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Hair disorders

• Signs and Symptoms
• What Causes It?
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Supporting Research

Hair disorders is a broad category that includes the following conditions:

• Alopecia: the loss or thinning of hair. There are two types of alopecia: scarring, in which hair follicles are destroyed, and nonscarring, which can be reversed.
• Male-pattern baldness (androgenic alopecia): This is the most prominent type of hair disorder affecting, to varying degrees, half of all men over 50 years of age.
• Hirsutism: excessive male-pattern hair growth affecting 8%of adult women.
• Hair shaft disorders: usually hereditary abnormalities.

Signs and Symptoms

Hair disorders are accompanied by the following signs and symptoms, depending on the type:

• Alopecia (nonscarring) involves hair loss all over or in circular areas, a receding hair line, broken hairs, a smooth scalp, inflammation, and possibly loss of lashes, eyebrows, or pubic hair.
• Alopecia (scarring) is limited to particular areas. Symptoms are inflammation at the edge and follicle loss toward the center of lesions, violet-colored skin abnormalities, and scaling.
• Hirsutism is male-pattern hair growth in women, irregular menstruation, lack of ovulation, acne, deepening of voice, balding, and genital abnormalities.
• Symptoms of Hair shaft disorders are split ends and hair that is dry, brittle, and coarse, as well as skin and other abnormalities.

What Causes It?

Hair disorders can be caused by any of the following:

• Alopecia (nonscarring) -- skin disorders, certain drugs, certain diseases, autoimmunity, iron deficiency, severe stress, scalp radiation, pregnancy, or pulling at your own hair.
• Alopecia (scarring) -- skin disorders, diseases, or bacterial infections.
• Hirsutism -- excess of androgen (a steroid hormone that stimulates development of male sex organs and secondary sexual characteristics). This overproduction of androgen could result from certain drugs or conditions.
• Hair shaft disorders -- overprocessed hair (coloring, permanent waves, excessive heating) or certain diseases.

Who's Most At Risk?

People with the following conditions or characteristics are at risk for developing hair disorders:

• Alopecia -- male gender, genetic predisposition, pregnancy, physical or emotional stress, poor diet.
• Hirsutism -- genetic predisposition, lack of ovulation.
• Hair shaft disorders -- genetic predisposition, damaging grooming practices.

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with a hair disorder, you should see your health care provider. A physical exam can help identify the type of hair disorder, and laboratory tests can reveal any underlying diseases. In the case of hirsutism, imaging may help diagnose the cause.

Treatment Options

Prevention

Having a well-balanced diet and avoiding potentially damaging hair treatments can help prevent some types of hair loss.

Treatment Plan

The primary goals of treatment are to treat the underlying cause, re-grow the hair when possible, and correct damaging grooming practices.

Drug Therapies

Your provider may prescribe the following medications:

Alopecia:

• Minoxidil (Rogaine), for hair regrowth and possibly to prevent further loss
• Tretinoin (Retin-A), to decrease thick scalp layer and increase minoxidil penetration
• Topical or injectable steroids

Hirsutism:

• Steroids
• Oral contraceptives

Hair shaft disorders:

• Minoxidil
• Drugs for underlying diseases

Surgical and Other Procedures

• Cosmetic therapies, such as surgical placement of follicle-supporting plugs or folds
• For hirsutism, possibly removal of ovarian tumor

Complementary and Alternative Therapies

A comprehensive treatment plan for hair disorders may include a range of complementary and alternative therapies.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your health care provider may want to test you for food sensitivities.
• Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens, and sea vegetables.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squashes and peppers).
• Avoid refined foods such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

You may be able to address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc and selenium.
• Omega-3 fatty acids, such as fish oil, 1-2 capsules or 1 tablespoonful of oil daily, to help decrease inflammation. Cold-water fish, such as salmon or halibut, are good sources.
• Vitamin C, 500 - 1,000 mg two times daily, as an antioxidant.
• L-lysine, 500 - 1,000 mg daily, for hair loss.
• B-complex vitamins, 1 tablet daily, for symptoms of stress.
• Melatonin, 2 - 5 mg before bed, for sleep and relaxation.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

For alopecia and hair shaft disorders:

• Milk thistle ( Silybum marianum ) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.
• Ginkgo ( Ginkgo biloba ) standardized extract, 40 - 80 mg three times daily, for antioxidant support and blood flow.
• Kava kava ( Piper methysticum ) standardized extract, 100 - 250 mg 1 - 3 times a day as needed for symptoms of stress and anxiety.
• Relora, 250 mg 1 - 3 times a day, for adrenal stress.

Topical applications of essential oils may benefit skin infections and stimulate new hair growth. Use three to four drops each of peppermint ( Mentha piperita) , rosemary ( Rosmarinus officinalis ), and sage ( Salvia officinalis ) in 1 tablespoonful of vegetable oil or olive oil. Massage gently into affected area one to two times daily.

For hirsutism:

• Saw palmetto ( Serenoa repens ) standardized extract, 160 mg two times daily, for hormonal support.

Homeopathy

Some of the most common remedies include Ignatia, Pulsatilla, and Sepia . Acute dose is three to five pellets of 12X to 30 C every one to four hours until symptoms are relieved.

Acupuncture and Massage

Acupuncture may help alleviate symptoms or hair loss. Acupuncture may help enhance immune function, normalize digestion, and address disease conditions.

Although not all abnormal hair loss is associated with stress, psychological stress can alter thyroid and sex hormone levels in the body, potentially leading to hair loss. Yoga, prayer, guided imagery,and a variety of other methods may help retrain your body's response to stress. Group support can also be a vital component of any stress reduction plan and can have measurable physiological impact.

Supporting Research

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Behrman RE, ed. Nelson Textbook of Pediatrics . 15th ed. Philadelphia, PA: W.B. Saunders; 1996.

Bilia AR, Gallon S, Vincieri FF. Kava-kava and anxiety: growing knowledge about the efficacy and safety. Life Sci. 2002;70(22):2581-97.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr . 2006;25(2):79-99.

Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine . 20 ^th ed. Philadelphia, PA: W.B. Saunders; 1996.

Dambro MR. Griffith's 5-Minute Clinical Consult . 1999 ed. Baltimore, MD: Lippincott Williams & Wilkins, Inc.; 1999.

Dawber RPR. An update of hair shaft disorders. Dermatologic Clinics . 1996; 14(4).

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine , 14 ^th ed. New York, NY: McGraw-Hill; 1998.

Fiedler VC, Alaiti S. Treatment of alopecia areata. Dermatologic Clinics . 1996; 14(4).

Fontani G, Corradeschi F, Felici A, et al. Cognitive and physiological effects of Omega-3 polyunsaturated fatty acid supplementation in healthy subjects. Eur J Clin Invest . 2005;35(11):691-9.

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Middlekauff HR, Yu JL, Kui K. Acupuncture effects on reflex responses to mental stress in humans. Am J Physiol Regulat Integrat Comp Physiol. 2001;280:R1462-R1468.

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Prager N, Bickett K, French N, Marcovici G. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. J Altern Complement Med . 2002;8(2):143-52.

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• Review Date: 8/6/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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