By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

TREATING HAIR LOSS REQUIRES KNOWING THE UNDERLYING CAUSE

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 -- a fancy word meaning “bald spot” -- can be the result of a number of conditions that cause a loss of hair. 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 spot 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. Because of the location of your husband’s bald spot, I think it’s likely that another condition is 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 –- two common examples –- 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 research about a decade ago suggested that it is an autoimmune disorder. As a result of this research, we now have new treatment options that your husband’s family physician might not have known about. Certain topical medications directed at the underlying autoimmune etiology have shown great success when started within one year of symptom onset.

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 Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at http://www.FamilyMedicineNews.org.