Dear Dr. Roach: I’m a 65-year-old male. For the past five years or so, I have been losing the hair on my legs. At this point, I seem to have stabilized, with virtually no hair from my toes to the tops of my thighs; however, from my groin to my neck, I am perfectly normal. I have a full head of rather thick hair for someone my age. My doctor has tested me for poor circulation (and found it to be normal) and for low testosterone (also normal). I am in relatively good health for someone my age. I take medication for moderately elevated cholesterol, triglycerides and blood pressure; I have a slight arrhythmia and borderline Type 2 diabetes. Any idea what could be causing this, and if it is something I should be worried about?
M.D.
Your doctor has done the testing that I would recommend. I do have a couple of thoughts that might be helpful.
“Circulation” is an ambiguous term, since there are three different types of vessels that carry fluid to or from the leg: arteries, veins and lymphatics. The arteries are of the biggest concern, and I suspect that your doctor used an arterial Doppler study to examine that. The study looks for blockages in the arteries, also called peripheral arterial disease. It’s important to know if you have this condition, especially because it predisposes people to blockages of the blood vessels in the brain and heart.
It can be treated with therapies that address the whole body: better diet, smoking cessation and control of diabetes (when appropriate). Often, cholesterol and blood pressure management are part of the picture. It also can be treated by opening blood vessels, either surgically or via a procedure done within the artery. Arterial circulation problems are the most likely cause for someone with hair loss.
Venous insufficiency happens when blood vessels can’t return the blood back to the heart at low pressure, usually because of defective valves. This causes swelling, which occasionally leads to hair loss. Sometimes the Doppler studies can indicate whether there is evidence for venous insufficiency. If so, it is treated with support stockings and leg elevation. Sometimes, surgical procedures are recommended for people who don’t get better with conservative treatment.
Poor lymphatic drainage causes lymphedema, sometimes but not always associated with surgery or cancer. The leg usually is very swollen before hair loss occurs.
Thyroid disease can cause hair loss, so a simple blood test is called for. Finally, many readers have written to tell me that their hair came back after switching from pants to shorts (many of these retirees), and I suspect that in those cases tight pants may have caused damage to the hair follicles.
Dear Dr. Roach: I read your recent column on nickel allergies and joint replacement. I worry that I have a nickel allergy since I break out in a red, itchy, pimply rash from contact with the back of watches, the tabs on the waistbands of jeans and the backs of earrings. Do I need to worry about getting a replacement aortic heart valve?
T.S.
My advice for you is similar to what I said for other joint replacements: First, find out if you really have a nickel allergy. Your history is suggestive, so find an allergist who can do skin testing. If you do have a severe nickel allergy, I read one report of a surgeon who reported the use of a nickel-free ON-X aortic valve, so I know there are options.
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.
