Hair disorders

Signs and Symptoms

Hair disorders are accompanied by the following signs and symptoms, depending on the type:

• Alopecia (nonscarring) involves hair loss all over or in circular areas, a receding hair line, broken hairs, a smooth scalp, inflammation, and possibly loss of lashes, eyebrows, or pubic hair.
• Alopecia (scarring) is limited to particular areas. Symptoms are inflammation at the edge and follicle loss toward the center of lesions, violet-colored skin abnormalities, and scaling.
• Hirsutism is male pattern hair growth in women, irregular menstruation, lack of ovulation, acne, deepening voice, balding, and genital abnormalities.
• Symptoms of hair shaft disorders are split ends and hair that is dry, brittle, and coarse, as well as skin and other abnormalities.

What Causes It?

Hair disorders can be caused by any of the following:

• Alopecia (nonscarring). Skin disorders, certain drugs, certain diseases, autoimmunity, iron deficiency, severe stress, scalp radiation, pregnancy, or pulling at your own hair.
• Alopecia (scarring). Skin disorders, diseases, or bacterial infections.
• Hirsutism. Excess of androgen (a steroid hormone that stimulates development of male sex organs and secondary sexual characteristics). This overproduction of androgen could result from certain drugs or conditions.
• Hair shaft disorders. Overprocessed hair (such as coloring, permanent waves, or excessive heating) or certain diseases.
• Inflammation

Who's Most At Risk?

People with the following conditions or characteristics are at risk for developing hair disorders:

• Alopecia. Male gender, genetic predisposition, pregnancy, physical or emotional stress, poor diet.
• Hirsutism. Genetic predisposition, lack of ovulation, endocrine disorders, polycystic ovaries.
• Hair shaft disorders. Genetic predisposition, damaging grooming practices.

What to Expect at Your Provider's Office

If you have symptoms associated with a hair disorder, you should see your health care provider. A physical exam can help identify the type of hair disorder, and laboratory tests can reveal any underlying diseases. In the case of hirsutism, imaging may help diagnose the cause.

Treatment Options

Prevention

Eating a well-balanced diet and avoiding potentially damaging hair treatments can help prevent some types of hair loss.

Treatment Plan

The primary goals of treatment are to treat the underlying cause, regrow the hair when possible, and correct damaging grooming practices.

Drug Therapies

Your health care provider may prescribe the following medications:

Alopecia:

• Minoxidil (Rogaine). For hair regrowth and possibly to prevent further loss.
• Tretinoin (Retin-A). To decrease thick scalp layer and increase minoxidil penetration.
• Topical or injectable steroids

Hirsutism:

• Steroids
• Oral contraceptives

Hair shaft disorders:

• Minoxidil
• Drugs for underlying diseases

Surgical and Other Procedures

• Cosmetic therapies, such as surgical placement of follicle supporting plugs or folds
• For hirsutism, possibly removal of ovarian or adrenal tumor

Complementary and Alternative Therapies

A comprehensive treatment plan for hair disorders may include a range of complementary and alternative therapies.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your provider may want to test you for food sensitivities.
• Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens, and sea vegetables.
• Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squashes and peppers).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy oils in foods, such as olive oil or coconut oil.
• Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

You may be able to address nutritional deficiencies with the following supplements:

• A multivitamin daily. Containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids. Such as fish oil, to help reduce inflammation. Fish oils may increase bleeding in sensitive individuals, such as those taking blood-thinning medications (including aspirin).
• Vitamin C. As an antioxidant.
• L-lysine. For hair loss. Avoid taking L-lysine with large amounts of calcium.
• B-complex vitamins. For symptoms of stress.

Herbs

Herbs may help strengthen and tone the body's systems. As with any therapy, you should work with your provider before starting treatment.

You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. (5 g) herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

For alopecia and hair shaft disorders:

• Ginkgo (Ginkgo biloba). Standardized extract, for antioxidant support and blood flow. Ginkgo may increase bleeding in sensitive individuals, such as those taking blood-thinning medications, including aspirin. Ginkgo may not be appropriate for people who have diabetes, infertility, seizure history, or bleeding disorders. Speak with your physician.

Topical applications of essential oils may benefit skin infections and stimulate new hair growth. Use 3 to 4 drops each of peppermint (Mentha piperita), rosemary (Rosmarinus officinalis), and sage (Salvia officinalis) in 1 tablespoon (15 mL) of coconut oil or olive oil. Massage gently into affected area 1 to 2 times daily. If using topical medications such as Minoxidil consult your provider regarding possible interactions between topical natural products.

For hirsutism:

• Saw palmetto (Serenoa repens). Standardized extract, for hormonal support. Saw palmetto may interact with some hormone therapies, including birth control, and may increase the blood-thinning effects of certain medications, such as aspirin and warfarin (Coumadin).

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of gastritis symptoms (such as nausea and vomiting) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment.

Some of the most common remedies include:

• Ignatia
• Pulsatilla
• Sepia

Acupuncture and Massage

Acupuncture may help alleviate symptoms of hair loss. Acupuncture may help enhance immune function, normalize digestion, and address disease conditions.

Mind and Body Therapies

Although not all abnormal hair loss is associated with stress, psychological stress can alter thyroid and sex hormone levels in the body, potentially leading to hair loss. Yoga, prayer, guided imagery, meditation, and a variety of other methods may help retrain your body's response to stress. Group support can also be a vital component of any stress reduction plan and can have measurable physiological impact.

Supporting Research

Abraham KC, Connor KM, Davidson JR. Explanatory attributions of anxiety and recovery in a study of kava. J Altern Complement Med. 2004;10(3):556-559.

Beattie PE. The patient with hair loss. Practitioner. 2003;247(1643):128-130, 132-134.

Bilia AR, Gallon S, Vincieri FF. Kava-kava and anxiety: growing knowledge about the efficacy and safety. Life Sci. 2002;70(22):2581-2597.

Blume-Peytavi U, Vogt A. Current standards in the diagnostics and therapy of hari diseases - hair consultation. J Dtsch Dermatol Ges. 2011;9(5):394-410.

Bope ET, Kellerman RD, eds. Conn's Current Therapy 2016. 1st ed. Philadelphia, PA: Elsevier; 2016.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Cassano N, Amerio P, D'Ovidio R, Vena GA. Hair disorders associated with autoimmune connective tissue diseases. G Ital Dermatol Venereol. 2014;149(4):555-565.

Cheng AS, Bayliss SJ. The genetics of hair shaft disorders. J Am Acad Dermatol. 2008;59(1):1-22.

Elston DM. What's new in the histologic evaluation of alopecia and hair-related disorders? Dermatol Clin. 2012;30(4):658-694, vii.

Fontani G, Corradeschi F, Felici A, et al. Cognitive and physiological effects of Omega-3 polyunsaturated fatty acid supplementation in healthy subjects. Eur J Clin Invest. 2005;35(11):691-699.

Harel S, Christiano AM. Genetics of structural hair disorders. J Invest Dermatol. 2012;132(E1):E22-E26.

Harrison S, Bergfeld W. Diseases of the hair and nails. Med Clin North Am. 2009;93(6):1195-1209.

Marks JG, Miller JJ. Hair disorders. In: Marks JG, Miller JJ, eds. Lookingbill and Marks' Principles of Dermatology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 20.

Middlekauff HR, Yu JL, Hui K. Acupuncture effects on reflex responses to mental stress in humans. Am J Physiol Regul Integr Comp Physiol. 2001;280(5):R1462-R1468.

Olszewska M, Warszawik O, Rakowska A, Slowinska M, Rudnicka L. Methods of hair loss evaluation in patients with endocrine disorders. Endokrynol Pol. 2011;62(1):29-34.

Pandi-Perumal SR, Srinivasan V, Maestroni GJ, et al., Melatonin. FEBS J. 2006;273(13):2813-2838.

Prager N, Bickett K, French N, Marcovici G. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. J Altern Complement Med. 2002;8(2):143-152.

Rai D, Bhatia G, Sen T, Palit G. Anti-stress effects of Ginkgo biloba and Panax ginseng: a comparative study. J Pharmacol Sci. 2003;93(4):458-464.

Randall VA. Androgens and hair growth. Dermatol Ther. 2008;21(5):314-328.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-247.

Rucker Wright D, Gathers R, Kapke A, Johnson D, Joseph CL. Hair care practices and their association with scalp and hair disorders in African American girls. J Am Acad Dermatol. 2011;64(2):253-262.

Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol. 2002;27(5):396-404.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Sinclair RD, Mallari RS, Tate B. Sensitization to saw palmetto and minoxidil in separate topical extemporaneous treatments for androgenetic alopecia. Australas J Dermatol. 2002;43(4):311-312.

Sufka KJ, Roach JT, Chambliss WG Jr, et al. Anxiolytic properties of botanical extracts in the chick social separation-stress procedure. Psychopharmacology (Berl). 2001;153(2):219-224.

Trueb RM. Systematic approach to hair loss in women. J Dtsch Dermatol Ges. 2010;8(4):284-298.

Wang SM, Kain ZN. Auricular acupuncture: a potential treatment for anxiety. Anesth Analg. 2001;92:548-553.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-596.

Zuckerman-Levin N, Tiosano D, Eisenhofer G, et al. The importance of adrenocortical glucocorticoids for adrenomedullary and physiological response to stress: a study in isolated glucocorticoid deficiency. J Clin Endocrinol Metab. 2001;86(12):5920-5924.