国外医生与患者的对话（译）

发之家

我女儿脱发了，但是她只有16岁，是不是太早了点啊？
我女儿今年16岁，她在大约11岁的时间已经开始有脱发和比较严重的生粉刺现象.我带她到医院做了各种血液化验和荷尔蒙测量，但是都没有确切的诊断结果，所有的诊断结果似乎都在正常范围以内.通过吃药我们已经很好的缓解了粉刺的出现，但脱发问题依旧挥之不去，虽然她的脱发情况现在再更加要重（没在现有稀薄头发的基础上继续脱发了），但她头顶的头发真的太少了，已经可以直接看到她的头皮了…
万幸的是她边缘和脑后上的头发还比较正常.
我想问的是，以她现在的年龄来看，她的脱发问题严重么？我看报道说，脱发问题通常出现于年龄在25岁或25岁以上吧？女性脱发真的是一个很严重的社会问题啊，特别是她们处在高中或大学生活阶段的时候，将受到尤为严重的影响.我真的希望能帮助到她.谢谢大家！！！
亲爱的Janet：
感谢你的来信，脱发对于任何年龄段的人来说都是是否麻烦的事，对于年轻女性就更加麻烦了.在个给你我的治疗建议前，我觉得还应该提到的是，她已经做过了荷尔蒙监测测量，并且结果显示这不是脱发的起因，其他可能引起脱发的情况可能是缺铁性贫血及甲状腺功能异常.你们应该找她的主治医生了解一下情况，是否能够排除这些可能.如果她还有其他什么症状，最好能和她的医生讨论清楚，尽管这些症状可能和脱发无关（比如什么皮肤或指甲方面的问题什么的），但他们可能代表着某些遗传因素在里面.你并没有提到她是否在接受药物治疗，如果有的话她有的话，这些药物也有可能是引起她脱发的原因.还有膳食方面问题，过度的节食和低热量的摄入都可能与脱发有关.
如果有家族脱发史，对于女性这可能是个引起脱发的重要因素.但尽管有家族脱发史，11岁就开始女性士脱发也是非常罕见的.你可以去查询一下，你们的家族上是否有过女性在年龄很小的时候有过脱发现象.
影响到皮肤和毛发的因素也可能导致脱发，但这需要进行切片诊断.比如斑秃会导致头皮顶的扩散性脱发.一旦确定了是属于这类因素，医生就可以选择最合适的治疗方法了.
我不赞同在未最终确诊，或是得到医生明确答复前就去考虑手术，采用生发水或落建（目前唯一 FDA核准用来治疗女性典型秃头症的药物）可能对你的女儿更合适一些，但没确定脱发真正原因，这些治疗很可能都是无效的，或许还有延误查找真正脱发原因的时间.
我能给你的最好建议就是，你最好为你的女儿找一个脱发症医学经验丰富、精通医学和外壳脱发手术的专业医生，找出你女儿在这样低的年龄脱发的真正原因是现在最首要的问题，只有找出了病因，才可以针对性的做出治疗计划.

My 16 Year Old Daughter Has Hair Loss - Is She Too Young For a Hair Transplant?
Written by James Harris, MD, FACS on November 25, 2008
My daughter is currently 16 years old.
She started experiencing hair loss when she hit puberty (approximately 11 years old) as well as fairly serious acne.
She has had numerous blood tests to check for various hormonal issues, but to date, no definitive diagnosis — everything appears within normal range.
Oral contraceptives have greatly improved the acne but have not helped at all with the hair loss.
Her hair loss has now stabilized (does not appear to be getting any thinner); however her hair is very thin on top (you can clearly see through to her scalp and there is no way to do a “comb over” — just not enough hair).
The hair on sides and back is fine (normally thick).
My question is:
Is she old enough to consider a hair transplant?
I’ve read that it is generally preferred to be 25 years or older (???), however I am concerned that female hair loss is a serious social burden that will be especially difficult through the remainder of her high school and college career.
I’d really like to be able to help her now.
Thanks,
Janet
- - - - - -

Dear Janet:

Thank you for your letter. Hair loss can be difficult to deal with at any age but it can be particularly hard for a young woman. Before addressing the possibility of surgery there are some other issues that should be mentioned. I think it‘s important that she had the work up to evaluate hormone levels even though it sounds as if this isn’t the primary issue related to her hair loss. Other common medical conditions that can contribute to hair loss are iron deficiency anemia and thyroid function abnormalities. She should be seen by her primary care physician to rule out these treatable causes of hair loss. If she is having any other medical signs or symptoms they should be discussed with the physician even if they seem unrelated to hair loss such as skin or nail problems as they may point to a genetic condition.
You didn’t mention if she was on any medications but if she is and the use of these medications preceded her hair loss, they could be contributing to the problem as well. Dietary issues, such as stringent dieting and low calorie intake, may be associated with hair loss.
A family history of hair loss, especially in the females, may be a contributing factor. However, even with a strong family history, it would be uncommon for a female to start having hair loss at 11 years of age due to female pattern alopecia. You might check to see if there are any females on either side of the family that experienced hair loss at a very early age.
There are conditions affecting the skin and follicles that can cause hair loss but require a biopsy for diagnosis. One example would be alopecia areata affecting the top of the scalp in a diffuse pattern. Once the diagnosis is established the doctor can make a recommendation for the most appropriate course of treatment.
As far as surgery is concerned, I don’t think it should be considered until there is a firm diagnosis of the condition and a definite lack of response to medical therapies if appropriate for the diagnosis.
It may be advisable for your daughter to consider trying minoxidil or Rogaine, but without knowing the cause of the hair loss this treatment may be ineffective and may delay the search for the actual cause.

Probably the most important piece of advice I can offer is that your daughter should be seen by a medical professional that is experienced in the diagnosis of hair loss disorders and well versed in the medical and surgical treatment of hair loss. It is very important that the reason your daughter is losing or has lost her hair is established so that the proper treatment plan can be devised.
Sincerely,
James A. Harris, MD, FACS
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

跳下去的冲动

这么多的英文，楼主辛苦了

小南瓜aini

看来还是不能盲目用药，我也得去医院看看

香烟

去医院，无非也就是那些药。保列治，蔓迪。甚至很多医生，都不知道植发这个手术。