When it comes to hair there is an enormous number of issues that can arise ranging from too little to too much hair. Both women and men suffer from both maladies. And while the hair follicle is the same no matter who and what you are looking at, the conditions that cause these issues are not. We at TSLMS know quite a bit about these conditions and pass that knowledge on to our membership. We hope that this installment of our blog will help you and your clients, and we hope that you will come to SCALE 2019 Music City next month to learn more.
When Hair Won’t Grow
There are several medical reasons that can explain a person’s lack, or loss, of hair. These are in reality, two very different things.
When a person is born without hair they have hypotrichosis. This is a medical condition “that affect individuals right from birth and usually stay with them throughout their lives. The majority of hypotrichoses are due to genetic aberrations or defects of embryonic development. There are hundreds of types of genetic hypotrichoses. Often, affected individuals have other physical or mental problems beyond a lack of hair. Conditions such as Graham-Little syndrome, Ofuji syndrome, cartilage-hair hypoplasia, Jeanselme and Rime hypotrichosis, Marie Unna hypotrichosis, and metaphyseal chondrodysplasia, among many others, can involve the symptom of hypotrichosis.” (Source).
Alopecia, on the other hand, is a condition in which people lose hair that at one point existed. As noted by Medical News Today, “alopecia areata is a common autoimmune disorder that often results in unpredictable hair loss. It affects roughly 6.8 million people in the United States.
In the majority of cases, hair falls out in small patches around the size of a quarter. For most people, the hair loss is nothing more than a few patches, though in some cases it can be more extreme. Sometimes, it can lead to the complete loss of hair on the scalp (alopecia totalis) or, in extreme cases, the entire body (alopecia universalis). The condition can affect anyone regardless of age and gender, though most cases occur before the age of 30.” Alopecia has genetic links, much like hypotrichosis does.
When Too Much Hair Grows
The literal opposite of too little hair is too much hair. Hirsutism is, as noted in an article by American Family Physician (albeit dated) describes this condition.
Hirsutism is excess terminal hair that commonly appears in a male pattern in women. Although hirsutism is generally associated with hyperandrogenemia, one-half of women with mild symptoms have normal androgen levels. The most common cause of hirsutism is polycystic ovary syndrome, accounting for three out of every four cases. Many medications can also cause hirsutism. In patients whose hirsutism is not related to medication use, evaluation is focused on testing for endocrinopathies and neoplasms, such as polycystic ovary syndrome, adrenal hyperplasia, thyroid dysfunction, Cushing syndrome, and androgen-secreting tumors. Symptoms and findings suggestive of neoplasm include rapid onset of symptoms, signs of virilization, and a palpable abdominal or pelvic mass. Patients without these findings who have mild symptoms and normal menses can be treated empirically. For patients with moderate or severe symptoms, an early morning total testosterone level should be obtained, and if moderately elevated, it should be followed by a plasma free testosterone level. A total testosterone level greater than 200 ng per dL (6.94 nmol per L) should prompt evaluation for an androgen-secreting tumor. Further workup is guided by history and physical examination, and may include thyroid function tests, prolactin level, 17-hydroxyprogesterone level, and corticotropin stimulation test. Treatment includes hair removal and pharmacologic measures. Shaving is effective but needs to be repeated often. Evidence for the effectiveness of electrolysis and laser therapy is limited. In patients who are not planning a pregnancy, first-line pharmacologic treatment should include oral contraceptives. Topical agents, such as eflornithine, may also be used. Treatment response should be monitored for at least six months before making adjustments.
Hair Disorder Treatments
As noted by the Cleveland Clinic, the removal of unwanted body and facial hair can be accomplished by any number of approaches – however, many of them are not permanent. The most lasting and effective are laser treatment, topical prescription and oral medication.
- Laser hair removal. This is one of the longest-lasting methods and generally requires 4 to 6 treatments spaced 4 to 6 weeks apart. The laser beam or a light pulse works to destroy the hair bulb. Several different wavelengths of laser or intense pulsed light (IPL) are available for hair removal. Your doctor or healthcare professional will help you decide which one is right for you. Laser hair removal is most effective on light skinned people with dark hair. However, it can be used on darker skinned individuals. Risks include post-inflammatory hyperpigmentation (dark spots) in previously treated areas. Overall success is variable depending on hair location, skin and hair color, the stage of hair growth, laser type, and treatment plan.
- Pharmacologic options. A topical cream called Vaniqa® (eflornithine 13.9%) was recently approved by the Food and Drug Administration for the removal of facial hair in women. This cream works by inhibiting an enzyme that is important for normal hair growth, but must be prescribed by a physician and used on a continuous basis. Studies show that when the cream is discontinued, the hair returns to pretreatment levels after about 8 weeks.
- Oral medications. As a last resort, when nothing else works, there are medications that doctors can prescribe.
On the other end of the spectrum, for those suffering from hair loss, as the University of Michigan Medical School points out, there are a number of medical options that have proven to be quite effective.
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