Hair, Skin, Nails
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Hair disorders

Alopecia (hair loss)
Premature graying

Alopecia (hair loss)
  • Overview: Symptoms of alopecia vary among patients. Patients may experience subtle hair thinning, extensive hair loss, or baldness. Balding may be regional or more generalized. Males, females, and children can experience alopecia.
  • If hair loss is excessive, it may lead to baldness. Hair loss and baldness can occur for a number of different reasons.
  • Causes: There are two main types of hair loss: alopecia areata and androgenetica alopecia.
  • Alopecia areata is an immune system disorder. Normally, the immune system helps protect the body against disease and infection. However, the immune system in patients with alopecia areata mistakes the openings in the skin where hair grows, called hair follicles, as harmful invaders. As a result, the immune system launches an attack against the hair follicles, causing hair loss.
  • Androgenetica alopecia is an inherited form of baldness. This means the condition is passed down through families. An estimated 60% of patients with androgenetica alopecia are male. Androgenetica alopecia in men is also called male-pattern baldness or hair loss.
  • Other causes: Hair loss may be temporary or permanent. It is normal for some hair to fall out as a result of aging. This type of hair loss is permanent. Newborns experience temporary hair loss during the first several months of life. They lose their baby hair, also called vellus, when they are several months old. This baby hair is replaced with more permanent hair. Other common causes of temporary hair loss include illnesses, surgery, medications, medical treatments (such as chemotherapy), pregnancy, poorly performed hair treatments (such as dying or bleaching), and poor nutrition.
  • Symptoms: Patients with alopecia areata usually lose small round patches of hair on the scalp, face, and chest. Other parts of the body, including the eyelashes, eyebrows, and genitals, may also be affected.
  • Males with androgenetica alopecia may experience hair loss during adolescence. This type of hair loss usually starts at the temples and crown of the head. Eventually, the patient may become partially or completely bald. Females with androgenetic alopecia usually experience hair loss at the front, sides, or top of the head. Unlike males, females rarely develop complete baldness. Females usually only experience hair thinning.
  • Some patients with hair loss may have a difficult time coping with their appearance and may experience a decrease in their quality of life or suffer from low self-esteem. These patients may benefit from medical or non-medical hair replacements. Treatment may include hair pieces, surgery, or medications.
  • Patients who experience hair loss have an increased risk of developing sunburn, especially if they have light or fair skin.
  • Diagnosis: In most cases, alopecia does not require testing for a diagnosis. The healthcare provider can usually determine the cause of hair loss after a physical examination and medical history. If there is a family history of alopecia, androgenetica alopecia is suspected. The healthcare provider will also ask questions about recent infections, new medications, diet, and hair treatments (such as dying or bleaching) to determine if such factors are causing hair loss. If alopecia areata is suspected, a fluorescent antinuclear antibody (FANA) test may be used to confirm a diagnosis.
  • Treatment: It is normal for infants to lose their hair, and it should not raise concern. If other factors, such as hair treatments, are causing hair loss, the condition is temporary, and the hair will begin to grow back over time. If a medication (such as birth control pills) or medical treatment (such as chemotherapy) is causing hair loss, the hair will grow back once the treatment is completed. If a doctor confirms that poor nutrition or an illness is causing hair loss, the hair will grow back once the underlying cause is treated. There is currently no cure for alopecia areata or androgenetica alopecia. Although some patients with alopecia areata or androgenetica alopecia prefer to let the hair loss run its course, treatments are available.
  • Individuals may choose non-medical treatments, such as wigs or hairpieces, to replace lost hair.
  • Several treatments, such as hair replacement/restoration surgery and hair transplants, are available to replace lost hair. Hair replacement surgery is used to fill in balding areas with a patient's own hair, and hair transplant surgery involves transplanting hair from an area of thick growth to bald areas.
  • In addition, medications, such as spironolactone (Aldactone®), minoxidil (Rogaine®), finasteride (Propecia®), finasteride (Proscar®), and cimetidine (Tagamet®), may help prevent or minimize hair loss.
  • If patients with alopecia areata decide to pursue pharmacological treatment, they typically receive drugs called corticosteroids for the rest of their lives. These drugs help reduce the body's immune response, which limits the number of hair follicles that are attacked. Patients may receive injections with corticosteroids, such as betamethasone (Celestone®), into the scalp. Patients typically receive these injections monthly. Some patients with extensive hair loss may take corticosteroid pills. Corticosteroid creams and ointments, such as betamethasone (Diprolene®), have been applied to affected areas of the skin. However, creams and ointments are generally less effective than injections.
  • Patients who are bald or have bald patches of skin on the scalp should put sunblock on the scalp to prevent sunburn and skin cancer. Patients should choose a sunblock with a sun protection factor (SPF) of 15 or higher. The sunblock should offer protection against both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Patients with hair loss should wear hats in the sun and try to minimize sun exposure, if possible. An umbrella or parasol may also be beneficial.

  • Overview: Dandruff is characterized by dry, flaky, and itchy skin on the scalp. It is estimated that 15-20% of people worldwide have dandruff.
  • Causes: A yeast-like fungus on the scalp, called malassezia, causes dandruff. This fungus, which feeds on the oils secreted by the hair follicles, is normally found on most healthy adults. Dandruff develops if the organism grows uncontrollably. Scientists have not discovered what causes an overgrowth of the fungus. It has been suggested that changes in hormone levels, stress, illnesses, neurological disorders (such as Parkinson's disease), a weakened immune system, increased oil production, and increased sensitivity to the malassezia fungus may lead to the development of dandruff.
  • Symptoms: Dandruff causes dry, itchy, and excessive flaking of skin on the scalp. White flakes of skin may be visible on clothing.
  • Diagnosis: A medical diagnosis is not required for dandruff.
  • Treatment: Patients can purchase medicated shampoos to treat dandruff. For instance, zinc pyrithione shampoos (Selsun Salon® or Head & Shoulders®), tar-based shampoos (Neutrogena® or T/Gel®), salicylic acid shampoos (Ionil T®), selenium sulfide shampoos (Selsun Blue®), and ketoconazole shampoos (Nizoral®) have been used to treat dandruff.

  • Overview: Hirsutism occurs when a woman develops excessive amounts of dark coarse hair on parts of the body where men usually grow hair, including the face (cheeks, upper lip, and chin), back, and chest. Researchers estimate that about 10% of Americans have hirsutism.
  • Causes: Hirsutism may develop if a woman has too many male hormones, called androgens. This is the case for about half of all women who have hirsutism. There are many conditions that may lead to high levels of androgens, including polycystic ovary syndrome, an adrenal gland disorder called Cushing's syndrome, congenital adrenal hyperplasia, and, in rare cases, tumors. Some medications that have androgenic activity, such as danazol (Danocrine®), may also lead to hirsutism.
  • Other cases of hirsutism are genetically inherited. The hair follicles of these individuals are unusually sensitive to androgens. The inherited form of hirsutism is most common in southern European and South Asian countries.
  • In some cases, there is no identifiable cause of the disorder. This is commonly called idiopathic hirsutism.
  • Symptoms: Coarse, dark hair develops on areas of the body, such as the face, back, and chest. If the condition is caused by high levels of androgens, women may also experience acne, decreased breast size, enlarged clitoris, increased muscle mass, amenorrhea (absence of menstruation), and deepening of the voice.
  • Diagnosis: A healthcare provider first takes a detailed medical and family history. During a physical examination, the doctor looks for excessive hair growth. The doctor may also look for additional physical symptoms that indicate an androgen imbalance, such as acne, decreased breast size, enlarged clitoris, increased muscle mass, amenorrhea (absence of menstruation), and deepening of the voice.
  • Blood tests may be performed to see if the patient has high levels of certain hormones in the blood, including testosterone and androgen. This helps the healthcare provider determine if high levels of androgens are causing the condition. An ultrasound may also be performed to determine if there are tumors or cysts on the ovaries or adrenal glands.
  • If high levels of androgens are detected, additional tests may be performed to determine the underlying cause. For instance, a computerized tomography (CT) scan of the adrenal glands may be performed to determine if an adrenal gland disorder, called Cushing's syndrome, is causing the disorder.
  • Treatment: A combination of self-care and medical therapies has been shown to effectively treat many patients with hirsutism.
  • Plucking, shaving, waxing, and threading may be used to remove unwanted hair. However, these procedures do not have long-lasting effects. Some women bleach their unwanted hair in order to make it less noticeable.
  • Patients may also undergo a procedure called electrolysis to permanently remove unwanted hair. During the procedure, a tiny needle is inserted into each hair follicle. An electrical pulse is used to destroy the hair follicle. Although this treatment is effective, it is painful and time consuming. There are some anesthetic creams available to help reduce the pain. Side effects of this treatment generally include lightening or darkening of the treated skin. In rare cases, it may cause scarring.
  • Laser therapy may also be used to remove unwanted hair. This therapy uses an intensely powerful beam of light to destroy hair follicles and prevent hair from growing. Treatment may last anywhere from a few minutes to hours, depending on the amount of hair that is being removed. Some patients may not grow any hair for long periods of time. Others may need to undergo repeat treatments from time to time. Because the laser beams are attracted to pigment, people with light skin and dark hair might benefit the most from this treatment. Laser therapy may be uncomfortable for some patients. Side effects may include color changes in the skin, redness and swelling on the treated areas, and sometimes burns on the skin.
  • Some patients may benefit from birth control pills or other medications that contain female hormones (estrogen and progestin), such as Cenestin®, Enjuvia®, or Gynodiol®. These medications stop the ovaries from producing androgen.
  • Medications, called anti-androgens, may also be beneficial. Anti-androgens, such as spironolactone (Aldactone®), prevent androgens from attaching to receptors in the body.
  • A prescription-strength cream, called elfornithine (Vaniqa®), is designed to reduce the growth of facial hair in women. The medication is applied to areas of the face that have unwanted hair. It may take up to two months before results are seen. This is because it slows the growth of new hair, but does not get rid of existing hair. The hair will start to grow back within eight weeks of stopping treatment. Common side effects include tingling or stinging sensations on the treated skin or a rash.

  • Overview: Poliosis is a condition that is characterized by a small patch of white hair. Poliosis can develop at any age and may affect hair on any part of the body. In some cases, poliosis may be a sign of an underlying medical condition.
  • Causes: Poliosis may be present at birth or occur later in life. Some cases are genetically inherited and are not a cause for concern.
  • Poliosis may also occur if the patient suffers from autoimmunity. This happens when the immune system, which is supposed to fight against disease an infection, mistakenly destroys the pigment cells in a localized area. This causes patches of white, colorless hair to grow.
  • Poliosis may also be a sign of underlying medical conditions, such as Marfan's syndrome, Waardenburg's syndrome, or a skin disorder called vitiligo.
  • Symptoms: Individuals with poliosis have white patches of hair that may develop anywhere on the body. However, most patients develop white patches on the front of the hairline.
  • Diagnosis: A healthcare provider will take a detailed medical and family history. A blood test may be performed to determine if an autoimmune or genetic disorder is causing the symptoms. A sample of skin may also be analyzed to determine if the patient has a skin disorder, such as vitiligo.
  • Treatment: There is currently no cure for poliosis. Individuals can choose to dye their hair so it matches their normal hair color. They may also style their hair in a way that covers or hides the white patch of hair.

Premature graying
  • Overview: Premature graying occurs when more than half of the hair on the head is white before the age of 40. Other hair on the body, including the facial, pubic, chest, and back hair, may also turn gray. Although the condition may be upsetting for some people, it is not a cause for concern.
  • Causes: Premature graying is an inherited condition that is passed down among families. People with family histories of premature graying have an increased risk of developing the condition.
  • Symptoms: The hair located near the temples is most likely to turn gray first. The gray hair may spread around the sides and to the crown over time. Other hair on the body, including facial, pubic, chest, and back hair may turn gray. Facial hair may also turn gray early, but chest and pubic hair usually turns gray a few years after the hair on the scalp does.
  • Diagnosis: A medical diagnosis is not necessary for premature graying.
  • Treatment: There is no cure for premature graying. Individuals can choose to dye their hair.

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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.