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LISA CLARK: Did you know that 1 in 4 women in the
United States experience hereditary hair loss? And that
hair loss affects over 30 million women in the United
States alone. It takes most women by surprise. For some,
the effects can be embarrassing and depressing. Here to
explain the causes and warning signs of hair loss are
two experts in the field.
We welcome Dr. Marty Sawaya, Adjunct Professor at the
University of Miami School of Medicine, and Dr. Michael
Reed, Assistant Professor of Clinical Dermatology at the
New York University School of Medicine, and also in
private practice here in Manhattan. Thanks to both of
you for joining us.
Now in our appearance conscious society, hair is a
huge issue. It is something that women stake a lot of
their looks and a lot of their self-esteem in. And when
they start to lose it, it can be extremely devastating.
Tell me a little bit about the reaction that some of the
people you've dealt with have had.
MARTY SAWAYA, MD: Women have a very hard time coping
with it. They get very anxious. Their family notices
that there's something wrong with them, in the way that
they're coping with the fact that they're noticing a lot
of hair shedding. Their hair isn't as thick as it used
to be. It's not as manageable. They're noticing the
changes, and it's going on and on for months into years,
and it can go on for quite a long time.
They seek a lot of medical help, but not always the
right answers. Our sources of information leading to
women trying to find the right answers is very confusing
for most women, and it can be very devastating, and a
path that just seems to be endless.
LISA CLARK: Dr. Reed, the statistic, one in four
women in the US will experience this, is astonishing.
You don't ever hear about this. And I guess there's a
tendency for women who start to experience this problem
to feel very isolated and very alone. How do you help
them understand the prevalence of this, and the
treatability?
MICHAEL L. REED, MD: I think they may first feel
isolated, but then they share their feelings with
everyone around them, starting in their family. Because
hair loss makes women absolutely crazy. It's a
catastrophe. Women have to have hair. And so they share
it, day and night, every moment of the day and night,
with their loved ones, until finally they and their
loved ones find a doctor, someone to see, whether it's
an expert or someone who claims to be an expert, and
they do seek help.
Whether or not women are seeking help more because
there's more things to help them, or whether they've
always had the problem but didn't know. Whether it's a
sign of the modern woman that she makes more male
hormone like the guys, and she has hair like the guys, I
don't know. It's probably all those things. But women
have to have hair, and it's an absolute nightmare for
them, beyond belief. It really is essentially what we
call cosmetic death for them, and they won't tolerate
it.
LISA CLARK: Well, you grow up, even in fairy tales:
Goldilocks, Rapunzel, it's all about hair, at a very
early level, and I think it's, as you say, a cosmetic
death is not overstating the case for some women.
Now, apart from the incorrect belief that this is a
rare situation for women until they experience it for
themselves, let's talk about a few of the myths that
people might be concerned about when they first start to
experience hair loss, and they think: Am I washing my
hair too often. Is that a common thing that you hear?
MARTY SAWAYA, MD: That's a common thing that people
are misinformed. They think the more they wash their
hair, the more their hair is going to fall out. If
anything, when patients come to see me, we have them
shampoo daily, to really get an estimate of how much
hair they're really shedding per day. We know that
there's about 50-100 hairs that we normally lose per
day, and the only way you're going to accurately assess
that is if you shampoo daily. So shampooing often does
not cause hair loss.
LISA CLARK: One of the other big myths is that hair
loss only happens to women after they reach a certain
age. That is not true, is it?
MICHAEL L. REED, MD: Hair loss can begin any time
after puberty in women. Although it's more common as
they get older, especially around the time of menopause,
when the male hormones have more of an effect on their
scalp. But we see many, many young women nowadays who
have very noticeable hair loss, and they need treatment
and they need help early. They're not going to wait.
LISA CLARK: Are hair loss patterns the same for men
as for women?
MARTY SAWAYA, MD: Patterns differ in women, and this
is something that most women aren't informed about. They
think that they have to have the same patterns as men.
But women have more of a centralized, diffuse thinning
on the top of the scalp, sparing the frontal hairline.
So that they have an intact frontal hairline, but
they're seeing most of the hair loss in the center part
of the scalp, where they're seeing more visible scalp
with time, continued time.
They notice, also, that their hair just isn't as
thick all over the scalp, but the most prominent area is
the top, center part of the scalp.
LISA CLARK: Let's talk about the fact that it is a
part of the natural cycle of hair that everyone loses
hair daily, on a daily basis. How much is considered in
the normal range, before you would say: This is
something to worry about?
MICHAEL L. REED, MD: Depending on how often the
person washes their hair, it can be up to 100 hairs a
day. Although, the typical patient with no hair loss
problems probably notices under 50 hairs a day; 20-30 is
probably fairly typical. Although once they start to
shed hair, then they become almost allergic or
hypersensitive. Everything comes out. They notice every
hair that comes out, and even though there's not more,
it seems like more hair to them.
LISA CLARK: Let's talk about the three major causes
of hair loss for women. We'll start with the first. It's
called androgenetic alopecia. This is genetically
related hair loss. How common is this type, and could
you describe how it appears, what it looks like?
MARTY SAWAYA, MD: It's a very common form of hair
loss for women, because women inherit the genes for hair
loss as men do, so that's why it's called androgenetic.
It's a combination of androgens, which are male
hormones, and the genes that we inherit from both sides
of the family. Not just mother, not just father's side,
both sides of the family. And it has a variable degree
of how severe it can affect you. So, for some people it
may be very mild, for other people it may be very
severe. There's a variability on the severity level of
what we inherit in androgenetic alopecia.
This can hit a large proportion of women. Usually
more prominently in their 20s and 30s. But again, it can
also start to exacerbate and have signs noticed in the
perimenopausal stages, when male hormones are coming to
the foreplay with regards to the ovaries and the changes
in the ovaries with menopause coming about. So they will
start to see this widened part area. If they part the
hair down the center of the scalp, they'll start to see
more visible scalp. The part does not look as tight as
it used to be. And this becomes very alarming for most
women.
MICHAEL L. REED, MD: But the term "male pattern hair
loss" and "female pattern hair loss" just refer to the
most common patterns, ergo the describer. A male pattern
is typically a receding hairline with a bald spot in the
back. They meet in the middle and the guy cueballs out
maybe sometime in life. The women get see-through hair.
They have a hairline; it's maybe not so great.The
hairline stays there, but behind it you see mostly scalp
and not hair. And that's a disaster.
LISA CLARK: Let me ask you a question. There's a
popular conception that you can predict baldness for men
by looking at the maternal father. (A) is that true, and
(B) are there similar predictors for women as they look
at their ancestors and say: Hmm, So-and-so had thinning
hair --I'm at risk?
MICHAEL L. REED, MD: I tell my patients who say that
there's no family history of hair loss, that that often
happens. That sometimes there's no hair loss even in the
neighborhood. No one ever came near their whole family.
The milkman was never, no one. And still they have this
problem in a typical case.
It's a polygenetic type of thing. There may be a gene
for onset, for progression, for endpoint, and when that
occurs in life. There are many modifying factors. It's
much more complicated than people realize. It's not
simply through the maternal line, although it seems to
me it has a noticeable trend in that direction, but it
clearly can come from all over the place.
LISA CLARK: Let's talk about the second type of
female hair loss. Telogen effluvium or, as you like to
say, defluvium.
MICHAEL L. REED, MD: I was a Latin scholar; I call it
"defluvium." But we won't argue the fine points. Most
people call it effluvium, which means a flowing out, a
coming out of resting hairs, which are called telogen
hairs, or club hairs. They're the little hairs that come
out when you comb your hair, brush your hair, wash your
hair. They have a little white tip on them. It's normal
for hairs to grow for three to four years on the scalp,
rest for three to four months, and then come out,
because they're being replaced by a new hair. That's
normal.
LISA CLARK: This form of hair loss is often
temporary, but not always. Let's talk about some of the
things that might spark a loss of hair in this type of
category, telogen effluvium.
MARTY SAWAYA, MD: Very commonly, stress or, as we
say, postpartum, after delivering a baby, is very common
to see, about two to three months after delivery of a
child, that your hair is starting to shed. And this is
from the effects of pregnancy, when the hair has grown
to such a great hair cycle where you're not seeing much
shedding at all. So now after the baby's been delivered,
you're seeing the shedding making up for lost time, so
to speak.
But there are other causes, such as anemia, blood
loss from menstrual cycles. Medications are a very big
factor for women, and there's a list of common
medications for blood pressure, depression, other types
of medications.
LISA CLARK: Beta blockers?
MARTY SAWAYA, MD: Beta blockers especially. They're
very prominent. So I always have patients go back six
months, a year ago, on new medications they may have
started. Oral contraceptives. We categorize them as the
good ones and the bad ones, and it really depends on
which one they're taking, because some of them can
actually exacerbate hair loss and get the cycle started.
And I always describe for each patient the hair
cycle, because it's very important for them to realize
that no matter what we try to instigate in therapy, it's
not going to happen overnight, because the hair cycle,
as we talked about earlier, goes through a resting stage
of three to four months. And for anything to help, it's
going to take four to six months to help turn things
around. So understanding that gives people the patience
to understand, so that they can stick to whatever
treatment or therapy that you're going to outline for
them.
So, again, medications are a big factor. Other
underlying medical conditions that they may have, like
thyroid disease, other autoimmune related factors that
they may have going on. Again, all these are very
intricate and complicated sets that you have to really
unravel, like being a detective, when I have a patient
come in. To really understand what is happening in this
particular patient. And it's not easy.
LISA CLARK: We have just a couple of seconds left,
and I want to address the third type of hair loss.
Alopecia areata, and not just areata, but there are
varieties of alopecia. Alopecia presents often as a
round spot?
MARTY SAWAYA, MD: Round, circular patch in childhood,
anywhere to adulthood. I say, with alopecia areata,
anything goes. This is an autoimmune related disease
which, there are genetic factors to this disease, and
they're doing a lot of HLA typing or factors in the
family makeup, to try and look at the genetic makeup of
this very complicated disease.
You can have circular patches, and you can totally do
nothing, and they grow back on their own. Or you can
lose all the hair on your body, not just the scalp hair
on your scalp. You can lose eyebrows, eyelashes. It's
very devastating to children as well as adults.
LISA CLARK: And another form is caused by perhaps too
much chemical processing?
MARTY SAWAYA, MD: That's a different entity. As we
say, pseudopelade or follicular degeneration, from
especially African-American women who do a lot of
perming and cosmetic things to their scalp through years
of perming and using colorants and harsh chemicals to
the scalp. With time it can have an effect on the hair
follicle deep in the scalp and cause the hair to scar,
and you totally lose the hair follicle. That's a very
difficult problem to treat, called scarring alopecia.
LISA CLARK: As we wrap up, I want to ask you: What
resources are available for women who are experiencing
hair loss? Where should they start, what should they
look for?
MICHAEL L. REED, MD: The first thing a woman should
do who's losing her hair, or having it come out, is see
a board-certified dermatologist. Dermatologists are the
experts in medical treatment for hair loss. A lot of
them also are good at surgical treatments, but always we
use medical treatments first. Dermatologists have
treatment that works. See them, and they'll tell you
what it is.
LISA CLARK: I'd like to thank both of you for joining
us here today. This is a very important issue for a lot
of women, a lot more than I realized initially. Thank
you both for being here, Dr. Marty Sawaya, and Dr.
Michael Reed. And thanks to you for tuning in for our
webcast. I'm Lisa Clark. |
