|| Beauty Care Business and Professional Network
U. S. Food and Drug Administration
From Personal Statement to Personal Problem
by Devera Pine
From the shaved heads of medieval monks, to the long-haired hippies of the
'60s, to the spiked hairdos of today's punk rockers, hair has always made a
"It's one of the leading ways people can establish their individuality
and express their style," says Jerome Shupack, M.D., professor of clinical
dermatology at New York University Medical Center in New York City. "Hair
has had sociological importance throughout the ages."
Because of its importance, anything that happens to our hair that we can't
control--falling out or turning gray, for instance--can be the source of much
In the United States, some 35 million men are losing or have lost their hair
from male-pattern baldness, according to the American Hair Loss Council.
Approximately 20 million women have experienced a similar loss of hair (from
female-pattern hair loss), and an estimated 2.5 million Americans have lost
their hair due to other causes.
Hair is produced by hair follicles--indentations of the epidermis (outer skin
layer) that contain the hair root, the muscle attached to it, and sebaceous, or
oil, glands. Hair is made up of dead cells filled with proteins, most of which
are known as keratins. The cells are woven together like a rope to form the hair
fiber. The hair fiber, in turn, has three layers: the outer cuticle with its
fish-scale-like structure; the cortex, which contains the bulk of the fiber; and
the center, or medulla. Hair color is determined by melanocytes, cells that
produce pigment. When these cells stop producing pigment, hair turns gray.
Although it seems as if the hair on your head is always growing, hair
actually has active and rest phases. The growth phase, known as anagen, lasts
for two to six years. At any given time, about 90 percent of scalp hair is in
the growth stage. The remainder is in the rest phase, known as telogen; this
lasts from two to three months.
Once the rest phase is over, the hair strand falls out and a new one begins
to grow. As a result, it's considered normal to lose from 20 to 100 hairs a day,
says Diana Bihova, M.D., a dermatologist in private practice in New York City.
Only a change in your regular pattern of loss is considered abnormal--but many
things, including genetic factors, diet, stress, and medications, can change
BALDNESS: MANIFEST DESTINY?
The most common cause of hair loss in both men and women is rooted in a
genetic predisposition. Called androgenic alopecia, it is known as male-pattern
baldness in men and female-pattern hair loss in women (alopecia is the
scientific term for baldness). According to the American Hair Loss Council,
genetics accounts for 95 percent of all cases of hair loss in this country.
Baldness results from a combination of genetic factors and levels of
testosterone (a hormone produced by the adrenal gland in both sexes and also by
the testes in men). If hormone levels are right, then the hair follicles will
express their genetic destiny by growing for shorter periods and producing finer
hairs. In men, who have higher levels of testosterone than women, this
eventually results in a bald scalp at the crown of the head and a horseshoe-
shaped fringe of hair remaining on the sides. In women, the hair thins all over
the scalp; the hairline does not recede. This type of hair loss doesn't usually
show up in women until menopause; until then, estrogen tends to counteract the
effects of testosterone.
ONE APPROVED DRUG
The only drug approved by the Food and Drug Administration to treat pattern
baldness or hair loss is minoxidil topical solution (Rogaine), which is rubbed
into the scalp. Originally approved for hereditary male-pattern baldness in
1988, it was also approved for treating female-pattern hair loss in August 1991.
However, it should not be used by pregnant or nursing women.
In his dermatological practice, Arthur P. Bertolino, M.D., Ph.D., director of
the hair consultation unit at New York University, says that this lotion helps
hair grow in 10 to 14 percent of the people who try it. He estimates that
approximately 90 percent of the time, Rogaine at least slows down hair loss. (Minoxidil
is also available in tablet form to treat severe high blood pressure. Oral
minoxidil has a potential for serious side effects and is not approved to treat
No one is certain yet just how topical minoxidil works to promote hair
growth. "One theory is that it dilates the blood vessels, so it may
stimulate nourishment of follicles," says Bihova. Alternatively, Rogaine
may convert tiny hair follicles that produce peach fuzz into large hair
follicles that produce normal-size hairs. Again, no one knows for sure.
What is certain is that, at least in men, Rogaine works better on patients
who fit a certain profile: they've generally been bald for less than ten years,
have bald spots on top of the head that are less than four inches in diameter,
and they still have fine hairs in their balding areas. "The process begins
very early," says Bihova. "I see 19-, 20-year-old males who have
The most common side effects with this medication are itching and skin
irritation. Also, according to Bertolino, once you stop using it, any hair that
grew as a result will fall out. Finally, the drug is expensive: in 1990, it cost
about $600 a year to use it twice a day.
Baldness can also be treated with hair transplants, in which plugs of
"donor" follicles from the patient's scalp are used to fill the
hairline. Although hair transplants work well in both men and women, the
treatment tends to have a more dramatic effect on appearance in men with bald
spots than it does on women with thinning hair.
"The less hair you have, the more drama in the change," says Robert
Auerbach, M.D., associate professor of clinical dermatology at New York
University School of Medicine. However, the American Hair Loss Council warns
against attempting to replace lost hair with hair pieces sutured to the scalp.
FDA has not approved any products specifically intended for this purpose,
however, this does not preclude a physician from using sutures, which are
approved devices, for this purpose. According to the council, although the
procedure is legal, it can result in scars, infections and even brain abscesses.
Another treatment for male-pattern baldness, hair implants made of
high-density artificial fibers surgically implanted in the scalp, was banned by
the FDA in 1984 because it causes infection. This is the only device FDA has
PRODUCTS THAT DON'T WORK
So-called "thinning hair supplements," "hair farming
products" and "vasodilators" for the scalp will not promote hair
growth, says Mike Mahoney, a spokesperson for the American Hair Loss Council.
Thinning hair supplements are nothing more than hair conditioners that
temporarily make your hair feel or look a little thicker. The main ingredient in
these products--polysorbate--is also found in many shampoos. Promotional
materials for hair farming products claim that they will release hairs that are
"trapped" in a bald scalp. Mahoney says these products, many of which
are herbal preparations, can do no such thing. And so-called vasodilators do not
increase the blood supply to the scalp and do not promote hair growth.
While male- and female-pattern baldness results in permanent hair loss, other
factors can cause temporary loss of hair. For instance, the drop in the level of
estrogen at the end of pregnancy can cause a woman's hair to shed more readily.
Two or three months after a woman stops taking birth control pills, she may
experience the same effect, since birth control pills produce hormone changes
that mimic pregnancy. A major physical stress, such as surgery, or a major
emotional stress--positive or negative--can cause hair loss.
"I've seen women start losing their hair before getting married,"
says Bihova. Even jet lag can have a similar effect.
In most of these cases, the hormonal imbalance or stressful situation will
correct itself, and the scalp will soon begin growing hair again. But, says
Bihova, since most women are extremely upset by even a temporary hair loss, many
dermatologists treat these conditions with either topical steroid preparations
or localized injections of low doses of steroids. Bihova emphasizes that these
are local, not systemic, injections of steroids, therefore, the shots do not
have the same risk of dangerous side effects as systemic steroids. However, only
a board-certified dermatologist should administer this treatment, she says.
The list of causes of temporary hair loss goes on: pressure on the scalp from
wigs or hairdos that pull too tightly can cause it. A fever of 103 degrees
Fahrenheit or more often causes hair loss six weeks to three months later. And
some medications can cause a temporary loss. These include vitamin A derivatives
such as Accutane, cough medicines with iodides, anti-ulcer drugs, some
antibiotics, beta blockers, antidepressants and amphetamines, anti- arthritis
drugs, blood thinners, some cholesterol-lowering agents, aspirin taken over long
periods, some thyroid medications, and chemotherapy.
YOU HAIR WHAT YOU EAT?
Although nutrition does play a role in hair loss and in the overall health of
your hair, only extreme nutritional deficiencies or excesses will cause hair
loss. For instance, people with anorexia and bulimia may temporarily lose hair.
So will others suffering from malnutrition.
"It's pretty rare in the United States," says Bertolino. "If
someone was on a real strange, restrictive diet, it could happen to them."
Megadoses of some vitamins--particularly A and E--and an iron deficiency may
lead to hair loss. People who claim they can determine which vitamins are
lacking in your diet by analyzing your hair, however, are not speaking from a
scientifically sound basis. The test used with this type of hair
analysis--atomic absorption spectrophotometry--is a legitimate analytical
chemistry method; however, used on hair, the results of this test do not
correlate with nutritional status, says Shupack. "Because of the
sociological importance of hair, a lot of people try to cash in on it," he
says. "Hair analysis is all witchcraft as far as I'm concerned."
There are, however, a few legitimate hair tests for substances such as
arsenic and lead.
FOR BEAUTY'S SAKE
Every time you shampoo, blow dry, perm, straighten or dye your hair, you
damage it slightly, says Bertolino. For the most part, hair can withstand this
type of treatment. But overzealous beautifying can damage the hair fiber,
resulting in many broken strands, and a frizzy, split-end look. For instance, if
you bleach your hair and then have a bunch of perms done in a short time, you're
heading for trouble.
Misuse of hair cosmetics can cause the hair to break as it comes out of the
scalp, says Frances Storrs, M.D., professor of dermatology at the Oregon Health
Sciences University. Permanent wave solutions break the bonds that hold hair
together and then reform them. But with a perm that is not diluted right or not
rinsed off properly, for instance, those bonds may not re-form and the hair
would soon fall out as a result. Fortunately, most professional hair dressers
know how to use perms correctly, says Storrs.
Most hair dyes are not as irritating as permanent solutions, mostly because
they do not break the bonds between hair fibers and are therefore not likely to
cause a hair loss, she says. However, a severe allergic reaction to hair dye
could cause hair loss. "The allergy is pretty common, actually," says
Storrs. Permanent solutions can also cause allergic reactions, though that's a
rare side effect.
Other beauty-related manipulations of the hair can cause problems, too: hot
irons, corn rows and braids may bring on temporary or permanent hair loss. If
the hair breaks often enough, the follicles may eventually not be able to
produce normal hair, says Bihova. "If someone has a problem with thinning
and excessive loss, we advise being gentle," she says. "Don't use
rollers; don't use blow dryers on a hot setting; don't wear tight hair
styles." Rough shampooing may accelerate any loss, though it's usually not
a problem in people with healthy hair.
THE MEDICAL SIDE
Some hair loss is the result of a type of immune disorder known as alopecia
areata--some 2.5 million people suffer from this condition in which antibodies
attack the hair follicle, causing the hair to fall out. Alopecia areata often
causes small, oval or circular areas of hair loss. However, in some forms of the
condition, all the scalp hair falls out; in other forms, all body hair is lost.
Although the loss is usually temporary, the condition can recur. Treatments
include topical steroids or the use of chemicals to produce an allergic reaction
to start the hair growing again.
Finally, chronic, systemic conditions--including one form of lupus, abnormal
kidney and liver function, and hypothyroidism or hyperthyroidism--can affect the
hair. If you're experiencing hair loss, see a doctor. He or she will want to
order some basic blood tests to rule out any medical cause of the condition.
Devera Pine is a freelance writer in New York City who frequently writes
about health and science.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service, Food and Drug Administration
Office of Public Affairs, 5600 Fishers Lane, Rockville, MD 20857