No one wants to lose their hair, but for a woman it is particularly distressing. While men can look perfectly presentable — even sexy — with their exposed scalp, no such options exist for the 30 million American women who grapple with thinning tresses. Dr. Maria Colavincenzo, a dermatologist at Northwestern University Feinberg School of Medicine, has a practice that specializes in preserving those precious strands — especially in cases of androgenetic alopecia, a hereditary condition that causes hair loss, mainly on the top and crown of the scalp. Without an appointment, she answered some of our questions:
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Thallium poisoning should be suspected in any patient manifesting nervous system and gastrointestinal symptoms along with alopecia. The hair loss affects the scalp, periocular hair, limbs, and sometimes the axillae. Examination of the hair roots under a microscope using polarized light shows distorted anagen roots and several black zones in continued poisoning.
Yes. Hyperandrogenism, a medical condition characterized by excessive production of male hormones called androgens, can cause hair loss in affected women. The most common cause of hyperandrogenism in women is functional ovarian hyperandrogenism, also known as polycystic ovary syndrome. In addition to hair loss, other signs include obesity, acne, and irregular menstruation, and it is one of the most common causes of infertility.
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However, the effects of alopecia reach far beyond symptoms of depression and include anxiety, obsessions, dissatisfaction with one’s appearance, and low self-esteem (Al-Mutairi and Eldin, 2011, Dlova et al., 2016, Hunt and McHale, 2005, Schmidt et al., 2001). There can be significant disturbance in a patient’s social life because they may change their hair style, clothing, or avoid social meetings (Al-Mutairi and Eldin, 2011). One study reported that 40% of surveyed women described marital problems and 63% had career-related issues that they ascribed to their hair loss (Hunt and McHale, 2005). These effects seem to occur regardless of patients’ age, race, or degree of hair loss (Dlova et al., 2016, Hunt and McHale, 2005, Schmidt et al., 2001). Another study of more than 200 women found that this psychologic morbidity occurs with equal frequency in women whose hair is typically covered by a headscarf (Erol et al., 2012).
Eyebrow thinning that manifests in irregular patches, especially accompanied by red and itchy skin, may indicate atopic dermatitis. This condition—commonly called eczema—can occur just about anywhere on the body and is usually hereditary. People with atopic dermatitis may be more sensitive to topical irritants, but eczema just from topical irritants is called allergic contact dermatitis or irritant contact dermatitis. While you wait on the appointment with your dermatologist, you can help ease eczema around the eyebrows by switching to mild soaps or a soap-free facial cleanser, and applying an intensive facial moisturizer within three minutes after bathing.
Scurf refers to the scales and greasy crusts that accumulate along the hair shaft and indicates the presence of seborrhea.[26,27] Collarettes are composed of hard fibrinous scales[25,28] surrounding each individual eyelash. They travel upward along with the growth of the lashes and are indicative of staphylococcal infection. Sleeves or cylindrical dandruff comprise scales that form a cuff around the lash root and are connected with it, in contrast to greasy scales which are not connected to the lash root. Sleeves indicate infestation with Demodex folliculorum.
Over-plucking or nutrient deficiency can be easily solved on your own with behavioral changes and nutritional supplements, but if you suspect that your thinning eyebrows are caused by a health problem, please see a doctor right away for treatment. Do not attempt to address hypothyroidism, eczema, or alopecia areata without the guidance of a medical professional.
Blow dryers, flat irons, and other devices: Frequent use of a blow dryer tends to damage hair. The high heat from a blow dryer can boil the water in the hair shaft leaving the hair brittle and prone to breakage. Dermatologists recommend that you allow your hair to air dry. Then style your hair when it is dry. Dermatologists also recommend limiting the use of flat irons (these straighten hair by using high heat) and curling irons.
Alopecia areata is a patchy hair loss associated with immune disturbances. In this condition the immune system attacks the hair follicles thereby impairing hair growth. It is more likely to occur in people with other immune-related disorders and has also been linked to psychological stress as well as with certain drugs like some types of ARVs used for HIV treatment. Alopecia areata does not only affect the scalp as commonly thought. The eyebrows and beard area, as well as hairy parts anywhere on the body may be affected.
Giorgos Tsetis: Consumers are lost, and that's the sad part about it. You have a serious problem, you go on the internet and see thousands of products making similar claims, and you can't choose. Most likely, you're going to try the cheapest product with the most compelling claims, realize it doesn't work, and only add further stress. When an industry is not properly regulated, this is the result. Education is such a big component of what we do. Reverse engineering a solution requires a tremendous amount of time and research. What we did was connect all these dots reading hundreds of pages of scientific literature. Education, when it comes to this, is broken into education for the physicians and education for the consumers. It's always hard to educate, because what you're really doing is changing behavior. Slowly but surely, we're actively changing the mindset of physicians and consumers, evolving the way they view and treat hair loss. That is huge, and one of the key reasons Unilever invested in the company. What we did was raise the bar by introducing a new category in the medical channel that remained untapped. That's how we disrupted the market, where now you see hundreds of doctors using Nutrafol as a trusted alternative for men and women. We also have several writers in the company who imagine how we can make this world simple and digestible for people. We want consumers to make smart choices.
Dozens of other causes of eyebrow loss are also possible including a variety of infectious, autoimmune and inflammatory conditions. Consultation with a dermatologist or hair transplant surgeon is recommended. I strongly advise consulting a dermatologist before proceeding to hair transplantation for women over 40 with new onset eyebrow hair loss after age 40.
Cyproterone acetate works in several ways. It not only competitively blocks DHT from binding to its receptors at target tissue (Gilman et al., 1990), but it is also a progestogen that lowers testosterone levels by decreasing the release of luteinizing and follicle-stimulating hormones through pituitary-mediated supression (Gilman et al., 1990, Varothai and Bergfeld, 2014). An open intervention study of 80 women who received treatment with spironolactone (200 mg daily) or cyproterone acetate (50 mg daily or 100 mg for 10 days per month if premenopausal) showed that three of four patients demonstrated an improvement or stabilization of their disease with no difference of effect between the therapies received (Sinclair et al., 2005).
Ludwig Scale: This is the most common classification for female pattern hair loss. There are 3 stages (ranging from mild hair loss to extensive, severe widespread thinning) and in each stage hair loss occurs on the front and top of the scalp with relative preservation of the frontal hairline. Regardless of the extent of hair loss, only women with stable hair on the back and sides of the scalp are candidates for hair transplant surgery.
Madarosis of non-scarring type is commonly seen in alopecia areata which is a hair-specific autoimmune disease associated with patchy loss of hair. It presents as round or oval patches of non-scarring hair loss. Madarosis occurs as isolated involvement [Figure 2] or as a part of alopecia universalis. When alopecia areata involves the eyelashes exclusively, there is rarely involvement of other parts of the body. Alopecia areata can involve both the eyelids without scalp involvement also. Short exclamation mark hairs are pathognomonic for alopecia areata.
Changing the shape, thickness and length of the eyebrow is a commonly practiced beauty technique. Some people even remove the eyebrow entirely only to replace it with a pencil-drawn mark (eyebrow pencil). As with any part of the body, repeated irritation can eventually lead to hair loss. Sometimes this is due to manual trauma, chemicals from cosmetics or even infections that arise when breaks in the skin occur. While eyebrow modification will not stop as a commonly practised beauty technique, it should at least be minimized.
In your quest for perfectly maintained brows, you probably keep regular maintenance appointments on your calendar. Instead, you might want to embrace a more natural, hands-off approach. “The trauma inflicted on hair follicles during waxing, tweezing, and threading can lead to permanent follicular damage,” explains Dr. Umar. “Women who grew up in the height of the ’90s overplucked, pencil-thin brow trend have begun to notice the difficulty in growing thicker eyebrows after years of this habit.”
There can be any number of different factors contributing to your hair loss. If you’re reading this and thinking, “well I have that and that, and am going through that,” then you may already have an idea of what is a contributing cause for you. You may already be doing much of what is suggested here and may learn of additional ideas to consider trying.