Alopecia

Characterizing Hair Loss in Patients 65 and Older

As the population ages, more patients are likely to present with concerns of hair loss. Hair loss with age may be physiologic due to the aging of hair follicles, hormonal changes, or consequences of various systemic diseases and medications.¹ An estimated 53% of men and 37% of women over 65 are balding; however, data regarding frequency and representation of hair loss conditions with advancing age are lacking.²⁻³ The study investigated hair loss characteristics among the elderly seen in a tertiary referral center.

Patients (≥ 65 years) seen for the first time at Cleveland Clinic without a history of hair loss were identified in the period from 2004 to 2014 (N = 163). Patients presented with all types of hair loss, including telogen effluvium (TE), lichen planopilaris (LPP), androgenetic alopecia (AGA), alopecia areata (AA), frontal fibrosing alopecia (FFA), and central cicatricial centrifugal alopecia (CCCA). The vast majority of patients were white females except for those with CCCA, who were all African American. Patients with AA and TE tended to wait the shortest period of time before their initial visit, while patients with FFA and AGA waited the longest. Worsening hair loss at initial visit was present in LPP, CCCA, and TE. Associated symptoms were most common among patients with scarring alopecia.

Demographic and Clinical Characteristics of Patients (≥ 65 years) With Hair Loss (N = 163)

2004 – 2014

TE = telogen effluvian, AGA = androgenic alopecia, AA = alopecia areata, LPP = lichen planopilaris, FFA = frontal fibrosing alopecia, CCCA = central cicatricial centrifugal alopecia

Existence of systemic diseases, hormonal imbalance, and nutritional deficiencies are of particular concern in the aging population. Elevated low-density lipoprotein (LDL) was most common among AGA patients, followed by those with CCCA, AA, LPP, and TE. Elevated testosterone was most common in patients with AGA, followed by TE, AA, and LPP patients. Low vitamin D was most common among those with CCCA, followed by those with LPP, TE, AGA, FFA, and AA. Low thyroid stimulating hormone was most often present in patients with LPP, followed by those with AA, and TE.

Hormonal and Nutritional Characteristics of Patients with Hair Loss (N = 163)

2004 – 2014

TE = telogen effluvian, AGA = androgenic alopecia, AA = alopecia areata, LPP = lichen planopilaris, FFA = frontal fibrosing alopecia, CCCA = central cicatricial centrifugal alopecia, DHEA-S = dehydroepiandrosterone sulfate, TSH = thyroid stimulating hormone

As the population continues to age, patients are more likely to present with concerns of hair loss. Among this population, TE was most common followed by LPP and AGA, likely because the onset of AGA is earlier, and patients would have had their first visit for hair loss before age 65. Unfortunately, hair loss in the elderly population has largely been ignored both clinically and in research, causing delayed diagnosis, disease progression, later initiation of treatment, and higher patient morbidity.

References
  1. Gude D. Hair loss: a harbinger of the morbidities to come! Int J Trichology. 2012;4:287-288.
  2. Hordinsky M, Sawaya M, Roberts JL. Hair loss and hirsutism in the elderly. Clin Geriatr Med. 2002;18:121-133, vii.
  3. Chen W, Yang CC, Todorova A, Al Khuzaei S, Chiu HC, Worret WI, Ring J. Hair loss in elderly women. Eur J Dermatol. 2010;20:145-151.