Improve Hair
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Improve Hair

Explore the available health information, treatment context, and integrative evidence for Improve Hair.

Background
  • Alopecia describes hair loss, which may occur in men, women, or children. Hair loss may eventually lead to excessive hair loss, called baldness. Hair loss and baldness can occur for a number of different reasons.
  • It is normal for some hair to fall out each day. It is estimated that adults lose 50-100 hairs each day because hair only lives two to six years. Once a hair is shed, a new hair grows to replace it. In general, hair grows about one-half inch each month. Hair growth may be less noticeable in patients with curly hair. As individuals age, most people experience hair thinning or loss.
  • There are two main types of hair loss: alopecia areata and androgenetica alopecia.
  • Alopecia areata is an immune system disorder. Normally, the immune system helps protect the body against disease and infection. However, the immune system in patients with alopecia areata mistakes the openings in the skin where hair grows, called hair follicles, as harmful invaders. As a result, the immune system launches an attack against the hair follicles, causing hair loss.
  • Patients with alopecia areata typically receive drugs called corticosteroids for the rest of their lives. These drugs help reduce the body's immune response, limiting the amount of hair follicles that are attacked.
  • Androgenetica alopecia is an inherited form of baldness. This means the condition is passed down through families. An estimated 60% of patients with androgenetica alopecia are male. When the condition occurs in men, it is called male-pattern hair loss.
  • Although there is currently no cure for androgenetica alopecia, there are several medical treatments available to replace lost hair. Individuals may also choose non-medical treatments, such as wigs or hairpieces, to replace lost hair. Some patients with androgenetica alopecia prefer to let the hair loss run its course.
  • In addition, several other factors may lead to temporary hair loss, including medications and medical treatments, poor nutrition, infancy, hair treatments, infections, and illnesses.
Risk Factors and Causes
  • Aging: Hair loss is a common sign of aging. The body slowly loses its ability to replace hairs that are shed. Males and females may experience hair thinning or baldness as a result of aging. This type of hair loss is permanent.
  • Genetics: Researchers believe that several genes play a role in the development of androgenetica alopecia. Hair loss that is inherited is permanent. An estimated 60% of patients with androgentica alopecia are male. This is because one of the genes associated with the condition is located on the X chromosome. Males have only one X chromosome. Therefore, if a male inherits the defective X chromosome he will develop alopecia. A male can look to his mother's father to determine whether or not he is likely to develop alopecia. If a male's maternal grandfather has alopecia, he has an increased risk of developing alopecia.
  • Females are less likely to develop alopecia because they have two X chromosomes. If the female inherits only one defective X chromosome, the other X chromosome will prevent alopecia from developing. Females need to inherit two defective X chromosomes in order to develop alopecia. In other words, a female may experience hair loss if her father has hair loss and her mother either has hair loss or carries the mutated chromosome, but does not have hair loss.
  • Hair treatments: Chemicals used for dying, tinting, bleaching, straightening, or perming the hair may damage the hair or cause breakage, especially if they are used excessively or incorrectly. Also, too much hairstyling that involves pulling on the hair may lead to some hair loss. This type of hair loss is temporary.
  • Infancy: Newborns often lose hair during the first several months of life. This baby hair, also called vellus, is replaced with more permanent hair. Also, many babies lose patches of hair on the back of their heads. This condition is often caused by rubbing against playpens, car seats, or mattresses. However, once the baby learns how to sit up, the hair will begin to grow back.
  • Immune system: Alopecia areata is an autoimmune disorder in which the body's immune system attacks hair follicles resulting in unpredictable patches of hair loss on the scalp, face, and other parts of the body. In healthy individuals, the immune system helps fight against disease and infection. However, for unknown reasons, the immune system in patients with alopecia areata mistakes the hair follicles for harmful invaders. The immune system then attacks the hair follicles as if they were disease-causing substances, such as bacteria. This type of hair loss can be managed with treatment.
  • Illness or surgery: Some patients may experience hair loss three to four months after an illness or surgery. These conditions do not cause the body to lose more hair than normal. Instead, they reduce the amount of new hair that is produced. Over time, the hair will begin to grow normally. Also, infections, such as ringworm, may infect the hair and skin on the scalp. As a result, the patient typically experiences hair loss. Once infections are treated, the hair will begin to grow back.
  • Medications and medical treatments: Temporary alopecia is a side effect of many medications, including some drugs that are used to treat arthritis, gout, depression, heart problems, cancer, and high blood pressure. In some female patients, birth control pills may cause hair loss. The hair will grow back once the medication is stopped.
  • Medical treatments may also lead to hair loss. For instance, patients who undergo chemotherapy or radiation therapy to treat cancer may develop temporary alopecia.
  • Poor nutrition: Poor nutrition may lead to alopecia. Patients who do not consume enough protein or iron in the diet may experience hair loss. Once the diet is corrected, the hair will grow back.
Signs and Symptoms
  • General: Symptoms of alopecia vary among patients. Patients may experience subtle hair thinning, extensive hair loss, or baldness. Males, females, and children can experience alopecia.
  • Alopecia areata: Patients with alopecia areata usually lose small round patches of hair on the scalp, face, and chest. Other parts of the body, including the eyelashes, eyebrows, and genitals, may also be affected.
  • Androgenetica alopecia: Males with androgenetica alopecia may experience hair loss during adolescence. This type of hair loss usually starts at the temples and crown of the head. Eventually, the patient may be partially or completely bald.
  • Females with androgenetic alopecia usually experience hair loss at the front, sides, or top of the head. Unlike males, females rarely develop complete baldness. Females usually only experience hair thinning.
  • Other: Alopecia that is caused by poor nutrition, infancy, hair treatments, infections, or illnesses may cause hair thinning, balding, or patches of hair to fall out. Unlike alopecia areata and androgenetica alopecia, these symptoms are temporary.
Diagnosis
  • General: In most cases, alopecia does not require a diagnosis. The healthcare provider can usually determine the cause of hair loss after a physical examination and medical history. If there is a family history of alopecia, androgenetica alopecia is suspected. The healthcare provider will also ask questions about recent infections, new medications, diet, and hair treatments to determine if such factors are causing hair loss. If alopecia areata is suspected, a fluorescent antinuclear antibody (FANA) test may used to confirm a diagnosis.
  • Fluorescent antinuclear antibody (FANA) test: The fluorescent antinuclear antibody (FANA) test is a blood test used to detect abnormal antibodies, called autoantibodies. The autoantibodies bind to components of and individual's own cells and cause the immune system to attack the body. If autoantibodies are present, the patient has an autoimmune disorder.
  • During the procedure, a small sample of blood is taken from the patient and sent to a laboratory. The scientist tests the blood to determine whether or not it contains autoantibodies.
  • If a patient has a positive FANA result and has symptoms characteristic of alopecia areata, the patient is diagnosed with the disorder.
  • In rare occasions, the FANA test results can be positive in people who do not have autoimmune disease. This is called a false positive test result. The frequency of false-positive test results increases with age. A false negative result is also possible, but it is uncommon. Patients can be re-tested if a false negative test result is suspected.
Complications
  • Dandruff: If patients develop alopecia as a result of poor nutrition, they may also have dandruff. Dandruff causes dry, itchy, and excessive flaking of skin on the scalp. Improving nutrition will help reduce symptoms of dandruff.
  • Dandruff and alopecia may also be unrelated. However, dandruff may become more noticeable when the individual loses hair. White flakes of skin may be visible on clothing. Patients can purchase medicated shampoos to treat dandruff. For instance, zinc pyrithione shampoos (Selsun Salon® or Head & Shoulders®), tar-based shampoos (Neutrogena® or T/Gel®), salicylic acid shampoos (Ionil T®), selenium sulfide shampoos (Selsun Blue®), and ketoconazole shampoos (Nizoral®) have been used to treat dandruff.
  • Quality of life: Some patients with hair loss may have a difficult time coping with their appearance. Some patients may experience a decrease in their quality of life or suffer from low self-esteem. These patients may benefit from medical or non-medical hair replacements. Treatment may include hair pieces, surgery, or medications.
  • Sunburn: Patients who experience hair loss have an increased risk of developing sunburn, especially if they have light or fare skin. Patients who are bald or have bald patches of skin on the scalp should put sunblock on the scalp to prevent sunburn and skin cancer. Patients should choose a sunblock with a sun protection factor (SPF) of 15 or higher. The sunblock should offer protection against both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Patients with hair loss should wear hats in the sun and try to minimize sun exposure, if possible. An umbrella or parasol may also be beneficial.
Treatment
  • General: There is currently no cure for alopecia areata or androgenetica alopecia. However, several treatments are available to replace lost hair. Individuals may also choose non-medical treatments, such as wigs or hairpieces, to replace lost hair. Some patients with androgenetica alopecia prefer to let the hair loss run its course. Patients with alopecia areata typically receive drugs called corticosteroids for the rest of their lives. These drugs help reduce the body's immune response, limiting the amount of hair follicles that are attacked. Patients should consult their healthcare professionals before making any decisions about hair restoration surgeries or medications.
  • If other factors, such as hair treatments or infancy, are causing hair loss, the condition is temporary, and the hair will begin to grow back over time. If poor nutrition or illness is causing hair loss, the hair will grow back once the underlying cause is treated. If a medication or medical treatment, such as chemotherapy, is causing hair loss, the hair will grow back once the treatment is completed.
  • Corticosteroids: Patients with alopecia areata may receive injections with corticosteroids, such as betamethasone (Celestone®), into the scalp. Patients typically receive these injections monthly. Some patients with extensive hair loss may take corticosteroid pills. Corticosteroid creams and ointments, such as betamethasone (Diprolene®), have been applied to affected areas of the skin. However, creams and ointments are generally less effective than injections.
  • Hair replacement: Non-surgical hair replacement is an option for those who suffer from significant hair loss and would like to regain the appearance of having a full head of hair without surgery. Examples of products available include semi-permanent attached hairpieces, temporary adhesive-attached hairpieces, and clip attachments.
  • Hair replacement/restoration surgery: Hair replacement surgery is used to fill in balding areas with a patient's own hair. New hair growth usually begins six to 12 weeks after surgery. The surgery is usually performed by a licensed dermatologic surgeon and rarely requires a hospital stay. Hair replacement surgery is most commonly used for male-pattern baldness. The second most common use is to treat female pattern baldness. Hair restoration can also be used to treat hair loss caused by scarring, burns, irradiation therapy, or past infections, as well as to restore hair to the eyebrows, eyelashes, beard, and any other area.
  • During the procedure, a small section of hair-bearing tissue is removed from the patient. The tissue is then dissected into individual follicular units and micro-grafts. These grafts are then inserted into tiny slits in the patient's scalp.
  • Hair restoration surgery may be performed during a cosmetic procedure such as a facelift or brow-lift. New options and techniques have made hair restoration safer and easier. Most procedures are done in an office setting under local anesthesia
  • Hair replacement surgery is generally considered safe when performed by a qualified, experienced physician. Still, individuals vary greatly in their physical reactions and healing abilities and the outcome is never completely predictable.
  • Insurance generally does not cover surgery that is done purely for cosmetic reasons. This means most patients usually have to pay for hair replacement surgeries themselves. It is the patient's responsibility to check with the insurance carrier for information on the degree of coverage.
  • Hair transplants: Hair transplant surgery is a procedure in which a physician transplants hair from an area of thick growth to bald areas. A person's own hair must be used because hair from others will be rejected and will not grow. Hair grows in clusters containing one to five individual hairs called follicular units. Grafting involves removing small strips of the hair-bearing scalp. The harvested strips of hair-bearing scalp are divided into grafts for placement in the balding areas. These grafts may be processed into a variety of different sizes, depending on the patient's specific needs. Very small grafts are useful, particularly at the hairline, and they can be undetectable when they grow out. Larger grafts containing more hairs are used to obtain greater density behind the hairline. The areas from which the strips are taken are carefully repaired, usually resulting in a very narrow scar easily hidden by overlying hair. Recently, body hairs have been transplanted to the scalp.
  • Medications: A variety of medications may be taken for hair loss. Some of these medications may work for both women and men. Others, however, are restricted in their use to one sex.
  • Spironolactone (Aldactone®) was originally marketed as a diuretic (water pill) for patients suffering from congestive heart failure. This medication is a pill that is taken once or twice daily. Women now take the drug because its anti-androgen properties may stop and sometimes reverse hair loss. This medication may take many months to show results in women. It may also be more effective in post-menopausal women and may be taken with a hormone replacement pill.
  • Minoxidil (Rogaine®) is available with a doctor's prescription to treat androgenetic alopecia. Once used to treat high blood pressure, minoxidil is now used to treat hair loss in both men and women. This medication is applied directly to the area of hair loss at least two times a day for at least four months. The medication usually does not take effect until four months to one year. Patients who discontinue use of minoxidil will most likely lose the hair that they have already grown. Minoxidil works by enlarging hair follicles.
  • Another prescription drug called finasteride (Propecia®) is indicated for the treatment of mild to moderate male pattern hair loss in men only. This pill must be taken daily to re-grow hair. Finasteride works by inhibiting high levels of a hormone called dihydrotestosterone (DHT) around hair follicles. High amounts of DHT cause hair follicles to shrink and hair falls out as a result.
  • Finasteride (Proscar®) was initially designed to treat an enlarged prostate, but it is now known to reduce hair loss in men. It is usually taken with minoxidil. This medicine decreases the body's production of DHT, the chemical responsible for shrinkage of hair follicles (opening in the skin where hair grows). The manufacturer states that Propecia® should not be used in women or children, and that pregnant women should not handle crushed or broken Propecia® tablets because the active ingredient may cause genital abnormalities in male fetuses.
  • Cimetidine (Tagamet®) was initially used as a prescription drug to treat heartburn and stomach ulcers. This medication is now available over-the-counter. While primarily used a histamine-blocking agent, it is also an anti-androgen and thus only works for women. Tagamet has been used to treat androgenetic alopecia in women.
  • Scalp extension or scalp expansion: Scalp expanders or tissue expanders may be used to increase the effectiveness of a scalp reduction. The extender acts like a large rubber band, while the expander acts like a balloon. During the procedure, the extender or expander is inserted under the scalp for about three to four weeks to stretch the hair-bearing areas so they can replace the balding areas. This allows for an even greater reduction in the balding regions. Scalp reduction surgery can be performed alone or in combination with a hair transplant.
  • Scalp lifts and scalp flaps: Scalp lifts and scalp flaps are surgical procedures that involve rotating larger sections of the hair bearing scalp to cover bald areas. This is mainly used to treat scarring or during trauma repair.
  • Scalp reduction: Scalp reduction is a treatment option for patients that are balding. It may be used to treat areas of hair loss that develop on the top and/or back of the head. The bald areas are reduced or eliminated by removing several inches of bald skin, pulling the sides together and stitching up the skin.
  • Other: There are many other hair restoration products available, including sprays, gels, and creams. These products vary in their effectiveness. Patients should consult their healthcare providers to determine whether or not such products are safe and effective for them.
Prevention
  • There is currently no known method of prevention of alopecia areata, androgenetic alopecia, or hair loss that is caused by aging.
  • Patients who are concerned that certain medications may lead to hair loss should talk to their healthcare providers. It may be possible for the patient to take a different drug or dose of the medication to prevent or reduce symptoms of hair loss.
  • Patients should maintain a healthy and well-balanced diet because poor nutrition may lead to temporary hair loss.
  • Patients should use hair treatments, such as hair dye, cautiously because they may cause temporary hair loss.
References
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  5. Brandy DA. Intricacies of the single-scar technique for donor harvesting in hair transplantation surgery. Dermatol Surg. 2004 Jun;30(6):837-44; discussion 844-5. . View Abstract
  6. Epstein JS. The treatment of female pattern hair loss and other applications of surgical hair restoration in women. Facial Plast Surg Clin North Am. 2004 May;12(2):241-7. . View Abstract
  7. Haber RS. Pharmacologic management of pattern hair loss. Facial Plast Surg Clin North Am. 2004 May;12(2):181-9. . View Abstract
  8. Hair Loss Information Center. . Accessed February 23, 2009.
  9. Leavitt M, Perez-Meza D, Rao NA, et al. Effects of finasteride (1 mg) on hair transplant. Dermatol Surg. 2005 Oct;31(10):1268-76, discussion 1276. . View Abstract
  10. Martinick JH. The latest developments in surgical hair restoration. Facial Plast Surg Clin North Am. 2004 May;12(2):249-52. . View Abstract
  11. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed February 23, 2009.