Thursday, January 26, 2012

Lupus and hair loss

Hair loss or alopecia is a common symptom of lupus, it happens in about 45% of people, although some places have the statistic at around 70%.  This is a very emotionally taxing problem that a lupus patient can have, it can have devastating affects on ones self esteem.  Hair is so important especially to woman, it is part of our sexuality, beauty, and confidence.  I had thin hair on and off for years at first I had no idea why it would get so thin but after my SLE diagnosis, I knew the culprit.  Alopecia also runs in my family in absence of lupus, it can happen alone and is considered an autoimmune disease itself.  This symptom can come and go, so  depending on the cause, it is not usually permanent.  

Hair loss (alopecia) 
Hair loss occurs in about 45 percent of people with lupus at some time during the course of their disease. Most frequently the hair loss occurs at the onset of the illness, and may be one of the first symptoms of the disease recognized by the person. Most often, the hair loss is from all over the head, but sometimes the hair falls out in patches. When the disease is brought under control, the hair should grow back. Sometimes there is a rash in the scalp—usually subacute or chronic discoid—that interferes with the hair follicle. In this situation, the individual is left with a permanent area of alopecia. Drugs used to treat lupus, such as prednisone and immunosuppressive therapies, also may be the cause of reversible hair loss.

Coping with Lupus-Related Hair Loss 

A lupus diagnosis often brings many physical changes-from skin rashes to weight gain. And often, the most upsetting of these changes can be losing your hair.
"For so many people, it is a major quality-of-life issue," says Victoria Werth, M.D., a professor of dermatology and medicine at the University of Pennsylvania School of Medicine in Philadelphia.
Although hair loss can be overwhelming, it needn't be totally devastating. These days it's easier than ever to face the problem head-on. Hair loss is a common side effect of both lupus and the medications used for treatment, so work with your doctor to discover the cause. "There are many reasons for hair loss," says Werth. "Some is caused by scarring associated with discoid scalp lesions, and some is diffusive and does not result from scarring, as with systemic lupus."
If hair loss is caused by medication, you may have to wait until your lupus is under control. Luckily, says Werth, this type is "mostly reversible." Hair loss associated with discoid lesions and scarring is generally permanent, so early treatment is key.
But don't experiment with over-the-counter medications, like Rogaine, without your doctor's approval. "Rogaine is for treating male- and female-pattern alopecia, which is a completely different type of hair loss than we usually see in lupus," says Werth.
Brittle hair also is common, and many treatments-including steroids and immunosuppressives-cause hair to thin.
Once your diagnosis is clear, maximize your assets. If your hair loss is mild, try a new haircut. Long hair is weaker than short, so consider a shorter 'do' with layers to hide thinning or bald patches. Wash fragile hair with baby shampoo, and use a leave-in conditioner with sun block. Avoid adding more stress to your hair from using curlers and alcohol-based styling products, which can irritate sensitive skin.
Finally, don't shy away from wearing a hairpiece, hair extensions, or a wig. Hairpieces and extensions can be added into thin areas to create a fuller look. Just make sure that these aren't too tight, because tension on weakened hair also can lead to hair loss. Wigs come in a wide range of styles, colors, and lengths. And don't forget your scalp! Keep it dry to prevent chafing, and remove the wig occasionally to allow your skin to breathe.
Whether you decide to go with a wig or a new hairstyle, remember that there's no wrong way to deal with hair loss. "Everyone has a different comfort level," says Werth. "It should be an individual decision." 

Action steps

Losing hair can be scary, but it’s usually treatable and often can be covered up. It may take a while for hair to grow back—sometimes 6 months or more—but eventually it usually does unless it’s caused by skin (“cutaneous”) lupus that leads to a “discoid rash.” (Patches of thick and scaly red “discoid” rash can scar hair follicles and cause lasting hair loss, so be sure to talk to your doctor about your options if these develop. “Alopecia” is the medical term for hair loss.)
For most hair loss, you aren’t powerless! Here are some strategies to try:

  • Refresh your hair style. Ask a hairdresser for ideas to cover up bald spots. To make hair look thicker, try a cut that layers. When blow drying, try lifting hair up and away from the head. Or ask about dying hair to cover up bare scalp that otherwise might show through.
  • Consider hair extensions.  If you still have some healthy hair and are just missing some patches on the sides (not the top)—and aren’t actively losing hair—consider hair extensions. Pre-made and custom-made extensions are available, and different ways to attach them (sewing, knotting, or adding in through tiny links are often best to avoid contact with chemicals, adhesives (glues) and heat.
  • Try a wig. These days wigs are so well-made that most people can’t tell you have one on. To start take a friend to just look around. You may well feel a lot better when you see what options there are!
  • Experiment with hair wraps, scarves, bandanas, accessories—tips are on the Internet! Enter “hair loss” along with the term “wrap,” or “scarf” in and you’ll get more free video demonstrations and ideas than you can handle!  
  • Last resort: cosmetic surgery. For extreme and permanent hair loss, stretching the remaining hair to cover what’s been lost may be an option, or even transplanting hair from another part of the scalp.
If you have lupus and are losing hair, do NOT experiment with over-the-counter hair loss treatments. Talk to your doctor about treatment options.  

What’s NOT to blame for lupus hair loss? 

While it’s only common sense to avoid harsh chemicals or even very tight braids that pull on your scalp, you can’t really blame serious hair loss on a lack of vitamins, washing your hair a lot, or using hair colorings or other common hair products. Some hair loss follows the pattern that your mother or father experienced as well, and is totally normal.


About 70% of people with lupus will experience hair loss (alopecia) at some point during the course of the disease. Hair loss in lupus is usually characterized by dry, brittle hair that breaks, and hair loss is more common around the top of the forehead. Physical and mental stress can also cause hair loss, as can certain medications, including corticosteroids such as prednisone. In many cases the hair will grow back, but hair loss due to scarring from discoid skin lesions may be permanent. There is no cure-all for hair loss, but treatments such as topical steroids and Rogaine may be prescribed. Sometimes dealing with the cosmetic side effects of lupus can be difficult, but some people find using hairpieces and wigs to be an effective means of disguising hair loss.

Natural Help for Hair Loss

Always ask your doctor before trying any new treatments even if it is natural.

By Kathleen Halloran
May/June 2000
Saw palmetto

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Sometimes what we see in the mirror every morning can affect our self-esteem more directly than any other event of the day. For men and women who are losing their hair, the mirror provides an unpleasant documentation of the problem. The extent to which hair loss and balding affects people’s lives is reflected in the millions of dollars spent each year on expensive products—both prescription and alternative—that purport to cure the problem. The few prescription drugs available for balding work in some cases, but not for all. Some can be accompanied by serious side effects.
If you’re experiencing hair loss, don’t rule out natural alternatives. Although no remedy will work for everyone, natural approaches have helped many.
“Herbal medicine has a variety of ways to contribute to the extreme slowing down of this process and the minor expression of genetics—as opposed to being completely bald like our ancestors,” says Thomas Lee, a naturopathic physician in Phoenix who has worked with dozens of balding men. Most of these men came to him for other health problems and began noticing within a few months that the herbal support and lifestyle changes were also resulting in thicker hair and less gray, he says.

Understanding hair loss

Hairs are made of the protein keratin, the same substance in nails and skin, and their growth is most often triggered by hormones. When a man reaches puberty and testosterone levels start to rise, he begins to develop underarm, pubic, and facial hair. For many men, the hormones at this stage are also believed to initiate what in later years will become male pattern baldness.
Each hair, which rises out of a bulblike follicle, goes through a cycle of growth for up to about five years. It then stops growing and shifts into a period of rest, after which it falls out and a new hair begins to grow. This cycle happens throughout our lives, and even people with healthy hair lose up to 100 hairs a day.
Hair loss can be caused by a number of factors, including circulation, stress, hormonal changes, and nutrition. But the most potent influence—and the toughest to combat—is genetics. In people experiencing genetic hair loss, there are believed to be more hormone receptors in the balding areas of the scalp. One male hormone that is converted from testosterone, called dihydrotestosterone (DHT), damages the hair follicles so that the hairs gradually become finer and the growth cycles shorter. The conversion of healthy male hormones to unwanted DHT is driven by an enzyme produced mainly in the prostate and adrenal glands. DHT also plays a role in prostate enlargement, so the two conditions are linked.
According to the American Hair Loss Council, more than half of all American men experience significant hair loss by the age of forty-five. Although pattern baldness also occurs in women, they have much lower levels of DHT, and the problem is ­almost always much less pronounced, resulting in thinning hair rather than bald heads; in women, the hair loss is often linked to the adrenal glands, Lee says.
Other causes of hair loss include auto-immune diseases, stress, poor nutrition, and side effects of radiation or medication for conditions ranging from arthritis and gout to heart problems and depression. Dealing first with those problems may well eliminate further hair loss.

What to do

Once the hair follicles die and a man has been bald for some time, it becomes impossible to revive the follicles and reverse the process. The lesson here is a common refrain today: Prevention is the best cure. Don’t wait until it’s too late or your only options are a toupee, a transplant, or some hair product that comes in a spray can.
The first drug approved by the Food and Drug Administration (FDA) for treatment of hair loss was Rogaine (minoxidil), originally developed to fight hypertension. Applied as a cream, Rogaine doesn’t work for everyone and doesn’t block the formation of DHT, so its effects on hair growth last only as long as a man uses the treatment, and it doesn’t prevent the deterioration of the follicle. More recently, a DHT blocker, Propecia (finasteride), won approval, but for a small number of men it has unfortunate side effects, including decreased sexual desire and impotence. Propecia doesn’t prevent baldness in women, and because it has been associated with birth defects, the FDA recommends that pregnant women avoid contact with the drug.
The natural treatment approaches, which have not been studied and tested for hair loss the way the pharmaceuticals have, generally focus on substances that help block the formation of DHT and restore vitality to the remaining hair follicles.

Alternative approaches

Among the herbs that naturopathic physicians often use to slow down hormonal effects are saw palmetto, pygeum, horsetail, corn silk, and licorice. (See “Healthy hair, the natural way” on page 56 for more detail.) Rosemary, horsetail, and nettle are among another category of herbs that encourage hair growth by promoting blood circulation to the scalp and unclogging pores so that nutrients get to the follicle more easily. General herbs for circulation such as ginkgo are also sometimes used, and women experiencing ­pattern baldness will most often respond to herbs that target adrenal insufficiency such as Siberian ginseng, astragalus, or licorice.
Vitamins, minerals, and amino acids are a critical part of having healthy hair and keeping it. Not only is it important to maintain sufficient quantities of these ­nutrients, but also that you take in a ­proper balance of them, because excessive amounts of one can create deficiences in another. The answer is good nutrition and a good multivitamin and mineral supplement, or work with an expert on a personal approach that is best for you.
Remember that hair growth is slow and the process takes time. Lee, the Phoenix naturopath, says at least 80 to 85 percent of his patients begin to see a noticeable improvement in their hair within four to six weeks, or sometimes as long as six months.
“Whether the improvement is as dramatic and complete as they would have liked is hard to say,” he says. With an issue such as balding, where vanity plays a powerful role, it’s difficult to keep expectations in bounds. So as you approach your own hair thinning, try to be patient and reasonable. The results may be a pleasant surprise.


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