Published Saturday  |  September 8, 2007
Hair loss in women: The thin and thick of it
BY THERESA FARRAGE
WORLD-HERALD STAFF WRITER

Women spend thousands of dollars on haircuts, permanents, dye jobs, extensions
and products to avoid having a bad hair day. But for some women, hiding behind a
scarf or hat is the only way they will be seen in public. Are they just having a
bad hair day or is it something deeper than split ends? For most women
experiencing hair loss, the problem is more than physical and emotional; it's
losing the essence of being a woman.

BurgessFor Julie Burgess, coming to terms with her hair loss was scary and
devastating.

"I was pulling it back into a ponytail and caught my profile. So much scalp was
showing it scared me and I just freaked out," the Omahan said.

Burgess noticed many round patches that seemed to turn into big, empty scalp
patches. She had always had long hair. Suddenly, it appeared to be coming out
more and more.

"I started wearing a hat because to me it was so ugly to look at. I tried to
keep a happy face, and I learned how to accessorize the hat with scarves and
pins, but I was so worried that at 46, I was going to be bald," she said.

Burgess decided it was time to visit her internal medicine doctor to make sure
it wasn't an underlying medical condition. Her doctor suspected that it might be
a condition known as alopecia areata, an autoimmune skin disease resulting in
the loss of hair on the scalp and elsewhere on the body.

However, the doctor didn't want to rule out a possible thyroid problem, so he
took blood samples.

"I was still so scared and holding out hope that it was something you could
treat with a pill. A thyroid problem could be taken care of that way, but not
alopecia," she said.

When the blood tests came back normal, Burgess decided to see her
endocrinologist, who told her it was definitely not a thyroid problem. She was
then referred to a dermatologist at Braddock Finnegan Dermatology, P.C. in
Omaha.

"Dr. Mary Finnegan told me it was classic alopecia areata, an autoimmune
disease. Essentially, my body saw these hair follicles as enemies and worked to
reject the hair," she said.

Finnegan said hair loss occurs in two basic patterns: nonscarring and scarring.
Nonscarring hair loss is the most common and may be related to internal disease
states. It occurs after stress such as childbirth, hospitalization, illness, a
response to changes in internal health, a manifestation of menopause and aging,
or as a result of common scalp problems such as seborrheic dermitis or
psoriasis.

Finnegan said it also may be a result of iron deficiency, a thyroid disease or
another disorder of the endocrine system. Autoimmune disorders such as lupus and
alopecia areata may lead to hair loss and, in rare cases, hair loss can be a
result of sarcoidosis, a chronic disease that involves inflammation that
produces tiny lumps of cells in various organs in the body. Another cause can be
lichen planus, a common skin disease that appears as shiny, flat-topped bumps
that often have an angular shape.

Both conditions require a skin biopsy for diagnosis.

"Most cases are the result of a combination of genetic predisposition with
superimposed medical conditions and may be exacerbated by stress," Finnegan
said.

It's normal, she said, to lose up to 150 hairs per day. If you have a sudden
change in hair loss, it may be a sign of a medical problem.

"When one notices hair shedding, she is often losing double the amount,"
Finnegan said. "Hair is part of the female identity. It's important to
understand what's driving the hair loss, and to treat what can be treated."

Burgess received treatment in the form of a topical steroid from Finnegan. She
used the topical steroid solution every day and started to notice that the hair
was growing back.

Burgess also made an appointment with SBT Hair Specialists' Dick and Deb
Koesters, co-owners and stylists in Omaha, who work with women experiencing hair
loss from chemotherapy to female-pattern baldness.

"We have seen women who would not go to a class reunion or have been wearing a
ponytail for years because of the embarrassment. Hair loss can make a woman look
sick or 10 years older," Deb Koesters said.

SBT Hair Specialists give women confidence by helping them with a hairstyle that
makes their hair look fuller as well as offering products that help make hair
feel thicker. For women in the early stages of hair loss, Koesters suggests
backcombing the hair, highlighting or texturizing the hair to create a fuller
look.

When hair loss has progressed to 20 percent or 30 percent, a system called
integration can be applied. It's a piece similar to a hair net that clips and
pulls your own hair through the holes. This process is best for women who only
want to replace missing hair.

"Sometimes people will want hair extensions, but this actually works best with
people with good, strong hair," Koesters said.

Full-cover top integration is for people who have lost more than 50 percent of
their hair and you can see their scalp.

"The great news is that it can be corrected and it is literally undetectable,"
Koesters said.

This process can be applied using clips and removed every day or it can be
bonded to existing hair and only taken off every three to four weeks. You can
shower, sleep and swim with this option, Koesters said.

When women lose more than 80 percent of their hair, the best option is a full
wig.

"Human hair wigs are great because they are all hand-tied, which makes it look
like the hair is growing right from the scalp," Koesters said.

When Burgess met with Koesters, she had her hair cut and then opted for a wig.

"Deb cut my hair the rest of the way, and I was ready to cry when it was really
apparent how much I had lost. Deb talked me into a wig. She was so
compassionate," Burgess said. "It was more hair than I had ever had in my life
because it was thick and lustrous. I named the wig 'Jules,' and it was my alter
ego for about two months. I called it my 'Republican housewife look.' It really
wasn't me, but it was better than bald."

Burgess was skeptical at first, but decided to try Rogaine, a topical hair
regrowth product, at Finnegan's suggestion. Even though her hair eventually grew
back, she was very careful about how she applied the Rogaine.

"I had visions of hair growing in my ears and eyeballs if it dripped there,"
Burgess said.

In an effort to take control and get her hair back, Burgess plans to continue
her treatments with Finnegan and SBT Hair Specialists. She's come to terms with
her condition and has since been given enough confidence not to retreat.

"Surround yourself with positive people who like you for who you are. You are
not your hair! Taking and believing my own advice, I'm so lucky to have a great
husband who loves me, not my hair. He is thinning, too, and we joke about who
has more. I want my hair to grow back, but if my journey is lighter because of
the lack of hair, that's OK, too," she said.

Theresa Farrage is a freelance writer who lives in Omaha and is a regular
contributor to HealthWise.

Published Saturday  |  September 8, 2007
Hair loss in women

Possible causes of hair loss in women

  Related to internal disease states
  After stressful events such as childbirth, hospitalization or illness
  Manifestation of menopause and aging
  Scalp problems such a seborrheic dermatitis or psoriasis
  Iron deficiency
  Thyroid disease or other disorder of the endocrine system
  Autoimmune disorders such as lupus and alopecia areata
  Sarcoidosis and lichen planus
  Hereditary female-pattern baldness
  Stress on the hair as a result of overuse of products or styling tools (mostly
  causes breakage)

*Remember to consult with your dermatologist to find out what is driving your
hair loss.

Source: Dr. Mary Finnegan, Braddock Finnegan Dermatology, P.C., Omaha