Hair today ... gone tomorrow?

by Tina Coleman

As many as 20 to 30 percent of women will experience some type of hair loss in their lives. Find out about types of hair loss, what the signs are, and what your course of action should be if you suspect your hair is thinning.

For centuries, women's hair has been romanticized in folktales, legends, literature, and real life. Why, if not for her hair, Rapunzel would still be in that dank tower. Lady Godiva would most likely have ended up in the town jail for indecent exposure, and O. Henry would never have penned the famous short story in which a woman sells her hair to buy her husband a watch fob only to find his gift to her is a comb for her lovely tresses.

Each year, women spend billions of dollars on hair care products seeking to avoid those dreaded "bad hair days." We primp, curl, perm, straighten, comb, wash, brush, blow dry, braid, twist, pull, and dye our locks into submission. Men, on the other hand, usually visit their barber every few weeks, finger comb their hair after showers, and they're off.

But one thing that does remain surprisingly equal between the sexes is the percentage of us who experience hair loss. According to Dr. Nia Terezakis, Clinical Professor of Dermatology at both Tulane and Louisiana State University, at least 20% to 30% of women will experience some type of hair loss during their lifetimes. This is statistically on a par with men.

The most common form of hair loss in women, she says, is hereditary thinning. Hereditary thinning, which occurs in all races, can be inherited from either the mother's or father's side of the family, or both. It begins at the onset of puberty, but several years can pass before the thinning becomes noticeable, so a woman who begins thinning at puberty may not even realize she's thinning until she's in her late teens or even her 20s. In fact, says Terezakis, a woman has to lose about one half of her hair volume before it becomes noticeable. The rate at which the hair loss occurs varies between women.

Hereditary thinning occurs in totally normal, healthy women, she says. Women with this type of hair loss retain their hairlines and thin diffusely, usually on the top of their heads. They may notice that their parts are wider on the top than on the sides.

A normal adult scalp sheds approximately 100 hairs per day. A woman with hereditary thinning will find that, although her hair is thinning, she's not shedding more than normal. This type of hair loss, Terezakis counsels, is very treatable with twice-daily applications of minoxidil (Rogaine). Such treatments should be discontinued if a woman becomes pregnant. Because of hormonal activity, chances are good that little hair loss will occur during pregnancy, she says, and treatments may be resumed after the baby is born.

It's not known precisely why Rogaine works, says Terezakis. One theory, she says, is that it causes dilation of the blood vessels, which then release growth factors that stimulate hair growth.

While most people are familiar with hair loss resulting from chemotherapy treatments, other medications including certain cardiac medicines and anti-depressants have also been reported to cause hair thinning. Some androgen-dominant birth control pills can also be a culprit, and elderly women may experience age-related hair thinning.

Hair loss can also be a sign of an eating disorder, warns Terezakis. Anorexia, bulemia, and fasting diets pull protein from the muscles, which can then cause diffuse sheddings.

Normally, one hair will grow for two to ten years and then go into a resting phase, with each hair in a different phase at any given time. However, severe emotional distress can send a lot of the hair into a dormant phase resulting in thinning, she says.

Innapropriate use or abuse of hair cosmetics can also lead to hair loss, she adds. Overusing perms or straighteners, wearing tight pigtails, ponytails, or cornrows, and sleeping with sponge rollers in your hair, she warns, can all result in hair loss. There are several congenital forms of hair loss, too.

Alopecia areata is a common disease that causes hair loss on the scalp and other parts of the body. In the severe form of the condition, alopecia universalis, all hair on the entire head and body is lost including eyebrows, eyelashes, and nose hairs. While research is ongoing, it is suspected that alopecia areata is an autoimmune disorder that may be genetic.

The disease usually starts with one or more small, round, smooth patches. Some people who develop only a few patches find their hair regrows within a year, even without treatment, according to the National Alopecia Areata Foundation. For others, treatment may require cortisone pills or cortisone injections into the affected areas, or the application of anthralin cream or ointment, topical minoxidil, or topical immunotherapy.

In extreme cases, wigs and hairpieces can be used to disguise the patches until hair regrowth begins. In any case, in alopecia areata the hair follicles remain alive below the skin surface, holding out the promise of regrowth.

Signs of hair loss include loss of more than 100 to 150 hairs per day, every day, says Terezakis. A total change in the texture of your hair can also signal trouble, as can signs that your hair is breaking rather than coming out by the roots.

If you believe you are experiencing hair loss, Terezakis suggests finding a dermatologist who is interested in hair loss; not an easy task, she says, but well worth it. The National Alopecia Areata Foundation maintains a list of such doctors. Keep in mind that many insurance companies balk at paying for hair loss treatments, claiming them to be cosmetic. Check with your individual insurer.

Lastly, says Terezakis, hair loss is not a hopeless situation. "It is really emotionally difficult," she says, so seek support. But remember, "it's treatable and controllable. A positive approach is very important."