DEAR DR. ROACH: I used to have lots of hair on my head, but I have lost most of it. My doctor diagnosed me with scarring alopecia. I don’t know anything about what causes this. It bothers me very much that I am losing my hair. Is there a specialist who could help me? — B.F.H.
ANSWER: Scarring alopecia, also called central centrifugal cicatricial alopecia, predominately affects women of African descent, though it can occur in Caucasian women and black men. Hair loss usually begins on the top of the head, and progresses out from the center. It’s cause is unknown, but inflammation of the hair follicle is key in the condition. This might allow further damage by bacteria or chemicals, such as hair relaxers. The diagnosis is made by a careful history and exam, with a biopsy of the scalp.
Treatment for cicatricial alopecia is challenging, and it often involves multiple modalities. It is important to discontinue using any chemicals that may be damaging the hair. Often, anti-inflammatory medications, such as steroids, and antibiotics, like tetracycline, are tried. Unfortunately, once the follicle is completely damaged, it can’t be repaired.
I found some very helpful information at www.carfintl.org, where you can get information about the condition and find support groups. A dermatologist is the type of specialist who would treat you, but you can email the organization for a referral to a subspecialist in this condition.
DEAR DR. ROACH: Is there a name for when a person steals for no reason? Say, a person who is well-off and doesn’t really want for anything in any way. Is there a cure besides jail? — S.A.D.
ANSWER: Kleptomania (from the Greek root “klepto” for “thief” and the Latin “mania” for “frenzy” or “madness”) is a mental condition, a type of impulse control disorder, in which people cannot refrain from stealing items. It is not strictly shoplifting, since it is not done for personal use or for financial gain. People report an uncontrollable urge, followed by a sense of relief and, often, inward revulsion at their actions. The stolen items usually are stowed in a secret place and never used, although sometimes they are given away or even returned to the place from which they were stolen.
The condition is underdiagnosed. In my career, I have never had a patient describe to me this condition, probably due to shame or to fear of legal repercussions. It’s unfortunate, since there are effective treatments — although, not a single treatment for everybody, since kleptomania is probably not just one condition. Both psychotherapeutic treatments and medication treatments are used, depending on the person.
If you are asking about a friend or loved one, I strongly urge you to get this person to see a mental-health professional soon. It is much better to get treatment before he or she gets into legal trouble.
DEAR DR. ROACH: My daughter, age 68, mentioned to me that she started to have weakness in her right hand, to the point that she’s unable to lift a medium-weight object. She dismissed the problem and doesn’t want to see a physician. I am concerned that this might be the onset of a muscle-deteriorating disease. Should I be? — A.L.
ANSWER: You are right to be concerned, and she should see a doctor right away. There are many possibilities, ranging from a peripheral nerve disorder (like carpal tunnel syndrome) to a central nervous system problem (like stroke or multiple sclerosis) to a nerve/muscle problem (like myasthenia gravis). Carpal tunnel is probably the most likely cause that I see in my primary care practice. Early treatment is critical in order to preserve function.
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.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.
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