Alopecia is the absence or slowing of hair growth in an area of the body where hair formerly grew. This disorder has several causes, including physical damage to the hair shaft or follicles and fungal infections. Telogen effluvium, which is when the hair's growth cycle is disrupted temporarily by such temporary problems such as a chemical imbalance or stress, is another cause. Alopecia areata, an autoimmune condition that causes patchy areas of hair loss on the scalp and sometimes the body, may also cause alopecia. The vast majority of cases of hair loss in both men (male pattern baldness) and women (female diffuse baldness), however, are genetic in origin. This is called androgenetic alopecia.

• Male pattern baldness. Thinning or absence of hair at the hairline and top of the head.
• Female diffuse baldness. A gradual thinning of hair, especially on the top of the head. The hairline generally remains intact.
• Broken hairs, or hairs easily removed.
• One or more round or oval bald patches.

In androgenetic alopecia, some hair follicles genetically produce a substance that reacts with male hormones. As you get older, this reaction eventually causes the follicle to shut down. Female diffuse baldness happens more slowly than male pattern baldness because women have a small amount of male hormones in their bodies. A hormone imbalance may make the problem worse.

Temporary hair loss may result from any shock to the body's systems. Reasons include starvation, systemic infection, childbirth, thyroid or immunologic disorders, drugs (especially chemotherapy for cancer), or stress. Hair follicles can be destroyed permanently by scarring from burns, severe scalp infections, x-ray therapy, or skin disorders. Damage may also result from tight hairstyles over a long period of time, chemical treatments such as hair coloring or permanents, or habitually pulling out hair. A fungal condition, called tinea capitis ("ringworm of the scalp"), also causes hair loss. With alopecia areata, or patchy hair loss, the body's immune system attacks the hair follicles, which grow smaller and don't produce as much hair. The condition may have a genetic factor, and often tends to occur in times of stress.

If the cause of your hair loss is uncertain, your provider may suggest thyroid function tests or a blood test to rule out immune system problems. Often your health care provider will takes biopsy, a small sample of scalp tissue for later examination.

Treatment options depend on the type of alopecia you have. Aggressive treatment depends how you feel about your hair loss and must be weighed against potential side effects. In many temporary forms of alopecia, the condition will go away without treatment. Surgery may be used to treat men with male pattern baldness for whom medical therapies are ineffective or cannot be used. Options include hair transplants, scalp reduction, and strip or flap grafts.

Drug Therapies

• Male pattern baldness -- minoxidil lotion, 2% to 5% applied twice daily; finasteride, 1 mg per day orally. Either drug must be used indefinitely to maintain regrown hair. If you use these medications, your health care provider should monitor you for side effects.
• Female baldness -- minoxidil lotion, 2% applied twice daily. The treatment must be used indefinitely to maintain regrown hair.
• Alopecia areata -- the most effective treatments involve steroid drugs, such as cortisone.
• Tinea capitis -- antifungal mediations such as griseovulfin, orally for 8 weeks, in combination with antifungal shampoo two to three times per week for 8 weeks. You must complete the entire course of treatment to prevent relapse.

Surgical and Other Procedures

Surgical options include hair transplants, scalp reduction, and strip or flap grafts.

Complementary and Alternative Therapies

These therapies have limited success in treating male pattern baldness.

Nutrition And Supplements

• Reduce your intake of pro-inflammatory foods (saturated fats, dairy products, and other animal products). Eat more fresh vegetables, whole grains, essential fatty acids, and, in particular, protein (non-animal sources of protein include nuts, legumes, and soy).
• Biotin (300 mcg per day) and trace minerals, such as those found in blue-green algae (2 - 6 tablets per day), help hair growth. Biotin and zinc aspartate have been used to treat alopecia areata in children.
• Androgenetic alopecia: vitamin B6 (50 to 100 mg per day), zinc (30 mg per day), and gamma-linolenic acid (1,000 mg twice a day) helps to inhibit 5-alpha reductase, an enzyme in the body that has been linked to hair loss.
• A .melatonin solution (.1%), applied topically once a day, showed promise in one study for androgenetic alopecia. Do not use melatonin if you are pregnant.
• Hormone imbalance: essential fatty acids (1,000 mg twice a day), B6 (50 to 100 mg per day), vitamin E (400 IU per day), and magnesium (200 mg twice a day) enhance hormone production.

Herbs

You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not use tinctures. You should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots.

• Combine the following in equal parts and use as tea (2 - 3 cups per day) or tincture (20 - 30 drops two to three times per day): ginkgo (Ginkgo biloba), rosemary (Rosemarinus officinalis), prickly ash bark (Xanthoxylum clava-herculis), black cohosh (Cimicifuga racemosa), yarrow (Achillea millefolium), and horsetail (Equisetum arvense).
• Androgenetic alopecia: Saw palmetto (Serenoa repens), 400 mg and beta-sitosterol, 100 mg, once a day.
• Hormone imbalance: Chaste tree (Vitex agnus cactus), 200 - 300 mg per day, has a normalizing effect on the pituitary gland.
• Viral origin or immune system cause: Herbs that support immune function can help treat the underlying cause of this type of alopecia. Echinacea (Echinacea angustifolia), astragalus (Astragalus membranaceus), and Siberian ginseng (Eleutherococcus senticosus).

Physical Medicine

Stress reduction techniques can increase blood flow to the scalp.

Massage

Therapeutic massage increases circulation and reduces stress. Scalp massage using essential oils of rosemary, lavender, sage, thyme, and cedarwood may help increase circulation. Add 3 - 6 drops of essential oil to 1 tbs. of jojoba or grapeseed oil. Massage into scalp daily.

Some men using finasteride may have a decreased sex drive or trouble getting an erection.

If you are pregnant, postpone treatment until after your baby is born.

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Hay IC, Jamieson M, Ormerod AD. Randomized trial of aromatherapy: successful treatment for alopecia areata. Arch Dermatol. 1998;134:1349-1352.

Lebwohl M. New treatments for alopecia areata. Lancet. 1997;349:222-223.

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Questions and Answers about Alopecia Areata. Pub. No. 03-5143

Prager N, Bicketee 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 Complent Med. 2002 Apr;8(2):143-52.

Whiting DA. The Diagnosis of Alopecia. Dallas, Tex: University of Texas. Baylor Hair Research and Treatment Center. Accessed at Neuropathy Research at the Medical College of Georgia, http://www.mcg.edu/ on January 13, 1999.