A beauty queen with no hair … that turns expectations upside down.
At the 90th Miss America competition in Las Vegas last weekend, Miss Delaware, Kayla Martell, was that girl. Martell usually — but not always — competes for titles wearing a wig, but far from trying to hide her baldness, she uses her beauty queen status to raise awareness about alopecia areata, the autoimmune disease that caused her to lose her hair as a child.
FOR THE RECORD:
Women's hair loss: An article in the Image section elsewhere in this edition, about thinning hair in women, identified Dr. Monte O. Harris as being affiliated with Cultura cosmetic medical spa in Washington D.C. Harris is with the Center for Aesthetic Modernism in Chevy Chase, Md. The error was discovered after the section went to press. —
Martell was a fan favorite in the competition, and although she ended in the top 10 — losing the Miss America title to Miss Nebraska, Teresa Scanlan — she did make us think about hair and the particular problems hair loss causes for women. In a culture where many look to movie stars and fashion magazines for standards of beauty, the term "brave" is often applied to women who've suffered hair loss.
"Men can get away with thinning hair, balding or a receding hairline but there really isn't a socially acceptable way for women to do that from an aesthetic point of view," says Dr. Monte O. Harris, of The Center for Aesthetic Modernism in Chevy Chase, M.D., who specializes in hair loss and hair transplants.
Hair loss causes are many. Only an estimated 2% of the population has the not-entirely-understood alopecia areata, which can cause partial or total hair loss that comes and goes. But other hair loss can be caused by genetics, stress, hormonal issues ( childbirth, coming off birth control pills, thyroid disease or menopause), medical conditions such as lupus, dieting (even losing 10 to15 pounds in a month can cause excess hair loss), nutritional deficiencies such as a lack of iron, medications, hair-styling practices and traction alopecia (often caused by pulling hair into tight styles such as ponytails or braids).
There is also a condition called central centrifugal cicatricial alopecia that can cause inflammation, scaling and scar tissue that eventually destroys the hair follicle so that hair can no longer grow in the affected area.
"What's important is to figure out why your hair is falling out," says David Kingsley, a well-known trichologist — a specialist in hair and hair loss. Thinning hair can be stopped or even restored in some cases, depending on the cause. "It's really important that people realize that it's not hopeless," Kingsley says.
Harris says that with the exception of genetic hair loss (and some experts consider even this condition potentially reversible), most of the aforementioned hair loss causes have a component that is reversible. "Prompt diagnosis and early therapeutic intervention is key," he says.
For instance, if hair loss is caused by tightly pulled hairstyles, you can alter your grooming practices. Hormonal hair loss following childbirth corrects itself with the passage of time. Hair loss related to vitamin deficiencies, anemia and thyroid abnormalities can all be reversed "if the culprit is identified," Harris says. "That's why obtaining basic labs during the initial work up is important. The unfortunate thing is that the reversible forms of hair loss often progress to emotional and irreversible [physical] scarring because they are left untreated."
Experts say genetic female pattern baldness is usually denoted by hair loss at the top and crown of the scalp. Hair breakage is different from hair loss at the root and often shows up at the hairline-temple area. Breakage can usually be stopped with a little TLC.
See a doctor about thinning hair when you see less hair on your scalp, a wider part or more hair than usual in your brush or sink; when the hair loss starts to bother you cosmetically; or when there's inflammation, pimples, scaling "or increased shedding for more than two to four weeks," says Kingsley who works with dermatologists when treating patients. Conditions such as these tend to get worse over time, not better, he and other experts say.
Make sure you go to a dermatologist who specializes in hair loss. "Many dermatologists don't specialize in hair loss because it's a slow, stubborn problem and the patients tend to be emotional," says Dr. Maria Colavincenzo, an assistant professor of dermatology at Northwestern University's Feinberg School of Medicine in Chicago, who is on faculty at Northwestern's Hair Loss Disorders Clinic.
Figuring out why you're losing your hair involves a bit of detective work. It could be a trauma that happened months ago (such as using a relaxer or going through divorce stress). Dying your hair may not cause it to fall out, but "it can certainly cause increased breakage of the hair shafts, which contributes to less hair fullness, less overall hair on the scalp," Colavincenzo says.
There are many methods for coloring hair, and Harris says he sees increased complications with permanent dyes that contain hydrogen peroxide — especially when applied to fragile hair or combined with another chemical process, such as straightening.
When you consult a doctor about hair loss, expect a series of tests, which may include blood tests and a biopsy of the hair. The doctor will take a case history, go over medical issues and hair styling practices and analyze the scalp.
"We find out if the hair loss is scarring or not," says Colavincenzo. This is important because usually scarring at the hair follicle means it's damaged at the root, and doctors don't know how to make it grow back. "Which is why it's so important to diagnose early on," she says. "It can start out nonscarring but can become scarring."
For women with thinning hair there are several possible treatments, including cortisone injections for inflammation at the hair follicle, hormone therapy and iron prescriptions. "But for female pattern hair loss, Minoxidil, marketed as Rogaine, is the No. 1 thing that we use," Colavincenzo says.
Kingsley says Minoxidil is for women whose hair loss is genetic. For women, a 2% Minoxidil solution is approved, compared with a 5% solution for men. "The problem with 5% is that women might get hair growth on their faces," Kingsley says. In addition, some products for men, such as Finasteride (a hair loss drug marketed as Propecia) carry warnings that they can cause birth defects if used by pregnant women. Spironolactone, marketed as Aldactone among other names, is another drug doctors say can sometimes help women with hair loss.
As far as the "grow hair" vitamins you see in supermarkets, health food stores and drugstores, many contain ingredients such as biotin and fish oil. Colavincenzo says that that there isn't scientific proof that they work to grow hair — but as long as they're not harmful and you don't take too many they're OK to try.
Other alternatives — such as serums, scalp treatments and shampoos — should be discussed with your doctor. "We don't have a lot of evidence that these things work. But I can't prove that they don't," Colavincenzo says. "But if part of the issue is breakage … making sure that the hair is well moisturized and treated well" — sleeping on a silk pillow case, for instance — "certainly makes a difference. But we don't consider breakage a true hair-loss problem."
The HairMax laser comb ($495) is a handheld device that purportedly can restore some hair by using laser technology. Some case studies have supported its efficacy, but so far the Food and Drug Administration has cleared the device for use only on men.
What's most important is that you don't try to battle serious hair loss on your own. "Sometimes women will find that they have low iron for example — but they do need to see a doctor and get checked, not just buy iron, because you might give yourself too much," Colavincenzo says. "There's a lot of stuff out there, sort of snake oil things, and a lot of people are self-diagnosing and self-treating and they are probably spending a lot of money on things that, truthfully, we don't have a lot of evidence works."
The Federal Trade Commission has sued companies for false advertising over products touted to prevent or reverse hair loss. But the FTC can't come close to catching every company making false claims. "So our advice for any health product is to consult with a trusted health-care consultant before you spend a lot of money on products," says Heather Hippsley, an assistant director in the FTC's advertising practices division .
Hair transplants are an often over-looked solution for women's hair loss. "And it shouldn't be seen as just a last-ditch resort," Harris says. In a transplant, hair is relocated from the back of the scalp to the front via strip harvesting or by follicular unit extraction in which individual hair follicles are transplanted. It takes at least six months to a year for those follicles to produce a hair shaft, but you can return to your normal routine after the procedure in as little as two days.
People who aren't good hair transplant candidates include those whose "donor area" is scarred or inflamed, those who have lost too much hair, have keloids or have a high risk of excessive scarring. "In some cases the best-case scenario for a woman who has lost a great deal of hair is to get just enough of her own hair back [via treatments recommended by her doctor] so that she can wear extensions or a weave," Harris says.
Harris recommends a comprehensive approach to hair loss, including using organic shampoos that don't have sulfates and are paraben-free. There are also shampoos, conditioners and other hair products that superficially thicken hair (look for words on the label such as "thickening," "amplifying," and "volumizing"). Hairstyles that give a fuller effect can help too, including short cuts, styles with lots of layers, roller sets or updos.