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Alopecia Thin Hair

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Figure 3.  (click image to zoom)

Traction alopecia

Disorders Affecting the Follicle

Androgenetic alopecia: Andro gen et ic alopecia or hereditary hair thinning is the most common form of hair loss in humans. This condition is also known as male-pattern hair loss or common baldness in men and as female-pattern hair thinning in women. Onset may occur in either sex at any time after puberty and the majority of thinning occurs in the teens, 20s, and 30s.

The cause of hereditary hair thinning is a gradual diminution of the hair follicle which occurs under the influence of androgens (Price, 1999). The smaller hair follicle results in a finer and shorter hair shaft. Women with hereditary thinning usually first notice a gradual thinning of their hair, mostly on the top of their heads, and their scalp becomes more visible. Over time, the hair on the sides may also become thinner. The patient may notice that her "ponytail" is much smaller. This diffuse thinning of the scalp can vary in extent but it is extremely rare for a woman to become bare on top.Click to zoomClick to zoom Figure 4.  (click image to zoom)

4a, Frontal part. 4b, Occipital part.Treatment for women with hereditary thinning includes topical minoxidil solution, which when used regularly can partially re-enlarge the miniaturized hairs. In women, the use of 5% topical minoxidil applied twice daily was recently proven more efficacious than the previously recommended 2% minoxidil; however, there is a higher incidence of side effects with the stronger preparation such as scalp pruritus, local irritation, and unwanted hypertrichosis (Callender et al., 2004). Women with androgenetic alopecia may also consider spironolactone (inhibits androgen receptor binding) which has less evidence to back its efficacy, but might be a good choice in women with hypertension or women with hirsutism (Bandaranayake & Mirmirani, 2004).

Alopecia areata: Alopecia areata is an autoimmune disease that affects almost 2% of the population in the United States (Price, 1999). In flammatory cells target the hair follicle, thus preventing hair growth. Typically a small round patch of hair is noticed; this patchy hair loss may regrow spontaneously (see Figure 5). In other cases there can be extensive patchy hair loss and in rare cases there is loss of all scalp and body hair (alopecia areata universalis). Alopecia areata occurs equally in males and females, at all ages, although young persons are affected most often. Although the most common presentation of alopecia areata is patchy hair loss in scattered or oval patches, the hair loss can also involve the temporoccipital bane (ophiasis pattern hair loss). Brows, lashes, and body hair may also be involved. The nails may show track marks or pitting. Figure 5.  (click image to zoom)

Alopecia areata

Using the systematic and meth odic approach to hair loss described here, dermatology clinicians can make the correct diagnosis in almost all patients with alopecia. This approach can be described to the patient: "Based on a review of your medical history, detailed exam of your hair and scalp, and laboratory test(s), the cause of hair loss is most likely X." Confident that the clinician has undertaken a thorough evaluation, the patient is often more open and accepting of counseling and treatment suggestions. When counseling the patient the word "bald" should be avoided. It is a difficult term for a woman to digest and comes with baggage. The only time it should be used is in the sentence, "You will not go bald." Instead, the preferred wording is "hair loss," "thinning," or "bare areas." After diagnosis and treatment have been discussed, the visit is not complete without addressing a woman's "worst fear." Often not verbalized, she is wondering "Am I going to go bald?" or "What does the future hold a wig?" Addressing these fears and giving as clear a picture of the future as possible can help the patient face her hair loss

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