September is Alopecia Areata (a type of hair loss) Awareness month. Given that hair loss is a very common complaint, and that it has been “front and center” lately in the wake of Covid, I thought it would be a good idea to talk about it.
Hair loss is divided into structural, scarring, non-scarring disorders.
Structural hair disorders may be genetic or acquired. An example of acquired structural hair loss is that which is caused by over-processed, over-treated hair.
In the scarring type of hair loss, the hair follicle is destroyed, resulting in irreversible damage.
Conversely, in the non-scarring type, the hair follicle is not destroyed, so the hair may return to normal. Three common causes of non-scarring hair loss are alopecia areata, telogen effluvium, and female pattern hair loss (FPHL).
Alopecia areata causes sudden losses of patches of hair due to the body’s immune system attacking itself (“autoimmune”) for unclear reasons. It affects men and women of different races equally. It is estimated to affect almost 7 million people in the United States alone. Most cases will occur before the age of 30, and most people will have more than one episode in their lifetime.
If mild, 50% of people will recover in one year.
Alopecia areata is not life-threatening and does not cause pain.
Telogen effluvium causes excessive shedding all over the scalp. It is one of the most common forms of non-scarring hair loss. It usually manifests after an illness, nutritional deficiency, major surgery or stress. Sometimes it is seen when there is too much traction on the hair for too long, such as in tight braids, ponytails, or weaves (AKA ‘traction alopecia’). Some prescription drugs can also be the culprit. Telogen effluvium is mostly self-limited, meaning it will improve when the underlying condition that caused it improves.
Female pattern hair loss (FPHL) frequently occurs on the crown of the head. The cause of FPHL in women is poorly understood. There is a genetic component however in the male-related alopecia.
Treatment
A good history and physical exam will help delineate the cause of the hair loss. While there is currently no cure for alopecia, there are ways to treat it and minimize its effects. I have seen the most effective treatment to be a holistic approach, which includes: de-stressing, adjusting diet, prioritizing movement in the body, understanding and healing the mind/body connection, getting plenty of sleep, taking helpful supplements, and lastly, using prescription drugs as necessary.
Stress Reduction
Since people who have hair loss may feel depressed or isolated due to their condition, stress reduction as treatment is one of the most critical steps that must be taken. How can stress be reduced? A few ways are: reaching out to people who will help and support you, journaling about your experience, taking a walk in nature, grounding exercises, meditation, giving yourself time and space to rest and restore, and being gentle with yourself.
Diet
Eating an anti-inflammatory diet is essential for supporting your body when you have an autoimmune condition like alopecia. The Mediterranean diet, modified to exclude gluten and dairy, is an excellent choice. Some anti-inflammatory foods that are a good starting point to include in your diet are: vegetables, fruits such as blueberries, nuts, seeds, whole grains, wild-caught fish and extra virgin olive oil. Avoid sugar and processed foods as much as possible.
Movement and Mind/Body Connection
Understanding the importance of movement and the mind/body connection is essential to healing any disease, but it is especially important in the case of autoimmune conditions such as alopecia. Staying active helps release stress and helps keep our organs, muscles and hormones regulated. Our mind and body are intricately connected and communicate constantly, so keeping one healthy is essential to keeping the other healthy.
Sleep
Sleep is also essential since with too little sleep, autoimmune conditions may worsen. Consistently good sleep (approximately 8 hours a night) regulates the immune system. Since sleep can be impaired via a number of reasons when a person has hair loss (usually from the underlying cause), it is extra important to prioritize good sleep to give your immune system the support it needs to heal and keep you healthy.
Supplements
Supplements are also important, but not as much as people often believe. Since a biotin deficiency can cause hair loss, biotin is often recommended, but evidence is lacking that supplementing with biotin is actually efficacious. Zinc and iron have been recommended as well, but their efficacy is also not proven. It’s important to work with your doctor to determine the appropriate supplements for you, and then test them for 3 months to see if they are having a positive impact.
Medical Treatments
Medical treatments can involve topical agents, steroid injections, oral treatments and laser and light therapy. Some of these treatments are safer than others, and each person’s individual experience will inform which medical treatment may be best for them. One step that is important is asking your doctor to order immune biomarkers for you. This will give your doctor the information they need to determine if you have alopecia, what the cause is, and how to treat it.
Get Social and Give Support
Other ways to cope with alopecia or bring awareness could involve getting social – sharing your story publicly on social media or joining an alopecia support group where you can connect with others and share experiences. Blue is the official color of alopecia awareness month, so to show your support, wear blue and tell others why you are wearing it! You can also research organizations that support wig creation and advocate for equal access to care for alopecia and wigs. If you or someone you love is experiencing alopecia, we want you to know we support you and we are here for you.
For more information, visit the National Alopecia Areata Foundation.