October 30, 2013

Ask The Doctors

My grandmother became rather bald in her late 70s, and I have noted that my adult daughter has a bald patch that is the size of a quarter on the top of her head. Is this the beginning of early baldness? And do I have to worry her about this? If I take her to the doctor about it, she may become very self-conscious, and so far she has hardly noticed it.

Hair loss actually occurs in all of us, because our hair follicles undergo cyclical changes that extend over the entire life. They go through active growth phases that alternate with periods of inactivity. This cycle of on-and-off growth leads to little change in the overall pattern of hair distribution, because not all hairs are involved in the same phase at the same time.

As we age, however, the hair follicles lose their full regenerative capabilities. It is actually stem cells that help the regeneration of the hair follicles. There are two main cells in the follicle that are involved in the hair growth: keratinocyte and melanocyte. As the melanocytes decrease in number, hair becomes depigmented and turns grey or white. As keratinocytes become fewer, so does the production of hairs. Some baldness is called male-type baldness and is related to the effects of testosterone. This can be genetic. It’s very common, however, for both men and women to produce fewer hairs on their head as they age. 

The normal cycle of hair growth can be influenced by the general health of the individual. Thyroid disorders, for example, are often associated with changes in the quality, thickness, and texture of one’s hair. Pregnancy also can affect a woman’s hair. 

What you are describing in your daughter sounds like a type of balding called “alopecia.” A coin-shaped patch baldness is typical of a condition called alopecia areata. This latter type of alopecia is different from the male-type or age-related hair loss. It is, in fact, an autoimmune disturbance.

Alopecia areata is loss of hair in a specific area, usually on the scalp or in the beard in a male. The loss can take place rapidly. Sometimes there is progression to several patches, or even total hair loss on the scalp. The most common variant, however, is that of patches of baldness in coinlike areas. 

Careful examination may reveal less obvious additional findings. There may be pitting in the fingernails, and short hair may be noted to be narrower toward the roots, sometimes called “exclamation mark hair.”

Diagnosis is relatively easy, and it would be wise to visit the doctor for a checkup. Treatment, however, is not easy, because there is a lack of well-conducted trials to guide the physician.

Even if the condition becomes progressive—and many do not—some doctors will suggest waiting for the natural remission that very frequently occurs. 

Immunosuppressant Therapy

The therapy generally preferred involves potent topical steroids, which may be applied with an occlusive dressing. Improvement may be expected in 25 percent of cases so treated. Intradermal injections of another steroid, triamcinolone, may achieve up to 65 percent improvement. Systemic steroids are usually avoided because of their side effects. An older treatment with an irritant called dithranol may also be used. Minoxidil, advertised widely as Rogaine, has also been used, but clear-cut benefits have not been demonstrated.

The condition tends to relapse and remit, and because the hair follicle is not totally destroyed, the condition is theoretically reversible. 

How your daughter will react to this condition can be a reflection of your own attitude. An accepting and unemotional response will encourage the same attitude in her. The patch may well disappear and be a single event. 

Do be sensitive to the anxiety and potential damage to self-esteem, but also don’t dismiss this as simply a cosmetic problem. n