Plenty of things cause hair loss
DEAR DOCTOR: I’ve been taking thyroid medication for several years, and my doctor says my blood tests are where they should be, but my face feels like sandpaper, my nails are brittle, and I’m losing so much hair that I can see my scalp. Could there be some underlying problem my physician is missing?
DEAR READER: Your thyroid hormone levels are an obvious place to start, because both low and high thyroid levels can lead to hair and nail changes. Symptoms of high thyroid levels include hair loss, skin that is unusually smooth and warm and nails that soften and loosen from the nail bed.
Autoimmune thyroid disease also can lead to hair loss, both patchy and more diffuse, as well as inflammatory conditions of the skin. Such disease isn’t always reflected in thyroid hormone levels. Checking anti-thyroid antibodies in the blood can identify autoimmune thyroid disease and point you and your doctor in a clearer direction.
Hair loss also can be caused by androgenic alopecia, linked to an excess of androgens, a type of male hormone. Simply checking levels
of testosterone and dehydroepiandrosterone (DHEA) can either rule out androgenic alopecia or suggest that it be explored further.
Another potential cause is medication. Some medications can lead to hair loss, so if your symptoms seem coincidental to starting a new medication, there might be an association.
Biotin deficiency, which is rare, can cause hair loss and inflammation of the facial skin. But if you have a normal diet and eat eggs, you have a low likelihood of this condition. Nonetheless, it’s something to rule out.
Iron deficiency also can lead to both brittle nails and hair loss. This doesn’t explain the skin manifestations that you have, but if you are looking at other possibilities, checking the iron level of the blood should be part of the workup.
Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA 90095.