Female Hair Loss: Don't Delay Search for Cause - Brief Article

0 Comments | Family Practice News, April 1, 2000 | by Sharon Worcester

NAPLES, FLA. -- When a woman has hair loss, don't wait to start the search for the cause, Dr. Lynn Drake advised at the annual meeting of the Florida Society of Dermatology.

Early diagnosis is particularly important when hair loss is associated with endocrine disease. Even when the underlying endocrine condition is identified and treated, hair regrowth may not be complete, although hair loss will end, said Dr. Drake, chair of the department of dermatology at the University of Oklahoma Health Sciences Center, Oklahoma City.

The cause of hair loss can be determined in about 70% of affected women, and most of those can be treated successfully. Resist the urge to tell patients their hair loss is just a result of aging and androgenicity because in most cases that's probably not true, she said.

In fact, the cause of hair loss can be determined in about 50% of women just by taking a thorough history. Causes can include postpartum effects, drug use, nutritional deficiencies, infection, endocrine disease, trauma, and malignancy.

If the cause isn't apparent in the patient's history, a flew tests can usually clear things up.

External factors contributing to hair loss, such as the use of chemical straighteners, can be determined by examining a hair sample under the microscope. Hair breakage suggests that the problem is not systemic.

The sample also can be used to compare anagen and telogen hair counts. If the anagen hair count is less than 80% of the total, the patient has true hair thinning and requires further evaluation, said Dr. Drake, immediate past president of the American Academy of Dermatology.

Rather than using a finger pluck of hair to obtain the sample--which is useful only if the patient has telogen or anagen effluvium--try doing an instrument pluck using a smooth-faced needle holder, she suggested. The needle holder can be used to clamp down on a small section of hair, and, with a flick of the wrist, will provide a good sample. For the examination, the hairs can be held down with a piece of tape.

Hair shafts that are very thin are suggestive of a nutritional or endocrine cause for the hair loss, she said.

A complete blood count, including hematocrit and hemoglobin, can help narrow down the diagnosis in terms of nutritional deficiencies. Adding measures of serum iron and total iron-binding capacity will help identify problems in women who are runners. They commonly have hair loss, and although their CBC will appear normal, their serum iron and total iron-binding capacity may be low.

Another useful test for determining the cause of true hair thinning is a thyroid profile. Hypothyroidism and hyperthyroidism both are common in women, and both can be associated with hair loss, Dr. Drake said.

Biopsy is rarely indicated but can be useful for distinguishing between scarring and nonscarring alopecia. The biopsy can also identify androgenetic alopecia, which should be a diagnosis of exclusion.

Hair loss due to most nonandrogenetic factors can be reversed by making appropriate changes. For example, hair loss associated with nutritional deficiencies is reversible when the deficiencies are corrected.

When drugs are the culprit, there are cases when drugs can be switched or discontinued. This is true for some patients receiving chemotherapy, but not for patients on lithium. (See box at left.)

Above all, remember when treating women with hair loss that these women tend to feel very vulnerable and to have a loss of self-esteem. One of the best things you can do is to provide support and reassurance during the slow process of hair regrowth, Dr. Drake said.

Chemotherapy Drugs and Hair Loss

Antimitotics are the drugs most often associated with hair loss, but there are some that are less likely to cause hair loss than others.

While you may be hesitant to "muck around" with a hair loss patient's chemotherapy regimen, doing so may be the best thing you can do for that patient, Dr. Drake said.

This is particularly true with breast cancer patients. In some cases they have already lost a breast, and they refuse chemotherapy because they don't want to lose their hair too, she said.

Working with the patient's oncologist to find a chemotherapy regimen that minimizes hair loss can help improve compliance. Low-dose intermittent therapy can be very effective while accomplishing both of these goals.

Antimitotics that are associated with extensive hair loss include Adriamycin and vincristine; those associated with less hair loss include methotrexate and Cytoxan, she added.

Ask Hair Loss Patients About OTC Products

Since nutritional deficiencies are a common cause of hair loss, it is important to ask what patients aren't putting in their mouths. It's equally important to ask what they are putting in their mouths.

A little detective work can go a long way toward identifying the cause of the hair loss.

Is the patient using 20-year-old mouthwash or an old bottle of Ex-Lax they found in their medicine cabinet? How about herbal supplements?

Years ago mouthwash contained borax, which can cause hair loss. Believe it or not, there are people who still have this stuff on their medicine cabinet shelves, Dr. Drake said.