Skin Deep: When It's Hair, You Can Be Too Thin
By LAUREL NAVERSEN GERAGHTY
As Joan Denton flipped through her son's wedding album two years ago, something caught her eye, and it wasn't the beaming groom or the radiant bride. It was the sight of her own scalp. "I realized I could see through my hair to the top of my head a little bit," said Ms. Denton, 59 , of Eatontown, N.J.
Since then Ms. Denton has invested thousands of dollars in pills, potions, gels, hair powders and special shampoos in an attempt to preserve, fatten and fluff up her hair. "But it just kept getting thinner," she said. "I felt horrible about myself - ugly."
Her experience is hardly unique. An estimated 30 million women - about one in five - suffer from female-pattern hair loss, according to the Women's Institute for Fine and Thinning Hair, an organization sponsored by Pfizer, the maker of Rogaine for men and women. Millions more suffer hair loss caused by compulsive hair pulling or by wearing tight braids, ponytails and other styles that tug at the scalp.
Cornrow braids, hot combing and hair relaxing treatments have led to an "epidemic" of hair loss among black women, said Dr. Susan C. Taylor, the director of Society Hill Dermatology, in Philadelphia. She estimates she has seen an increase of 50 to 60 percent in hair loss caused by styling in the past 15 years.
Women are still not as likely as men to be troubled by thinning hair; as many as one in two men lose their hair by the age of 50. And their loss is rarely as obvious as men's bald crowns. Women's hair thins over the entire head. Still, this thinning can be noticeable. It raises the risk of sunburn and even skin cancer on the scalp. And it is a source of great anxiety.
"Hair is like our security blanket," said Felicia Milewicz, the beauty director of Glamour, who said that thinning hair is a common complaint voiced by readers. "Without hair we feel totally exposed. It's like standing naked in front of the entire world."
Women have long suffered in silence, resorting to wigs and scarves to conceal their sparse locks. But they are increasingly coming forward to ask for remedies, doctors and salon owners say. As new medical treatments have boosted standards of perfection for every part of the face - whiter teeth, smoother skin, wider eyes - women may be less willing to tolerate thinning hair. And, said Dr. Alan J. Bauman, a hair transplant surgeon and founder of the Bauman Medical Group, in Boca Raton, Fla., women are increasingly aware that topical medicines, hair transplants and laser treatments designed for men can help them, too.
But there are no perfect treatments. Doctors understand less about how to treat hair loss in women than in men, and they do not know how to keep hair from falling out in the first place.
Hair loss is as natural as hair growth. Healthy heads drop 50 to 100 hairs every day, according to the American Academy of Dermatology. (Human heads have a total of 90,000 to 140,000 hairs.) With age, the thinning increases. "At 50 you have about half the number of hairs you had when you were 15," said Dr. John E. Wolf Jr., the chairman of dermatology at Baylor College of Medicine, in Houston. "The follicle begins to produce less quality hair. It is thinner, sparser and whiter."
For women trouble starts when so much hair is lost that the scalp becomes visible. This can be temporary, when it happens after childbirth, for example, or because of an underactive thyroid, or in response to stress like a raging fever, a crash diet or general anesthesia.
Megan Parks, 17, a freshman at George Fox University in Newberg, Ore., estimates she lost half her hair in June after a weeklong 103-degree fever from salmonella poisoning. It is starting to return though. "I've got cute little fuzzies on the top of my head," Ms. Parks said.
But female-pattern hair loss is usually permanent. It is thought to be influenced by levels of sex hormones, which fluctuate dramatically after menopause, but it is unclear exactly which hormones are to blame and why.
Tight ponytails and braids and hair extensions may cause permanent hair loss by continually tugging on the roots, scarring the follicles. Another cause of follicle damage is trichotillomania, the compulsion to tug or pull at the hair. Six million to eight million Americans experience this form of hair loss, nine times as many women as men, said Dr. Janet L. Roberts, a clinical professor of dermatology at Oregon Health & Science University, in Portland, and the secretary-treasurer of the North American Hair Research Society. Stress, anxiety and depression seem to contribute to the disorder.
Hair loss treatments work by strengthening follicles to prevent further loss. This is somewhat easier in men than in women because in men the hormone that triggers hair loss - dihydrotestosterone - is known. Doctors can counteract its effect by prescribing Propecia. "We have this silver bullet that puts the freeze, if you will, on male-pattern baldness," Dr. Bauman said. "We don't have a treatment like that for women."
Rogaine (the brand name of the drug minoxidil) is the only medicine known to slow hair loss in both men and women. Women's Rogaine is less potent than men's - a 2 percent strength, rather than 5 percent as in men's - but many dermatologists recommend the 5 percent solution for women, too. It is meant to be dripped onto the scalp twice daily (at a cost of about $25 a month). Because it has not been studied in pregnant women, patients are advised to talk to their doctors if they are expecting or thinking of becoming pregnant.
Other drugs target specific causes of hair loss. Those who have abnormally high levels of male hormones, for instance, may be prescribed birth-control pills containing estrogen or may take spironolactone, a drug that blocks the metabolism of male hormones. Those who have alopecia areata, which results from an autoimmune disorder, may be given cortisone shots in the scalp or a topical cream.
Some doctors, including Dr. Bauman, give patients a series of treatments with low-intensity laser light ($3,500 to $4,000 for a year of treatments). A few small studies have suggested that the light may help stimulate cellular metabolism and boost hair growth, though many doctors remain skeptical. Perhaps the most low-tech of all strategies are powders and sprays like Toppik Hair Building Fibers ($20) and Fullmore colored hair thickener ($20), meant to add texture to existing hair. "It really does kind of cover up the bald spots," said Ms. Denton, of New Jersey, who tried the Toppik product.
Some hairstylists recommend body-building shampoos like Nioxin Bionutrient Protectives Cleanser ($13). "They often make the hair appear thicker, but they definitely do not help grow new hair," Dr. Taylor said.
Wigs and hairpieces remain vulnerable to wind and wisecracks, but replacement hair has become more sophisticated. Gentle adhesives are used and synthetic or natural strands are blended in with existing hair. The result is fuller hair that lasts four to six weeks before needing to be reapplied and usually costs about $2,500 for the hair and a year of cleaning, cutting and styling.
Ms. Denton tried many of these treatments before resorting to hair transplantation surgery, a four-hour procedure that cost about $10,000. "That was my face-lift," she said. "That's what I decided to do for myself."
Unlike with the hair plugs of old, new micrograft surgeries implant follicles taken from the back of the head one, two or three at a time. Visible thickening results in four months, and full growth occurs in one year, Dr. Bauman said.
Four months after her surgery, Ms. Denton said: "My hair is growing up a storm. I'm all salt and pepper, but I love it."
Better treatments may be on the horizon, now that scientists have identified hair stem cells in the follicle. "Now there is hope that one day we can harvest stem cells from an adult's own head, put them in areas of hair loss and generate new hair cells," Dr. Taylor said.
Scientists still need a "better understanding of the molecular processes that govern hair growth," Dr. Wolf said, including genes and hormones involved. "It's all a very complex, very difficult science," he said, "and I think that is probably a number of years down the line."
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