Alopecia totalis

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.