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Q:  I am a 28 year old woman living in Australia and am considering traveling to New York to see Dr Redmond as I have had alopecia areata intermittently since I was six years old and it has now become alopecia universalis as no treatments are working. My hair fell out as a child almost annually until i got my period at 14yrs old, and didn't fall out aging totally until I was 25. From 20 to 25 there were a couple of patches which were treated with cortisone injections, but at 25 all my hair fell out and no treatments (minoxidil, puva, diphencyprone) were effective. I have worn a wig for 2 years and my hair has started to grow and fallen out again twice within that time.

I recently had my hormones tested 3 times and each time the estrogen levels were low, so my doctor referred me to a hormone specialist who has put me on Diane. Every time my hair falls out I get acne and bad headaches and am extremely exhausted, and my glands swell under my arms. The doctors don't make any connection with these symptoms to my hair loss because they say it takes six weeks for your hair to fall out so its just a coincidence. But its happened so many times now that I don't agree. I think there is a definite link.

My thyroids are fine, my sister has lupus, but my tests are all clear. I feel that I have both types of alopecia, and my hormone imbalance is making the alopecia uncontrollable at the moment. But because my periods are regular, the doctors don't want to give me HR and I don't think the pill is enough. I've been on Diane now for two months and my eyelashes are now falling out (I have no other hair!)

Can you tell me if you think its worthwhile for me to come to New York for an appointment, and should I email/fax a more detailed history for you to see if you might be able to help me. I am happy to pay for your time by credit card if you would look into my case to see if it would be worth the o/s travel.

Thank you.

A:  Alopecia areata/universalis is not itself hormonally caused. Main treatment is steroid injections into the scalp. Some of the other problems you describe may be hormonal. What is hard for me to tell is whether you have hormonal alopecia as well, which might be treatable. If the problem is mainly areata, I would not suggest you come to the US, since treatment here would not differ from that in Australia.

Hope this is helpful.

Geoffrey Redmond, MD

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