Description: Losing Your Hair

First, don’t panic

In 1981, 26 year old Debbie Pond of Toronto was having her thick, curly dark tresses trimmed when the snipping of her stylist friend’s scissors suddenly paused. “She said, ‘Oh, Debbie, you have two bald spots,’ “Pond recalls.

Those smooth spots on her scalp turned out to be a sign that Pond, the newly married and only a few years into her career with the RCMP, had developed a condition called alopecia areata.

“Alopecia is just the medical term for hair loss,” notes Dr. Ian Landells, a St. John’s dermatologist and president of the Canadian Dermatology Association. “There are many, many different types of alopecia.”

In alopecia areata, which affects an estimated one to two per cent of the population, the characteristic bald patches (which can occur on any area of the body) are a result of damage due to misguided immune system attacks on hair follicles. (A follicle is the sac-like structure from which a hair root sprout.). While technically an autoimmune disease, unlike many of its relatives, alopecia areata doesn’t cause physical pain or disability, confining its path of destruction to the hair and, sometimes, the nails. (Pitting of the nails; brittle, vertically ridged nails; and concave, spoon-like depressions in the nail are some possible clues.) Nor does it necessarily signal the presence of more dire diseases, though eczema and thyroid disease seem to be somewhat more common among people with alopecia than they are overall.

“For the most part, alopecia areata is not associated with other autoimmune problems,” says Dr. Marni Wiseman, a Winnipeg dermatologist and assistant professor at the University of Manitoba and Cancer Care Manitoba.

Mind you, that doesn’t mean the condition can’t cause significant harm. Because hair plays such an important role in appearance, and the way we present ourselves to the world, suddenly losing it can be very distressing. “For some people, it can be a substantial life issue,” Wiseman observes. “Some spend hours trying to cover the bald spots, or clipping in extensions to cover them.” Often, at least at first, those affected will report feeling as if everyone is staring, and noticing either the bald patches themselves or the wig or hairpiece used to disguise them. “It can be very psychosocially disabling,” Wiseman says. Some people lose their eyelashes or eyebrows, which can be doubly devastating, according to Dr. Jeff Donavan, a dermatologist and hair loss specialist at Toronto’s Sunnybrook Health Sciences Centre.

But, while there’s currently no cure for alopecia areata, wigs, weaves, and brow tattoos aren’t the only options; effective treatments do exist.

“For the most part, alopecia areata is not associated with other autoimmune problems,” says Dr. Mami Wiseman



Description: Don't panic

Treatment Options

The first, most important step on the treatment path is to consult a physician experienced at diagnosing different causes of hair loss, which range from thyroid disorders and nutritional deficiencies (lack of iron being one potential culprit) to the physical shock of major surgery, various medications (including some antidepressants and certain blood thinners), and even skin cancers. What’s more, other, rarer types of alopecia can cause permanent scarring, and, thus, permanent hair loss. Consequently, it’s critical to untangle what’s at the root of the shedding and rule out other, more serious, cause as soon as possible. In the right hands, a careful history and physical exam are often sufficient to uncover the culprit, though sometimes, a scalp biopsy is necessary. (One signature sign of the condition are “exclamation mark” hairs broken hairs that are much thinner at the base than the tip which are often found at the edges of a bald patch.)

Once a diagnosis has been made, together, the patient and physician can weigh the various treatment options. Watchful waiting is one possibility; without any treatment, hair regrowth will spontaneously occur within a year in up to 80 per cent of cases, though some people do go on to experience a second episode of hair loss.

If the wait and see approach isn’t acceptable, the doctor can try one of several methods aimed at stopping the attacks on the hair follicles. (Scientists don’t understand exactly what triggers the underlying problem in alopecia areata: one theory is that hair follicles and the “coat” of a particular virus share a small sequence of proteins in common, causing immune cells to mistakenly identify the hair growing sacs as a threat.) “If you can shut that process down, the hair is fully regrow-able,” Donovan says. Typically, the type of treatment considered will depend on the extent of the hair loss.

Corticosteroids, which dampen immune cell activity, are the first-line option, and they work best when used within two years after the start of shedding, and when hair loss is limited to less than half the scalp. “Patients can apply creams and lotions at home, and then come in every four to six weeks for scalp injections,” Donovan explains. “In about 60 to 70 per cent of patients, that can help grow hair.”

Another plus? Injections are typically covered by provincial health plans, though the topical variety are not. However, you extended health insurance plan may pick up the tab.

In addition to the inconvenience and momentary discomfort, injections pose a small risk of side effects, such as thinning of the skin, depressions in the scalp (which usually fill in over time), and tissue damage.

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