FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SOME HAIR LOSS REQUIRES TREATMENT OF UNDERLYING DISEASE

Question: My husband has developed a bald spot on the side of his head. Our family doctor said that it is alopecia and that there is nothing that can be done for it. The bald spot is so conspicuous that my husband is considering shaving the rest of his head. He thinks being totally bald would be less troubling for him. What causes alopecia and is it untreatable?

Answer: Alopecia is actually only a term that describes a bald spot rather than being an illness. Therefore, any condition that causes a loss of hair can be correctly diagnosed as alopecia. As you might logically assume, the treatment options for alopecia depend upon the specific cause. The accurate diagnosis and treatment of skin conditions can be quite complicated, and that is why there is an entire medical specialty area, dermatology, dedicated to it.

Your family doctor believes the cause of the alopecia is a condition for which there is no effective treatment. However, if it were my head with the bald spot, I'd get an opinion from a dermatologist before I reached for the razor. Let me explain a few of the things the dermatologist will need to consider.

Certain information can provide leads on possible causes of alopecia in a particular case. This information includes the size, shape and location of the hair loss as well as a description of its initial appearance and how it has changed since then. The character of the skin and the nature of the skin and hair at the border of the lesion are also important in establishing the diagnosis.

The most common form of alopecia is called male pattern baldness. I think almost everyone is familiar with this condition. I know I just need to look in the mirror to be reminded of it. I'm sure your husband has another condition causing his alopecia.

Infection of the scalp with one of several different types of fungus causes inflammation of the scalp and hair loss, a form of alopecia called Tinea capitis. Bacterial infection of the scalp can also produce a similar appearing area of alopecia. Even infection by syphilis, long after the original genital infection, can cause it. Fortunately, all of these causes are quite treatable with appropriate medications.

Conditions that affect the entire body, not just the scalp, may also cause alopecia. Low thyroid levels and iron deficiency anemia ñ two common examples ñ are are easily tested for and relatively easy to treat. Unfortunately, there are other more serious conditions that can cause alopecia, too. Scleroderma, discoid lupus erythematosus and a number of cancers are good examples of these.

My best guess is that your husband has the condition alopecia areata. The exact cause of this form of hair loss is still unclear, but new research suggests that it is an autoimmune disorder. In the past there was no effective treatment available for this malady, just as your family doctor said. However, today is a brighter day. Research has give us new options. Topical medication directed at an underlying autoimmune etiology shows great success, particularly in those who have suffered with it for less than one year.

I'd recommend that your husband see a dermatologist. He or she will examine your husband and probably remove a small sample of skin for study in the laboratory. This will provide important information and help determine the correct diagnosis. Then you can decide if the razor is actually the best treatment!

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.