A full head of hair is a hot commodity.
Your patients — both male and female — place
a lot of importance on their pate's appearance, so a
thinning patch can send them into a panic, even though
some hair loss is perfectly normal. "Most men and women
experience some degree of hair loss with aging," says
Dr Robert Schemmer, a hair transplantation and cosmetic
dermatology specialist in Aurora-Newmarket, ON.
By far the most common cause of
hair loss, or alopecia, is genetics, adds Dr Robert
Jones of the Toronto Hair Transplant Centre. But stress,
endocrine disorders, underlying conditions such as anemia
and lupus, and even certain medications like anticoagulants,
birth control pills and antidepressants, can also cause
lost locks.
DON'T
SPLIT HAIRS
There are several different types of hair loss, but
Dr Schemmer says that if you take a good history and
carefully observe the pattern of thinning, you shouldn't
have a problem making an accurate diagnosis. He suggests
going back a few generations to see if there's a history
of alopecia in the family. "But the big myth that it
always comes from your mother's side is just not true,"
notes Dr Jones.
You should also ask your patient
how much hair they're losing in the bathtub, in their
brush or on their pillow — anything over 100 hairs
a day is too much. If you want to make sure your patient
isn't overreacting, conduct what's called a pull test:
grab about 20 hairs and pull gently from the scalp to
the end of the hair. If you end up holding more than
three to five, you can safely tell your patients their
concern is warranted.
Androgenic alopecia (AGA):
"Ninety-eight percent of the patients I see have male-
or female- pattern baldness," says Dr Jones. In men,
this presents as the characteristic M-shaped pattern
of hair loss on the temples and crown, while women experience
a generalized thinning with age.
Minoxidil and finasteride are the
only two treatments approved for AGA. Minoxidil is available
as a 2% solution that can be used by men and women and
a more concentrated 5% solution that should be used
by men only. Patients need to apply it to their scalp
twice daily for a good year before you can figure out
if it's working. "Minoxidil reduces the percentage of
hairs in the resting phase, so hair will look thicker,"
explains Dr Jones. But while it may help decrease the
amount of shedding, Dr Schemmer says there's very little
regrowth. For this reason, minoxidil doesn't work on
completely bald areas.
Finasteride dramatically reduces
levels of dihydrotestosterone (DHT), the culprit for
male pattern baldness, and is indicated for men only
(it's not been shown to work in women and can cause
defects in male fetuses). Dr Jones says 90% of patients
will stop losing their hair and about 20% will experience
regrowth, usually on the crown. "There's a 1-2% risk
of impotence associated with finasteride, but that's
reversible when you stop the medication," he adds. Like
minoxidil, finasteride must be taken forever —
if and when the patient stops, they'll start losing
their hair again.
Telogen effluvium is caused
by an increase in the number of hairs in the telogen,
or resting, phase of growth. The resulting shedding
can usually be traced back to an inciting event: having
a baby, severe infection or illness, or periods of intense
psychological stress. "Pregnant women, for example,
secrete a hormone that keeps them from losing their
hair," says Dr Jones. "It's normal to lose a significant
amount of that hair postpartum." This type of hair loss
will resolve on its own with time or when the underlying
cause is resolved.
Alopecia areata usually
starts with a localized area of complete hair loss that
can extend to the entire body. The condition is rare,
and usually inherited. For some patients, spontaneous
recovery can occur within six to 12 months, but the
prognosis worsens as the problem persists.
Topical immunotherapy is the preferred
treatment for chronic disease. Dr Schemmer says it's
best to refer these patients to an experienced dermatologist.
Mild steroid solutions are injected in the affected
areas, but the side effects can be pretty severe and
patients will need to be followed carefully.
Tinea capitis is a fungal
infection of the scalp most often seen in children that
can lead to widespread hair loss and increased hair
fragility. It's most often seen in African American
children or Caucasians who've had contact with infected
animals, says Dr Schemmer. Oral antifungals will easily
clear up the infection.
Traction alopecia affects
the frontal regions of the scalp and is caused by tightly
pulling the hair in braids or "cornrows," as well as
by straightening products. A new hairstyle is the best
prescription.
GET
PLUGGED IN
Hair transplant surgery has come a long way since the
first hair plugs of the 80s. The current method of choice
is called follicular unit extraction. A strip of hair
is removed from a donor site at the back of the head
and dissected under a microscope into some 3,000 units
of about four follicles apiece (early hair plugs contained
just 15-25) and transplanted to the recipient site.
Dr Jones has taken the process one step further —
he harvests the units one at a time. "It's much more
tedious, but the advantage is that it doesn't leave
a scar at the back of the head," he says. The transplanted
hair will start to grow in 10-12 weeks, but it will
take about a year to see the full effects.
Both Dr Jones and Dr Schemmer agree
that the key to a successful hair transplant is picking
the right patient. For once, older is better. "I won't
perform a transplant on a patient who's younger than
25 because their pattern of thinning may not be established
and it's hard to plan what they'll look like in 10-15
years," says Dr Schemmer.
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