Actor Yul Brynner's trademark was his completely bald head, much of which was shaven.Actor Patrick Stewart's bald head is considered part of his distinctive attractiveness.Gorillas evolved anatomically enlarged foreheads to convey increased status and maturity.Retired NASA Astronaut Story Musgrave.Alopecia universalis victim John D. Rockefeller, with toupee
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Alopecia

Alopecia, commonly known as baldness, is a set of disorders which involves the state of lacking hair where it would normally grow, especially on the head. The most common form of baldness is a progressive hair-thinning condition that occurs in adult humans and other primate species. more...

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Nonetheless, the severity and nature of condition can vary greatly; it ranges from male and female pattern alopecia (alopecia androgenetica), to alopecia areata, which involves the loss of some of the hair from the head, alopecia totalis, which involves the loss of all head hair, to the most extreme form, alopecia universalis, which involves the loss of all hair from the head and the body. Treatment for alopecia has limited success. The more hair lost, the less successful the treatment will be. The psychological implications of alopecia include stress, anxiety and depression, and can in many cases involve issues relating to identity change, particularly when the eyebrows and eyelashes are also lost. Hair loss is sometimes the result of chemotherapy treatment for cancer sufferers.

Male pattern baldness is thought to occur in varying forms in about 66% of adult males at some point in their lives. It is characterized by hair receding from the lateral sides of the forehead, known as "receding hairline" or "receding brow." An additional bald patch may develop on top (vertex). The trigger for this type of baldness, which is also known as androgenic alopecia, is currently believed to be 5-alpha reductase, an enzyme that converts the hormone testosterone into dihydrotestosterone (DHT), which, in genetically-prone hairs on the scalp, inhibits hair growth. Onset of hair loss sometimes begins as early as end of puberty, and is mostly genetically determined. Male pattern baldness is classified on the Hamilton-Norwood scale I-VIII.

Female pattern baldness, in which the midline parting of the hair appears broadened, is less common. It is believed to result from a decrease in estrogen, a hormone that normally counteracts the balding effect of testosterone, which normally occurs in women's blood. Female pattern baldness is being classified on the Ludwig scale I-III.

There are several other kinds of baldness. Traction alopecia is most commonly found in people with ponytails or cornrows that pull on their hair with excessive force. Wearing a hat shouldn't generally cause this, though it is a good idea to let your scalp breathe for 7 hours a day. Traumas such as chemotherapy, childbirth, major surgery, poisoning, and severe stress may cause a hair loss condition known as telogen effluvium. Some mycotic infections can cause massive hair loss. Alopecia areata is an autoimmune disorder also known as "spot baldness" that can result in hair loss ranging from just one location (Alopecia areata monolocularis) to every hair on the entire body (Alopecia areata universalis).

Etymology

The term alopecia (al-oh-PEE-she-uh) is formed from the Greek αλωπηζ (alopex), meaning fox. The origin of this usage is because this animal changes its hair two times a year.

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Alopecia
From Gale Encyclopedia of Medicine, 4/6/01 by J. Ricker Polsdorfer

Definition

Alopecia simply means hair loss (baldness).

Description

Hair loss occurs for a great many reasons--from pulling it out to having it killed off by cancer chemotherapy. Some causes are considered natural, while others signal serious health problems. Some conditions are confined to the scalp. Others reflect disease throughout the body. Being plainly visible, the skin and its components can provide early signs of disease elsewhere in the body.

Oftentimes, conditions affecting the skin of the scalp will result in hair loss. The first clue to the specific cause is the pattern of hair loss, whether it be complete baldness (alopecia totalis), patchy bald spots, thinning, or hair loss confined to certain areas. Also a factor is the condition of the hair and the scalp beneath it. Sometimes only the hair is affected; sometimes the skin is visibly diseased as well.

Causes & symptoms

  • Male pattern baldness (androgenic alopecia) is considered normal in adult males. It is easily recognized by the distribution of hair loss over the top and front of the head and by the healthy condition of the scalp.
  • Alopecia areata is a hair loss condition of unknown cause that can be patchy or extend to complete baldness.
  • Fungal infections of the scalp usually cause patchy hair loss. The fungus, similar to the ones that cause athlete's foot and ringworm, often glows under ultraviolet light.
  • Trichotillomania is the name of a mental disorder that causes a person to pull out his/her own hair.
  • Complete hair loss is a common result of cancer chemotherapy, due to the toxicity of the drugs used. Placing a tourniquet around the skull just above the ears during the intravenous infusion of the drugs, may reduce or eliminate hair loss by preventing the drugs from reaching the scalp.
  • Systemic diseases often affect hair growth either selectively or by altering the skin of the scalp. One example is thyroid disorders. Hyperthyroidism (too much thyroid hormone) causes hair to become thin and fine. Hypothyroidism (too little thyroid hormone) thickens both hair and skin.
  • Several autoimmune diseases affect the skin, notably lupus erythematosus.

Diagnosis

Dermatologists are skilled in diagnosis by sight alone. For more obscure diseases, they may have to resort to a skin biopsy, removing a tiny bit of skin using a local anesthetic so that it can examined under a microscope. Systemic diseases will require a complete evaluation by a physician, including specific tests to identify and characterize the problem.

Treatment

Successful treatment of underlying causes is most likely to restore hair growth, be it the completion of chemotherapy, effective cure of a scalp fungus, or control of a systemic disease. Two relatively new drugs--minoxidil (Rogaine) and finasteride (Proscar)--promote hair growth in a significant minority of patients, especially those with male pattern baldness and alopecia areata. When used continuously for long periods of time, Minoxidil produces satisfactory results in about one quarter of patients with androgenic alopecia and as many as half the patients with alopecia areata. Both drugs have so far proved to be quite safe when used for this purpose.

Over the past few decades there have appeared a multitude of hair replacement methods performed by both physicians and non-physicians. They range from simply weaving someone else's hair in with the remains of your own to surgically transplanting thousands of hair follicles one at a time.

Prognosis

The prognosis varies with the cause. It is generally much easier to lose hair than to regrow it. Even when it returns, it is often thin and less attractive than the original crop.

Key Terms

Athlete's foot
A fungal infection between the toes, officially known as tinea pedis.
Autoimmune disease
Certain diseases caused by the body's development of an immune reaction to its own tissues.
Chemotherapy
The treatment of diseases, usually cancer, with drugs (chemicals).
Hair follicles
Tiny organs in the skin, each one of which grows a single hair.
Lupus erythematosus
An autoimmune disease that can damage skin, joints, kidneys, and other organs.
Ringworm
A fungal infection of the skin, usually known as tinea corporis.
Systemic
Affecting all or most parts of the body.

Further Reading

For Your Information

    Books

  • American Society of Health-System Pharmacists Inc. American Hospital Formulary Service Drug Information. Bethesda, MD: American Society of Health-System Pharmacists Inc., 1998, pp.2964-9.
  • Bennett, J. Claude and Fred Plum, ed.Cecil Textbook of Medicine Philadelphia: W. B. Saunders, 1996, pp.2215-17.
  • The Burton Goldberg Group. "Hair loss." Alternate Medicine: The Definitive Guide. Puyallup, WA: Future Medicine Publishing, 1993, p.892.
  • Isselbacher, Kurt, et al., ed. Harrison's Principles of Internal Medicine New York: McGraw-Hill, 1994, pp.291-2.

    Periodicals

  • Amichai B., Grunwald M.H., and R. Sobel. "5 alpha-reductase inhibitors--a new hope in dermatology?" International Journal of Dermatology (March 1997): 182-4.
  • Barone, Jeanine. "Coping with Hair Loss." Better Homes and Gardens (September 1997): 102.
  • Lewis, Eric J. et al. "Some common--and uncommon--causes of hair loss." Patient Care (December 15, 1997): 50.
  • Nielsen, Timothy A. and Martin Reichel. "Alopecia: diagnosis and management." American Family Physician.
  • Watson, Fiona. "Dermatologists must sift through alternative Tx." Dermatology Times (November 1997): 58.
  • Wyndham, Mike. "Alopecia." Practitioner (December 1996): 704.

    Other

  • Hairloss Information Center. "Rogaine: does it really work?" 1997. http://www.hairloss.com/rogaine.htm (19 April 1998).
  • Houston Academy of Medicine. "Propecia: male baldness pill." December 30, 1997. http://library.tmc.edu/t-prop.html (19 April 1998).

Gale Encyclopedia of Medicine. Gale Research, 1999.

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