Hair loss on legs has reader puz­zled

Imperial Valley Press - - NASCAR THIS WEEK - KEITH ROACH, M.D. Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­ or re­quest an or­der form of avail­able health new

DEAR DR. ROACH: I’m a 65-year-old male. For the past five years or so, I have been los­ing the hair on my legs.

At this point, I seem to have sta­bi­lized, with vir­tu­ally no hair from my toes to the tops of my thighs; how­ever, from my groin to my neck, I am per­fectly nor­mal. I have a full head of rather thick hair for some­one my age.

My doc­tor has tested me for poor cir­cu­la­tion (and found it to be nor­mal) and for low testos­terone (also nor­mal). I am in rel­a­tively good health for some­one my age. I take med­i­ca­tion for mod­er­ately el­e­vated choles­terol, triglyc­erides and blood pres­sure; I have a slight ar­rhyth­mia and bor­der­line Type 2 di­a­betes.

Any idea what could be caus­ing this, and if it is some­thing I should be wor­ried about? -- M.D.

AN­SWER: Your doc­tor has done the test­ing that I would rec­om­mend. I do have a cou­ple of thoughts that might be help­ful.

“Cir­cu­la­tion” is an am­bigu­ous term, since there are three dif­fer­ent types of ves­sels that carry fluid to or from the leg: ar­ter­ies, veins and lym­phat­ics.

The ar­ter­ies are of the big­gest con­cern, and I sus­pect that’s your doc­tor used an ar­te­rial Dop­pler study to ex­am­ine that.

The study looks for block­ages in the ar­ter­ies, also called pe­riph­eral ar­te­rial dis­ease. It’s im­por­tant to know if you have this con­di­tion, es­pe­cially be­cause it pre­dis­poses peo­ple to block­ages of the blood ves­sels in the brain and heart.

It can be treated with ther­a­pies that ad­dress the whole body: bet­ter diet, smok­ing ces­sa­tion and con­trol of di­a­betes (when ap­pro­pri­ate).

Of­ten, choles­terol and blood pres­sure man­age­ment are part of the pic­ture.

It also can be treated by open­ing blood ves­sels, ei­ther sur­gi­cally or via a pro­ce­dure done within the artery.

Ar­te­rial cir­cu­la­tion prob­lems are the most likely cause for some­one with hair loss.

Ve­nous in­suf­fi­ciency hap­pens when blood ves­sels can’t re­turn the blood back to the heart at low pres­sure, usu­ally be­cause of de­fec­tive valves.

This causes swelling, which oc­ca­sion­ally leads to hair loss.

Some­times the Dop­pler stud­ies can in­di­cate whether there is ev­i­dence for ve­nous in­suf­fi­ciency. If so, it is treated with sup­port stock­ings and leg el­e­va­tion.

Some­times sur­gi­cal pro­ce­dures are rec­om­mended for peo­ple who don’t get bet­ter with con­ser­va­tive treat­ment.

Poor lym­phatic drainage causes lym­phedema, some­times but not al­ways as­so­ci­ated with surgery or can­cer.

The leg usu­ally is very swollen be­fore hair loss oc­curs.

Thy­roid dis­ease can cause hair loss, so a sim­ple blood test is called for.

Fi­nally, many read­ers have writ­ten to tell me that their hair came back af­ter switch­ing from pants to shorts (many of these re­tirees), and I sus­pect that in those cases tight pants may have caused dam­age to the hair fol­li­cles.

The book­let on edema and lym­phedema pro­vides in­for­ma­tion on the causes of foot and an­kle swelling. Read­ers can or­der a copy by writ­ing: Dr. Roach, Book No. 106, 628 Vir­ginia Dr., Or­lando, FL 32803.

En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low four weeks for de­liv­ery.

DEAR DR. ROACH: I read your re­cent col­umn on nickel al­ler­gies and joint re­place­ment. I worry that I have a nickel al­lergy since I break out in a red, itchy, pim­ply rash from con­tact with the back of watches, the tabs on the waist­bands of jeans and the backs of ear­rings. Do I need to worry about get­ting a re­place­ment aor­tic heart valve? -- T.S.

AN­SWER: My ad­vice for you is sim­i­lar to what I said for other joint re­place­ments: First, find out if you re­ally have a nickel al­lergy. Your his­tory is sug­ges­tive, so find an al­ler­gist who can do skin test­ing. If you do have a se­vere nickel al­lergy, I read one re­port of a sur­geon who re­ported the use of a nickel-free ON-X aor­tic valve, so I know there are op­tions.

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