Get To The Root of hair disorders, nails

While society has traditionally regarded hair loss as a man's problem, losing your "crowning glory" also can be devastating to women, teens and even children.

Not too long ago, few lasting and satisfying remedies were available for people who began to experience thinning hair or baldness. Today, thanks to research that has resulted in new medical treatments, hair loss is not necessarily permanent. The type of treatment, though, depends on the form of hair loss.

First of all, some hair loss is normal and incredibly common, according to dermatologists. Typically, each person sheds about 50 to 100 hairs a day, an amount that most people don't even notice. As people age their rate of hair growth decreases. A hair disorder is evident when hair loss is out of proportion to the normal amounts of loss on the scalp, or elsewhere on the body.

There are many forms of hair loss, some of which are inherited and some of which are due to physiological stress or even a medical condition. If you have excessive hair loss, or notice your hair is becoming thinner or falling out, consult a dermatologist to find the reason for the disorder.

Male pattern hair loss. The most common forms of hair loss is androgenetic alopecia, or pattern baldness which is largely hereditary. A baldness gene can come from either your mother's or father's side of the family. Pattern hair loss affects an estimated 40 million men and 20 million women. What differs is the pattern of hair loss.

With men, pattern baldness usually begins in the early 20s, explains Amy McMichael, M.D., assistant professor of dermatology at Wake Forest University School of Medicine in North Carolina. It starts in the front, crown and sides of the hairline. Males are more strongly affected than females and often get completely bald. With women, hair thinning usually occurs later in life and affects the crown and front of the head, but the hairline does not recede.

"Some estimates indicate that about 50 percent of all people over the age of 45 have androgenetic alopecia to some degree," Dr. McMichael says. So where does that leave you and your dermatologist when considering treatments for hair loss?

Currently there are two drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of hair loss.

Minoxidil, marketed as Rogaine, is a topical solution and is available over-the-counter at pharmacies. The medication causes increased blood flow to the scalp, which has been linked to increased hair growth. Dermatologists say while minoxidil doesn't work on everyone, it does have a fairly good likelihood of positive results with few side effects. But it takes about three to six months to see any effects. However, any medications used to treat androgenetic alopecia will take about that long because hair has to go through its own growing cycle. While the medication may help regrow the hair, it will not speed up the growth.

Another medication used to treat thinning hair is the oral prescription drug finasteride, marketed as Propecia. Finasteride is taken daily and works by blocking the formation of dihydrotestosterone (DHT), the male hormone that is associated with a shortening of the growth phase of the hair. Too much DHT in the affected hair follicles causes thinning and baldness. Finasteride has been FDA approved for use by men only.

"Right now we know it's not effective in post menopausal women and we know it has the potential to be associated with birth defects in pregnant women who are carrying a male fetus," says Maria Hordinsky, M.D, professor and director of the Division of Clinical Research at the University of Minnesota.

Other physician treatments for those experiencing hair loss include surgical hair transplants, which moves a person's own hair to the thinning area, and modified scalp reductions. Dermatologic surgeons can perform hair restoration surgery to correct hair loss and create a natural-looking hairline. The latest technological advancements have led to new options and techniques that make hair restoration safer and easier for patients with more attractive results.

Telogen effluvium. A second common form of hair loss is telogen effluvium, a temporary form of shedding that occurs as a result of some physiologic stress to the body. Pregnancy or stopping birth control pills is the most common cause. You may notice this hair loss if you see excessive strands caught in your brush, comb or shower drain. A severe infection or a disease, such as lupus erythematosus, a surgical procedure, long-term illness or even losing weight from dieting can also be associated with hair loss. Often, with physiologic stress the hair loss may occur two to six months after the stressful event so it's difficult to link cause with effect.

"So basically, a dermatologist has to be a detective in order to figure this out," explains Dr. McMichael. "Because people will have a life-threatening case of pneumonia in April, but when hair starts falling out in August, they don't really connect the two events because they're better and it's over."

Telogen effluvium also may be caused by medication, so when the medication is stopped, the hair eventually returns. Childbirth is another precipitant. In cases where dieting is a factor in thinning hair, a lack of protein can cause hair to fall out. Eating the proper amount of protein can reverse the condition.

Alopecia areata. Alopecia areata is another form of hair loss characterized by hair falling out in smooth, round patches on the scalp. In some cases, alopecia areata can cause the complete loss of scalp and body hair. This hereditary condition is most common in people under 30. Scientists are not sure exactly why, but it is believed that something triggers the immune system to suppress the hair follicle. Alopecia areata isn't always permanent. It can last a week, a month or even years. An initial sign of the disorder can be small circles of hair loss.

While Dr. Hordinsky says sometimes the condition clusters in families with autoimmune diseases, "Most of the time it appears as a solitary disease, in an otherwise healthy individual." More than four million people in the United States have alopecia areata.

Hair follicles may remain alive in all people with cases of alopecia areata so hair growth may return without treatment. Although there is no cure, in some cases treatments can help. These range from cortisone injections, daily applications of topical minoxidil and use of steroid creams and ointments to cortisone pills, scalp treatments, and even wigs depending on the severity of the case.

Of course there are a number of other reasons why people suffer from hair loss such as medical illness, hormone imbalance, or serious nutritional problems.

"Seeing a dermatologist for an opinion and a treatment option is probably the safest route," says Dr. McMichael. "There are a lot of companies out there who will take advantage of people who are frustrated and upset about hair loss and will recommend various vitamin treatments, or other therapies that have no effect and can be harmful."

Usually, a dermatologist can make a diagnosis through a clinical exam and personal medical history, including current medications and diet, noting your hair loss pattern; and seeking signs of illnesses or scalp infection. Sometimes a scalp biopsy may be necessary. Women may also require a blood test to detect possible hormonal abnormalities.

Nail Health

The Long and Short of Nails
Nails in good condition can be very attractive. They also reflect an individual's personal habits - good or bad. Aside from their cosmetic appeal, nails serve many important functions. They help us pick up and manipulate objects and support the tissues of the fingers and toes. Most importantly, nails often reflect our general state of health.

More that Meets the Eye
Nails are produced by living skin cells in the fingers and toes. They are composed primarily of keratin, a hardened protein also found in skin and hair. The nail itself consists of several different parts, including:

Nail Plate:	The visible part of the nail on fingers and toes.
Nail Bed:	The skin beneath the nail plate.
Matrix:	The area under the cuticle, the hidden part of the nail unit where growth takes place.
Lunula:	This is part of the matrix and is the whitish, half-moon shape at the base of the nail, usually most pronounced on the thumb.
Cuticle:	Tissue that overlaps the plate and rims the base of the nail.
Nail Folds:	The folds of skin that frame and support the nail on three sides.

Nails, like hair, grow from the matrix. As older cells grow out, they are replaced by newer ones, they are compacted and take on a hardened form. The average growth rate for nails is 0.1 mm each day; individual rates depend on age, time of year, activity level, and heredity. Fingernails grow faster than toenails. Nails also grow more rapidly in the summer than in the winter. Nails on a person's dominant hand (right vs. left) grow faster, and men's nails grow more quickly than women's, except possibly during pregnancy and old age. Nail growth is affected by disease, hormone imbalance, and the aging process.

Physical activity in poor fitting shoes can cause joggers nails.

Common Nail Disorders
Due to their exposed location, nails take a lot of abuse. Nail disorders comprise about 10 percent of all skin conditions. Most of us, at one time or another, have closed fingers in doors, suffered from ingrown toenails, or endured minor nail infections. Most minor nail injuries heal on their own, although, they might be unsightly for a while due to the nail's slow growth rate. More serious injuries or disorders may require professional treatment. Symptoms that could signal nail problems include color or shape changes, swelling of the skin around the nails, and pain. Additionally, the persistence of white or black lines, dents, or ridges in the nail should be reported to your dermatologist.

White Spots - White spots on the nails are very common and usually recur. These small, semi-circular spots result from injury to the base (matrix) of the nail, where nail cells are produced. They are not a cause for concern, and will eventually grow out.

Splinter Hemorrhages - A disruption of blood vessels in the nail bed can cause fine, splinter-like vertical lines to appear under the nail plate. Splinter hemorrhages are caused by injury to the nail or by certain drugs and diseases. However, trauma is the most common cause. Splinter hemorrhages resolve spontaneously.

Ingrown nails can be very uncomfortable until treated.

Ingrown Nails - Ingrown toenails are a common nail problem. The great toenails are particularly vulnerable. Improper nail trimming, tight shoes, or poor posture can cause a corner of the nail to curve downward into the skin. Ingrown nails can be painful and sometimes even lead to infection. Seek treatment for the condition rather than attempting to cut away the nail yourself, as infection may result.

Onychomycosis - Fungal infections of the nail can cause discoloration and abnormal growth.

Fungal Infections - Fungal infections make up approximately 50 percent of all nail disorders and can be difficult to treat. More common in toenails than fingernails, they often cause the end of the nail to separate from the nail bed. Additionally, debris (white, green, yellow, or black) may build up under the nail plate and discolor the nail bed. The top of the nail or the skin at the base of the nail can also be affected. Toenails are more susceptible to fungal infections because they are confined in a warm, moist, weight-bearing environment. Candida or yeast infections are common in fingernails especially if the hands are always in water or if the patient is diabetic.

Bacterial Infections - Redness, swelling, and pain of the nail skin folds often indicate a bacterial infection. The most common cause is trauma to the nail or surrounding skin, or frequent exposure to water and chemicals.

Warts can be on the skin surrounding the nail and underneath the nails.

Tumors and Warts - Tumors and warts can be found near any portion of the nail unit. However, the nail plate can change shape or be destroyed as a result of the tumor or wart growth. Tumors of the nail unit are classified as cancerous or non-cancerous (benign). The most common non-cancerous tumors are warts. Warts are viral infections that affect the skin surrounding or underneath the nail. They are painful and can sometimes cause limited use of the affected finger or toe. Treatment of warts usually involves freezing or chemical application for removal. If the wart or tumor extends into the nail folds or is located under the nail plate itself, dermatologic surgery may be necessary to remove it.

Psoriasis can also affect the nails.

Psoriasis - Psoriasis is a chronic skin disease characterized by red, scaly patches. Approximately 10 to 50 percent of people with psoriasis, and 80 percent of people who suffer from inflammatory arthritis associated with psoriasis, also have nail problems. The most common nail problems include pitting, rippling, or discoloration of the nail, reddish-brown discoloration of the skin under the nail, separation of the nail from the nail bed, splinter hemorrhages, crumbling and/or splitting of the nail, as well as swelling and redness of the skin surrounding the base of the nail. The signs of psoriatic nail are usually most noticeable on the fingernails.

Habit Tic - Repeated picking at the cuticle can lead to an abnormal appearing nail.

A Hard Habit To Break
Nail biting is a common problem, especially among young children. While the habit typically disappears with age, it has been linked to anxiety with older children and adults. Not only does nail biting ruin the look of the nails, it is also a good way to transfer infectious organisms from the fingers to the mouth and vice versa. Nail biting can also damage the skin surrounding the nails, allowing infections to enter and spread. How can one break the habit? Many people are cured by applying bad tasting nail polishes or liquids to the nail.

Nail disorders can affect our ability to pick up small objects, the way we walk, and our sense of touch. Infrequent in children, nail problems usually increase throughout life and affect many of the elderly. This is due to the susceptibility of the nail to fungal infections, its increased thickness with age, circulation problems, and the regular use of medications that may affect the nails.

In general, nail disorders respond very slowly to therapy because of the slow growth rate of the nail and its inability to absorb medications very well. Treatments are defined generally as surgical or non-surgical. Surgical treatment is common to remove tumors or correct structural abnormalities. Non-surgical treatments include the use of topical or oral medications.

Condition	Nail Appearance
Liver Diseases	White Nails
Kidney Diseases	Half of nail is pink, half is white
Heart Conditions	Nail bed is red
Lung Diseases	Yellowing and thickening of the nail, slowed growth rate
Anemia	Pale nail beds
Diabetes	Yellowish nails, with a slight blush at the base

A Window On Health
The nails can reveal much about a person's overall health. Many diseases and serious conditions can be detected by changes in the nails. Most doctors will check the nails carefully during a physical examination. The most common health conditions and their effect on the nails are listed below:

Nail Care
Since many nail disorders result from poor nail care, developing good nail habits early will help keep them healthy. Remember the following tips:

Keep nails clean and dry. This helps keep bacteria and other infectious organisms from collecting under the nail.
If toenails are thick and difficult to cut, soak them in warm salt water (one tsp. of salt to a pint of water) for five to ten minutes and apply a 10 percent urea cream - available at drug stores without a prescription. Trim as usual.
Nails should be cut straight across and rounded slightly at the tip for maximum strength. Use sharp nail scissors or clippers to do the job. Filing the nails into points will weaken them.
Do not remove your cuticle. It will allow infection to develop.
Use a "fine" textured file to keep nails shaped and free of snags.
Avoid biting fingernails.
Avoid "digging-out" ingrown toenails, especially if they are already infected and sore. Seek treatment from a dermatologist.

Report any nail irregularities to your dermatologist. Nail changes, swelling, and pain could signal a serious problem. A vertical black or brown streak, especially if new, should be reported to a dermatologist. This is especially important in an adult with a single nail streak and/or pigment in the cuticle area (Hutchinson's sign). This can also be due to a benign mole, hemorrhage from trauma, or a fungal infection, but it should be evaluated by a dermatologist.