By Allen Douma, M.D.
Tribune Media Services

Q: I’m only 20 years old, and suddenly I’ve started developing bald spots on my head. I’ve also noticed patches on my chest that have lost the fine hair. My GP said I had alopecia and that it would probably go away if I rubbed steroids on the areas. But is has been months and it’s still there. What’s your advice?

A: The medical term for hair loss is alopecia. There are many types of alopecia and many factors that cause it.

In younger people, the most common type of alopecia is called telogen effluvium. This may happen spontaneously but does so especially after pregnancy. It can also be caused by crash dieting, high fever, iron deficiency, stress, malnutrition and birth control pills.

Fortunately, telogen effluvium typically goes away by itself. But if it continues, the most important step is to seek medical advice and testing to determine the cause.

With aging, the most common type of hair loss is pattern baldness, which is also called androgenic alopecia. It occurs in both men and women. It is related to heredity, hormonal factors and aging.

Pattern baldness in women more typically involves the thinning of the entire scalp, which may be increased near the hairline.

For women with male pattern baldness, hormonal supplementation may be helpful. Minoxidil (Rogaine) has been proven effective for this condition for both men and women.

Scarring can also cause alopecia. Scarring can be caused by chemical, physical or radiation injury, and by some severe infections and diseases. Alopecia caused by scarring is often irreversible and permanent.

Alopecia also may result from the scratch cycle. The scalp may itch for any number of reasons, which leads to scratching. And the scratching not only creates physical injury to the skin but also causes further irritation and itching.

Two other types of alopecia are called alopecia universalis and alopecia areata. Universalis occurs over the entire body, whereas areata is characterized by a rapid loss of clumps or patches of hair, usually on the scalp.

The physical mechanisms that underlie alopecia universalis and areata are unknown, but the conditions are thought to be caused by an immune system problem with the T lymphocytes. Alopecia universalis and areata are associated with immune-related problems of the thyroid, type I diabetes, lupus and certain types of anemia. Psychosocial stress is also thought to play a part in the onset or worsening of alopecia areata.

Alopecia can also be caused by a variety of drugs. Anticancer drugs, retinoids, anticoagulants, oral contraceptives and amphetamines are only some of the drugs that may cause temporary baldness.

Treating a potential cause is the first step in reversing alopecia. Topical corticosteroids are the most commonly used medication. One study found that clobetasol propionate was especially effective. Corticosteroids can also be taken orally or injected into the affected skin. Another treatment involves chemically producing an irritation or sensitization at the site of the hair loss, which can promote hair growth.

My advice is for you to talk with a dermatologist about your problem. Before doing so, write down anything that you think might be related, refer back this column, and take it with you to the appointment.

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