I was out of town when I received a text message stating a patient needed an urgent return call. I called the patient. The urgent message? “My hair is falling out.” When I saw the patient the following week she explained that when asked if the call was urgent, she said, “No, but it is to me.” That is the point. If a woman is losing her hair it can be devastating.
In this particular case, the patient had seen her hairdresser a couple of months before and was told she had a small bald patch. Because the patient could not see it, she blew it off. At the next appointment the hairdresser exclaimed, “Oh my God, it is twice the size!” which hurtled the patient into a frenzy of anxiety about going bald. Thus, the need for an emergency visit. On exam, I saw a bald spot on the back of the scalp about the size of a club cracker. The diagnosis? Alopecia Areata.
No one knows the cause of alopecia areata, but we suspect that it is some sort of autoimmune process where your own cells attack your hair and the hair falls out. The majority of patients have only a few small bald patches and the hair eventually grows back. Less commonly, all of the hair falls out. While new treatments are being developed, there is currently not a cure for alopecia areata. For my patient, I injected the spots with cortisone which seems to jumpstart the regrowth of hair.
Statistically speaking, patients who only have a few spots will not go completely bald. In this setting it is important to counsel patients their hair should grow back. This reassurance puts the patient at great ease and takes the stress of an unlikely outcome out of the picture.
Alopecia areata is an uncommon type of hair loss in women over 50. The most common type of hair loss in this age group is female pattern androgenetic alopecia. This type of hair loss seems to be genetic and comes with age. Unlike men, who will recede at the hairline, women will maintain a frontal hairline, but the top of the scalp will get thin, sometimes to the point of seeing scalp through the hair. Health, stress and medication can all play a role in aggravating this type of hair loss. But even under the best circumstances, the fact remains that if you are fortunate enough to live beyond eighty, you will not have the full head of hair you had at eighteen.
While many shampoos, vitamins and devices have been recommended to grow hair, the results of these so-called treatments are not great. Like alopecia areata, most cases of androgenetic alopecia do not go on to produce complete baldness and patients learn to compensate by trying different hairstyles that mask the scalp thinning. There is science-based evidence that topical minoxidil will grow hair in about half of the women who use it consistently and stops the progression of loss in another thirty percent. The amount of hair that grows is often not significant enough for my patients to justify the time and expense. As patients realize they are not going to go completely bald they discontinue the treatment and accept the new normal of thinner hair.
For some patients, a wig is the answer. I see a number of patients who come in to the office and, when I go to examine their scalp, take off a wig that I did not even realize they were wearing! Like Patricia Cutler, my 85-year-young patient who wears a wig told me, it’s “Better than real hair and easier to take care of.” She also likes not having to go to the hair salon. She purchases her wigs from Paula Young.
Another patient with alopecia areata, who has been wearing wigs since her 40s advises to “Get a wig that looks like you. Go with how you used to look.” She recommends purchasing two wigs. Kim Reed, the owner of MiMi’s Wig Boutique, likes the convenience a wig offers. She says that many of her clients get them for traveling. That way, they spend less time working on their hair and more time enjoying the location.
Also, check with the wig vendor when you make your purchase, as some medical conditions may warrant a tax exemption.
As the holidays approach, it might be fun to try a wig. Fifty-three year old actress, Felicity Huffman, calls a wig, “…dress up for your hair.”
During this Thanksgiving season, I am thankful I live in a time and place where I have options; I feel blessed and I hope you do too. I would also like to thank my patients with hair loss who have taught me what true beauty is.
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