Q: I'm only 40 years old and have been suffering from hair loss for over six months. My hair used to be very thick, but not anymore. Every time I wash my hair, a lot of it comes out my brush. I'm afraid I'm going bald. I've seen a doctor and dermatologist but neither can give me any explanation. I'm otherwise healthy and the only medication I'm taking is an oral contraceptive. Please help me. -- G.Y., Minneapolis
A: Hair loss occurs all the time. For unknown reasons, the rate of loss can be cyclical so that at times it's much more noticeable.
However, hair loss, also called alopecia, can be due to many factors, some related to scarring and others not. Scarring can be caused by chemical, physical or radiation injury, and by some severe infections and diseases. Scarring-caused alopecia is often irreversible and permanent.
Non-scarring causes of alopecia can include diseases like lupus, syphilis, thyroid and pituitary problems, and anemia. The only treatment in such cases is treatment of the underlying condition.
Non-scarring alopecia can also be caused by a variety of drugs. Anticancer drugs are especially toxic. Thallium, retinoids, anticoagulants, oral contraceptives and amphetamines are only some of the other drugs often implicated in temporary balding. Stopping or reducing these drugs may reverse alopecia.
Also, shampoo and hair dryer use may contribute to the thinning of your hair by making it more brittle. It also appears that after many years of hair dying, especially if strong bleaches are used, some people will experience a greater amount of loss than normal.
Androgenic baldness is much more common in men and is inherited. The extent of hair loss is variable and unpredictable, but hair is lost gradually and according to pattern. Both men and women can now be treated for this disorder with minoxidil.
Alopecia areata is a common hair loss disorder, especially in children and young people, and is characterized by a rapid loss of clumps or patches of hair, usually on the scalp.
The cause of alopecia areata is unknown but thought to be associated with an immune-system problem. It is associated with disorders of the endocrine system, especially the thyroid, and some forms of anemia. Psychosocial stress is also thought to play a part in the onset or worsening of alopecia areata.
Corticosteroids, either taken orally or injected into the affected skin, can be an effective treatment in persistent cases. Another treatment involves chemically producing an irritation at the sight of baldness, which can promote hair growth
I couldn't presume to diagnose your problem without more information. But from what you've said, your hair is thinning slowly rather than coming out in clumps and has been doing so for some time, suggesting association with a chronic medical problem or drug.
I'm sure you're disappointed that your dermatologist has not arrived at a diagnosis after so long a time. The cause of alopecia can often be determined by analysis of biopsied skin from the scalp. Did you have this done?
If your hair loss continues after stopping the birth control pills for a while (please do so only under medical direction), you may want to seek a second opinion and a detailed physical exam.
This article published in the Athens Banner-Herald on Tuesday, August 14, 2001.