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Articles: Hairloss in women should
be taken seriously New York - Whether hairloss in women is transient or permanent, it is important to find the cause in order to determine the appropriate treatment. In many instances, the cause can be determined and treated. "Physicians should not write [this] off as stress. If a woman presents with hairloss, it behooves you to discover the cause," said Lynn Drake, M.D., Oklahoma City. "Don't dismiss these patients - it's not simply stress. Losing hair is not normal in the vast majority of instances, and if a woman presents to a physician with hair thinning, the doctor needs to take her condition seriously." Hairloss may point to serious underlying causes, including thyroid or liver disease, drug toxicity, and hepatic or renal failure, said Dr. Drake, chair and professor, department of dermatology, University of Oklahoma Health Sciences Center. Many women experience thinning hair. It can begin as early as their 20s or as late as their 60s, she explained. If a woman loses hair before menopause, she should be seen by a physician to determine the cause. If she loses hair after menopause, she should not assume the loss is part of normal aging. All women with hairloss deserve to be seen, she said. "In the natural aging process there will be some hairloss, but it should not get extraordinarily thin." Dr. Drake performs a thorough history and physical on initial presentation. She said she almost always gets a good idea of what is going on in about a 20- minute examination of the patient. Different From Male Pattern Diffuse hair thinning in women presents differently than in men. Women tend to preserve the frontal hairline, whereas men get temporal recession. Women's hair thins on top of the head. "Many think this is androgenetic alopecia, but I feel that the diagnosis should only be made after other causes are ruled out," Dr. Drake noted. Women lose their hair for a variety of reasons. Telogen effluvia (hair is lost in a transient manner) frequently follows events such as receiving anesthesia, childbirth, starting or stopping birth control pills, and running a very high fever. Stress Is Rarely Cause Stress is seldom related to hairloss. Only severe stress causes telogen effluvia, she explained, such as that experienced after the death of a loved one or an acute psychotic break. Telogen effluvium is easy to diagnose because it can be determined with a simple hair pluck. The hair usually regrows once the insult is resolved. Another type of alopecia is endocrine related. Individuals with hypothyroidism or hyperthyroidism, essential fatty acid deficiency, zinc deficiency, or any condition that upsets the ovarian, adrenal or pituitary axis, can cause hair thinning. "Hairloss can frequently be a marker for a serious underlying disease," Dr. Drake continued, with thyroid disease being a common culprit. Another major category for alopecia is nutrition. Vegetarians, for example, can lose hair because they are protein deficient. "It's difficult to eat enough protein if one is a vegetarian. Often I will ask my vegetarian patients to meet with a dietitian," Dr. Drake said. Other nutritional issues include anorexia, bulimia, and ingestion of too much vitamin A. To help make the diagnosis, "Doctors must inquire about what patients are eating or not eating," she advised. Infections Can Be Culprit Local viral, fungal, or protozoan infections can also cause alopecia. The hairloss that occurs with systemic infection is usually secondary to high fever. The amount of time it takes for hairloss to occur after the systemic infection varies as to the cause, she said - anywhere from a week to several months. Hundreds of drugs have been implicated in alopecia. Antimitotics - such as those used for chemotherapy - can cause hairloss within a week, while others, such as bromocriptine (used to inhibit lactation), can take three to five years to manifest themselves. Beta blockers, ACE inhibitors, amphetamines, and anticholesterol agents have also been implicated in alopecia. A whole array of systemic disease can cause hairloss. For example, more than 50 percent of patients with lupus have hair thinning. "I have diagnosed nine patients with systemic lupus based on a hair thinning problem," Dr. Drake said. Discoid lupus erythematosus as well as renal and hepatic failure are other etiologies for hair thinning. Another group who may present are runners, who can develop an anemia that leads to hairloss. "These patients may have a normal hematocrit or hemoglobin, but their serum iron or total iron-binding capacity will be low. Physicians be must be diligent in their workup on these patients," said Dr. Drake. "Often these women have amenorrhea." DT Causes of hairloss or hair thinning in women: * thyroid or liver disease SOURCE: LYNN DRAKE, M.D. Contact Us: |