. "They see themselves as looking older than their age and feel less attractive."
Women also suffer from pattern hair loss, although not as prominently as men. The condition occurs in up to 25 percent of pre-menopausal women and in 38 percent of post-menopausal women. While pattern hair loss normally does not affect the frontal hairline in women as it does in men, thinning over the front and top of the scalp is typical and can be devastating to a woman's self-esteem.
"Women are especially embarrassed by even slight hair loss," commented Dr. Shapiro. "More than men, women will try to hide their hair loss. Oftentimes, they'll discuss their problem with a hair stylist and try to develop a hair style that disguises the problem."
Pattern hair loss in both sexes is marked by a progressive miniaturization of hair follicles, causing a shortening of the hair's growth cycle. As the growth phase shortens, the hair becomes thinner and shorter, to the point where there is no growth at all. Because hereditary hair loss is gradual, the sooner treatment is started, the better the chances of results.
"When someone confronts his or her hair loss and treats it early, treatment is more effective," said Dr. Shapiro. "It's important for patients to realize all there is to gain by addressing hair loss sooner rather than later."
Although there is no cure, there are several different treatment options for men and women suffering from pattern hair loss:
-- Minoxidil topical solution works on hair follicles to reverse the shrinking process and stimulate new growth on the top of the scalp. It is sold over the counter in 2 percent and 5 percent solutions and is approved by the U.S. Food and Drug Administration for use by men and women. Minoxidil is the only hair regrowth ingredient approved by the FDA for use by women. It must be used indefinitely to continue its effectiveness.
-- Finasteride, a pill taken orally, stimulates hair regrowth by blocking the formation of the active male hormone dihydrotestosterone (DHT). It is FDA-approved for use by men and is available by prescription. Like minoxidil, finasteride must be used indefinitely to continue its effectiveness.
-- Hair transplant surgery involves removing healthy hair follicles from one area of the scalp and transplanting them to the bald areas. Newer techniques such as strip harvesting and follicular unit grafting have revolutionized the procedure to give very natural-looking results.
"These newer techniques make for the best possible cosmetic results," said Dr. Shapiro. "Patients can expect a totally natural-looking hair transplant because the grafts are taken from the patient's own scalp."
The difference between pattern hair loss and alopecia areata is the difference between thinning hair and a complete absence of hair on parts of the body. Patients suffering from alopecia areata have lost entire patches of hair, and not necessarily just on the scalp. Other areas potentially affected are the eyebrows, eyelashes, beard, moustache, and pubic hair. This autoimmune condition affects almost 2 percent of the U.S. population, or 4.5 million people. It occurs in men and women of all ages and races, although it typically begins before age 20 in 60 percent of all patients.
"Alopecia areata can be psychologically devastating," stated Dr. Shapiro. "The cause is unknown and there is no cure. Fortunately, some patients develop only a few bare patches that regrow hair within a year."
Alopecia areata occurs in two forms that behave quite differently: a mild patchy form where less than 50 percent of scalp hair is lost, and an extensive form where greater than 50 percent of scalp hair is lost. The good news is that all affected hair follicles remain alive and have the capacity to resume normal hair production, sometimes even without treatment. When treatment is required, there are several options, depending mainly on the patient's age and the extent of hair loss.
For the mild, patchy alopecia areata the most common treatment is a monthly cortisone injection into the patches of bare skin. Topical minoxidil may also regrow hair on the scalp, eyebrows, and beard when applied in the stronger, 5 percent solution. In addition, anthralin cream or ointment, a synthetic, tar-like substance often used for psoriasis, can be applied once a day to bare patches of skin, with new hair growth possibly occurring in eight to 12 weeks.
For the extensive alopecia areata where greater than 50 percent of hair is lost, cortisone pills are sometimes given for extensive scalp hair loss. Cortisone taken internally is much stronger than local injections of the drug into the skin. Topical minoxidil is again effective, as is topical immunotherapy, which produces an allergic rash that induces hair regrowth.
The polar opposite of hair loss conditions like alopecia areata is hirsutism, a condition characterized by excessive growth of hair on the female face and body. One in 20 U.S. women suffer from hirsutism and the psychosocial issues that accompany it. Male-like patterns of hair may appear on the upper lip and chin, and more hair growth than usual may be seen on the arms and legs and even the chest and groin area between the abdomen and thighs.
"In women, hirsutism can be as emotionally distressing as hair loss on the scalp," said Dr. Shapiro. "Hirsutism has been known to affect job performance, mental health, and social interaction."
Hirsutism may be caused by abnormally high levels of the male hormone androgen in the blood. Genetics are often the cause, although several medical conditions, including polycystic ovarian disease, can also trigger the condition.
Medical treatments include birth control pills, hormonal suppression, and androgen blockade, the elimination of male sex hormones in the body. In addition, eflornithine cream, the first topical prescription treatment for women with unwanted facial hair, may be used to inhibit the growth of facial hair. Cosmetic treatments for hirsutism include bleaching creams, waxing, plucking, electrolysis and laser hair removal.
"Whether a person is experiencing pattern hair loss, alopecia areata or hirsutism, there are an increasing number of treatments available," commented Dr. Shapiro. "That's why it's important to consult with a dermatologist who can get to the root of the problem and begin treatment early."
The American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of over 14,000 dermatologists worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical, and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; supporting and enhancing patient care for a lifetime of healthier skin. For more information, contact the AAD at 1-888-462-DERM or www.aad.org.
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