Hair loss is one of the most dreaded conditions, and it affects a whopping 25 percent of women and 50 percent of men over the age of 50. But it isn't merely age-related. In fact, hair loss can be the result of several different factors, including genetics, hormones, medications, and general lifestyle choices. Most life stressors, including illness, emotional trauma, protein deprivation (during strict dieting), and hormonal changes like those in pregnancy, puberty, and menopause may cause hair loss, according to Sapna Palep, M.D., a dermatologist at Spring Street Dermatology in New York City.
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One of the most common culprits behind hair loss, especially when it happens before age 50, is autoimmune disease, which affects somewhere between 14.7 and 23.5 million Americans to date, according to The Autoimmune Registry. With these types of conditions, one's immune system mistakenly attacks the body—and one of the most common side effects, along with a slew of others, is hair loss. "Similar to the situation in extreme dieting and stress, the body shuts down hair growth to preserve energy," explains Dominic Burg, hair trichologist and Chief Scientist for Evolis Professional. Here, a look at some of the most common autoimmune diseases that cause hair loss, explained by the experts who treat them.
This is the most common condition that results in hair loss, affecting an estimated 6.6 million people in the United States and 147 million people worldwide. "It is characterized by patches of hair loss that can progress to complete loss of hair from the scalp (alopecia totalis) or from the whole body in severe cases (alopecia universalis)," says Gary Linkov, M.D., a New York City-based facial plastic surgeon who specializes in hair restoration.
Unfortunately, there is no FDA-approved treatment for alopecia areata, but there are some solutions. "For the patchy hair loss associated with alopecia, a course of corticosteroid injections into the scalp or skin can sometimes help," says Alan J. Bauman M.D., founder of Bauman Medical in Boca Raton, Florida. "PRP, or Platelet Rich Plasma, injections are a non-pharmaceutical treatment option that has been reported to be successful in some cases." Sometimes, he adds, these treatments are given in tandem with topical applications of over-the-counter minoxidil.
An estimated 1.5 million people in America live with this chronic autoimmune disease, according to The Lupus Foundation of America. "It can affect many different systems and organs in the body, creating a wide range of symptoms such as fatigue, headache, painful joints, anemia, abnormal blood clotting, and hair loss," says Dr. Palep. "Hair loss occurs when antibodies created by the body infiltrate the hair follicles, causing the hair shaft to be rejected by the body and fall out." During remission periods, hair may grow back, however if any scarring occurs in the follicles, the loss may be permanent.
Also known as chronic lymphocytic thyroiditis, Hashimoto's is the leading cause of hypothyroidism, a condition in which the thyroid gland does not produce enough hormones to regulate metabolism the way it should. "This causes inflammation of the thyroid gland, thereby interfering with its ability to function and resulting in an underactive thyroid," explains Dr. Palep. "Some people experience thinning hair or large amounts of hair falling out in the shower or sink, as well as changes in hair texture (it can become dry, coarse, or easily tangled)." This hair loss will continue until thyroid levels are normalized through medication or other methods.
This is another disorder that causes a disturbance in the thyroid. "With Graves' disease, antibodies bind to the surface of thyroid cells, stimulating them and overproducing thyroid hormones and resulting in an overactive thyroid called hyperthyroidism," says Dr. Linkov. "It can also affect the production of new hair on the scalp and sometimes elsewhere on the body." Anti-thyroid drugs such as propylthiouracil and methimazole, which interfere with thyroid hormone production, can be used to treat Graves' disease, he adds.
This skin condition, which most often occurs on the elbows, knees, and knuckles, can also occur on the scalp. "When the scalp is impacted, psoriasis can be severe and result in scales, redness, and sometimes itching," says Dr. Palep. "Psoriasis usually does not cause large amounts of hair loss, but it can—and since the scaling on the scalp is very tight, the hairs' diameter may change and cause breakage."
Crohn's Disease and Inflammatory Bowel Disease
Patients with one autoimmune disease are also at an increased risk of developing another, like Chron's disease (an inflammatory bowel condition), which can cause further hair loss, according to Dr. Bauman. "Treatments for Crohn's Disease may involve medications, surgery, and nutritionals to control inflammation, correct nutritional problems, and reduce symptoms," he says. "Medications typically include biologic immunosuppressants to reduce inflammation and treatments focuses on nutraceuticals, laser therapy, topical prescriptions, and PRP."