Hair Loss – Its Cycle, Most Common Causes, and the Effect of Stress on It

Hair Loss 7…..I would like to start a discussion of hair loss in women.  This is a common condition for many women.  By age 50, 50% of women will suffer from this problem.  Another term for significant hair loss is alopecia, and affected women can suffer great anxiety and stress.

…..There are two types of alopecia: scarring and non-scarring.  Scarring alopecia can be found in discoid lupus erythematosus and other conditions.  The scar formation destroys the hair follicle, thus causing the hair loss.  These patients should see a dermatologic specialist as soon as possible.  On the other hand, in non-scarring alopecia, the hair follicles are not permanently destroyed, and so the hair loss may be reversible.

What Cycle Does Your Hair Bear Throughout Your Life?

…..Let us start with the hair growth cycle.  There are three phases of this cycle: anagen (growth phase), catagen (transitional or resting phase), and telogen (testing or shedding phase).

…..In the anagen phase, the hair grows, and 80 to 90% of all hair follicles are included in this phase.  This growth pattern can last for 2-3 years, and the length of time is genetically determined.

…..The catagen phase lasts only for 2-3 weeks.  In this resting phase, only 1 to 3% of the scalp follicles are included.

…..The last phase is the telogen phase.  This is when hair is shed usually at a normal rate of 75-100 hairs per day, and it lasts for about 3-4 months.  So it is important to remember that it is natural for some hair loss every day!

Why Is Hair Loss Harrowing You?  What is the Cause?

For most patients, a careful history of their hair loss will give a good indication of the cause.  There are many questions to be considered; the following are some of them:

  •  Is the loss diffuse or is it in a specific area?  If it is in a specific area, it is important to delineate the location.
  • Hair care techniques and the products used can provide important Hair Loss 4information.  Are chemical straighteners being used?
  •  Are cornrows part of a new style of yours or have they been used for some time?  Traction alopecia has been seen with the cornrows hairstyle.
  • During a physical exam, the scalp should be carefully inspected.  Is there any scaling, inflammation, or reddish areas?

…..In the areas of the hair loss, if there are hair follicles then you are dealing most likely with non-scarring alopecia.  If there are no follicles then this could be scarring alopecia, and this patient should be sent to a dermatologist, who will consider a biopsy.  The hair should be evaluated for its length, thickness, and fragility.  Lastly, a pull test could be performed, which will help determine if active shedding is taking place.

Women: Your Most Common Cause of Hair Loss

…..The most common cause of hair loss in women is androgenetic alopecia (AGA), which is also known as female pattern hair loss.  This is a genetic disease that can be inherited on many genes, but it does not affect everyone who carries the genes.  By menopause, 40% of all women will be affected in some way.  It is identified as a gradual onset of diffuse hair loss.

…..The problem’s basis is the male hormone found in all women.  It attaches to sites on the hair follicles and affects the follicles that are genetically susceptible.  These follicles have a shortening of the growth phase, and the hair from these follicles are short and thinner than normal ones.

…..Again, hair loss in women is generally diffuse, and there is usually a preservation of the frontal hairline.  This is distinct from male pattern hair loss, with frontal peak and top loss.  AGA’s onset is usually gradual with no specific bare areas.  There does not appear to be an increase in shedding because the hair growth does not become less but is only affected.

…..At the medical exam, the scalp should be examined for redness, signs of infection, and scarring.  A family history should be taken to look for a similar condition in other family members.  Usually, there is not an endocrine cause for this problem, but if general hirsutism accompanies the finding, then a full hormonal investigation should be started.

…..The only FDA-approved treatment is the topically applied vasodilator called Minoxidil (Rogaine).  It comes in an over-the-counter preparation of 2% and 5% foam or liquid, which are all effective.  There seems to be better results with the 5%, but there may be an increased chance of local irritation.  How it specifically works is uncertain but there seems to be an increased growth phase, and the hairs grow longer and stronger.  Remember, the treatment is 2x per day and forever.  When you stop, the hair you gained will be lost.  Lastly, you may not see any results for 3-4 months, so patience is needed.

Is the Stress in Your Mind Causing Stress on Your Hair?

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…..Remember how our mothers always told us that stress could cause so many 

problems and make us feel terrible?  As always, our mothers were right.  For women, a severe illness, psychological stress, or having a baby are inciting stressful events that can cause physical effects.  One of these effects is hair loss.

.…..Usually 90% of our hair is in the growth phase, with 10% in the resting phase.  Keep in mind that some hairs are always shedding in the resting phase, and it is usually a small and regular amount.

…..Telogen Effluvium (TE) is a condition of diffuse hair loss that is caused by an identifiable stressful life situation; three of those situations were stated above.  In TE, 70% of hairs are in the growth phase and 30% in the resting phase.  This results in about 3 times as many resting phase hairs being shed daily.  The hair loss is gradual and diffuse and may be similar in appearance to the loss associated with the female patterned hair loss called androgenic alopecia (AGA).

…..With TE, a woman usually is aware of shedding, but with AGA, the loss is gradual, and shedding is not usually a complaint that is presented.  Also with TE, the loss may not become apparent for several months after the stressful event.

…..To treat TE, you must first identify and resolve the stress the body has been subjected to.  With pregnancy or an acute illness, the hair loss is usually self-limiting with complete recovery within 6 months after having the baby or recovering from the illness.  When TE is caused from psychological stress, since the treatment and recovery can take some time, the hair recovery can also involve a prolonged period.

Four Reasons Why Your Hair Could Be Losing

…..Now we will close our discussion of hair loss in women with a few more causes.

…..Traction Alopecia is hair loss from excessive pulling at the hair roots over a prolonged period of time.  The loss occurs where the hair is pulled in one direction, for example, by a ponytail or a cornrow pattern of braids.  The treatment is usually just discontinuing the particular hairstyles, and in time, the problem resolves.

…..Tinea Capitis is caused by a fungal infection of the hair shaft.  It is most common in children.  However, it can be found in immunocompromised adults such as AIDS patients and patients receiving chemotherapy.  The presentation is usually a round patch of hair loss associated with pruritis and scaling.  The diagnosis is made with cultures and the examination of scrapings along the border of the lesion.  The usual treatment is oral antifungals.

…..Trichotillomania is classified as an impulse control disorder.  It involves compulsive and repetitive pulling or plucking of the hair, which leads to noticeable hair loss.  Patients have described feeling tension before pulling out the hair, and the tension is relieved after the hair is pulled out.  This condition is usually managed by a trained mental health professional.

…..Anagen Effluvium involves an acute loss of scalp and body hair when the growth phase of hair is disrupted.  This occurs mostly with patients on chemotherapy.  Because 80 to 90% of hair is in the growth phase, this hair loss is dramatic and diffuse.  The loss usually begins 1-3 weeks after the chemotherapy is started, and the hair returns typically 3-6 months after the treatment is finished.  The initial hair that returns may differ from the patient’s usual hair, but these changes are mostly temporary.  Permanent hair loss from this condition is usually rare.

…..I hope this information on hair loss in women has been enlightening and helpful.

-Dr. P

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Preterm Births – Information You Should Be Aware Of

Baby Looking UpWhen a pregnant woman “breaks her water” usually it is the start of an exciting time of her pregnancy because labor has started or is about to begin.  This is fine if the pregnancy is near the due date, but if the water breaks and the pregnancy is not near the due date, then there is a problem.  Preterm premature rupture of membranes (PPROM) is a bad problem and is a leading factor in premature births.

  • About 12% of births in the US are preterm
  • Most pregnancies last about 40 weeks
  • Babies born between 32 and 37 weeks are considered preterm, and babies born before 32 weeks are considered early preterm
  • About 5% of births in the US are complicated by PPROM

Since the most common outcome of PPROM is delivery of the baby within 1 week of the water breaking, information about this potential complication must be available to everyone.

-Dr. P

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Hysterectomies in This Day and Age

.Surgery….A hysterectomy is the surgical removal of the uterus.  There are many reasons to have this surgical procedure, and the decision to undergo a hysterectomy must never be made lightly.  Today, the decisions are becoming more complicated as the surgical techniques change and more options are available.

…..The first laparoscopic hysterectomy was performed about 25 years ago, and this changed gynecological surgery forever.  The instruments used were very basic, the technique was new, and acceptance was gradual.

…..In 2008, only about 20% of hysterectomies performed in the USA were being performed with a laparoscopic technique, but by 2012 the number had risen to about 40%.  This minimally invasive route includes the robotic and the conventional laparoscopic procedures.  The refinement of instruments and robotic technology continues the march to an even larger percentage of hysterectomies being performed by the minimally invasive approaches.

…..Remember, before undergoing any surgery, do your research into the indication for the surgery and the type of procedure.  Check into the surgeon’s experience and background, and always ask many questions before any decisions are made!

-Dr. P

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What Factors Place Adolescents at an Increased Risk of Developing STIs?

Young women are at a high risk of acquiring STIs (sexually transmitted infections) and of developing the serious complications of untreated chlamydial and gonococcal infections.  Almost half of all STIs occur in teenagers and young adults between the ages of 15 and 25.  Physical and behavioral factors place the sexually active teenager at an increased risk to develop these infections.

Physically, the cervix is more vulnerable to these infections because it has not fully developed, exposing more susceptible cells to the infections.  Since the young woman may be coming into contact with these infectious agents for the first time, her immune defenses are not strong.

Behavioral risk factors include having multiple new sexual partners and not using condoms or not using condoms properly.  The U.S. Department of Health and Human Services has a goal to increase the simultaneous use of both condoms and hormonal contraception (birth control pills).  This combination of methods is highly effective in preventing a pregnancy and preventing the acquisition of STIs.  Yet currently, some studies reveal that only about 5% of adolescent females are using this practice.

-Dr. P

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You May Experience This Common Complication of Early Pregnancy

…..I would like to begin a review of one of the most common complications of early pregnancy, vaginal bleeding.  This is the number one reason patients will have an emergency visit in the first trimester, and it is a cause of great anxiety to patients and theirYou May Experience This Common Complication of Early Pregnancy families.  There are a few important facts you should be aware of:

  • About 15% of recognized pregnancies will end in miscarriage
  • 80% of miscarriages occur in the first trimester
  • Trauma, smoking, excessive alcohol use, and advanced maternal age increase the risk of first trimester bleeding
  • 25% of pregnant women will report first trimester bleeding or spotting
  • 8% of pregnant women report heavy vaginal bleeding
  • Of the patients who report bleeding, 75% will have 1 episode, 20% will have 2 episodes, and 10% will have 3 or greater episodes
  • The amount of bleeding is the most significant predictor of an impending miscarriage
  • Again, advanced maternal age is a significant risk factor for first trimester bleeding and subsequent miscarriage; 50% of pregnancies in women over 40 result in a miscarriage, with abnormal chromosomes in the fetus being a primary factor
  • For women under the age of 35, the rate of a spontaneous miscarriage is 2%.

-Dr. P

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Is the Stress in Your Mind Causing Stress on Your Hair?

…..Continuing our discussion on hair loss in women….

…..Remember how our mothers always told us that stress could cause so many problems and make us feel terrible?  As always, our mothers were right.  For women, a severe illness, psychological stress, or having a baby are inciting stressful events that can cause physical effects.  One of these effects is hair loss.Hair Loss  Patch Blog Post 2

…..Usually 90% of our hair is in the growth phase, with 10% in the resting phase.  Keep in mind that some hairs are always shedding in the resting phase, and it is usually a small and regular amount.

…..Telogen Effluvium (TE) is a condition of diffuse hair loss that is caused by an identifiable stressful life situation; three of those situations were stated above.  In TE, 70% of hairs are in the growth phase and 30% in the resting phase.  This results in about 3 times as many resting phase hairs being shed daily.  The hair loss is gradual and diffuse and may be similar in appearance to the loss associated with the female patterned hair loss called androgenic alopecia (AGA).

…..With TE, a woman usually is aware of shedding, but with AGA, the loss is gradual, and shedding is not usually a complaint that is presented.  Also with TE, the loss may not become apparent for several months after the stressful event.

…..To treat TE, you must first identify and resolve the stress the body has been subjected to.  With pregnancy or an acute illness, the hair loss is usually self-limiting with complete recovery within 6 months after having the baby or recovering from the illness.  When TE is caused from psychological stress, since the treatment and recovery can take some time, the hair recovery can also involve a prolonged period.

-Dr. P

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Women: Your Most Common Cause of Hair Loss

…..More about hair loss in women…Women Your Most Common Cause of Hair Loss

…..The most common cause of hair loss in women is androgenetic alopecia (AGA), which is also known as female pattern hair loss.  This is a genetic disease that can be inherited on many genes, but it does not affect everyone who carries the genes.  By menopause, 40% of all women will be affected in some way.  It is identified as a gradual onset of diffuse hair loss.

…..The problem’s basis is the male hormone found in all women.  It attaches to sites on the hair follicles and affects the follicles that are genetically susceptible.  These follicles have a shortening of the growth phase, and the hair from these follicles are short and thinner than normal ones.

…..Again, hair loss in women is generally diffuse, and there is usually a preservation of the frontal hairline.  This is distinct from male pattern hair loss, with frontal peak and top loss.  AGA’s onset is usually gradual with no specific bare areas.  There does not appear to be an increase in shedding because the hair growth does not become less but is only affected.

…..At the medical exam, the scalp should be examined for redness, signs of infection, and scarring.  A family history should be taken to look for a similar condition in other family members.  Usually, there is not an endocrine cause for this problem, but if general hirsutism accompanies the finding, then a full hormonal investigation should be started.

…..The only FDA-approved treatment is the topically applied vasodilator called Minoxidil (Rogaine).  It comes in an over-the-counter preparation of 2% and 5% foam or liquid, which are all effective.  There seems to be better results with the 5%, but there may be an increased chance of local irritation.  How it specifically works is uncertain but there seems to be an increased growth phase, and the hairs grow longer and stronger.  Remember, the treatment is 2x per day and forever.  When you stop, the hair you gained will be lost.  Lastly, you may not see any results for 3-4 months, so patience is needed.

-Dr. P

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Vitamin D – More Important Than You May Think!

…..This past year has seen the discovery of vitamin D deficiency in a large portion of our population.  In my office, we never measured the value before but now I speak about low vitamin D many times a day. Today you will be given some basic points, and over the next few blogs you will have a good understanding of the situation.

  • Vitamin D is important to maintain bone health.
  • Some studies have reported that being low on vitamin D can be related to heart problems, cancer, diabetes, and autoimmune disease.  However, few true clinical trials have been taken.
  • Too much vitamin D should be avoided because of possible harm and lack of beneficial evidence.
  • The best measurement for the deficiency is the value of 25(OH)D in the blood.  The supplementation of the vitamin should be given to reach a target 25(OH)D value.

…..This is a start of your vitamin D education!

Vitamin D Benefits

-Dr. P

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