A woman aged 59 years complains of thinning hair on her scalp. She has been on a vegetarian diet for the past two years and takes no prescription medications but is currently on hormone replacement therapy. Could her diet be causing hair loss? — Anne Rich, CNP, St. Cloud, Minn.

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Diffuse hair loss in postmenopausal women may be multifactorial. Hair density decreases with age. Menopause can be associated with changes in hair growth rate, percentage of anagen hairs and hair diameter; all of these changes heighten the perception of decreased scalp coverage in postmenopausal women (Br J Dermatol. 2011;165[Suppl 3]:2-6 and Br J Dermatol. 2011;165[Suppl 3]:7-11). Indeed, androgenic alopecia may worsen following menopause, and such other causes of hair loss as telogen effluvium may be superimposed upon female-pattern hair loss.

Diffuse telogen effluvium hair loss may be triggered by physiologic stress, emotional stress, medical conditions and diet. Deficiency of zinc, iron, vitamin D, biotin or essential fatty acids can result in diffuse telogen hair loss. Telogen hair shedding can also be precipitated by malabsorption syndromes, crash dieting and chronic starvation associated with severe restriction of calories, fatty acids and protein (Cleveland Clinic J Med. 2009;76:361-367; available at www.ccjm.org/content/76/6/361.long, accessed June 15, 2012).

Although alopecia areata (and it variants alopecia totalis and alopecia universalis) are less common in postmenopausal women, trichotillomania — associated with such concomitant conditions as depression, anxiety disorders, obsessive-compulsive disorders, panic attacks and psychosis — is being observed more commonly in older women (Chen W et al. Eur J Dermatol. 2010;20:145-151, accessed July 24, 2012). — Philip R. Cohen, MD (165-4)

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