What is alopecia, anyway?
If you look it up in a medical dictionary you will discover that it is a disease where the hair follicles attack their own hairs and the patient becomes bald. There are several different types of alopecia–from total loss of body hair to just having small bald spots appear sporadically. The causes of this illness are unclear and can be from excessive stress, rubbing or pulling excessively, medications, pregnancy, hereditary status or even illness. Children have been known to loose hair due to a very high fever that lasts longer than normal. There actually are over 30 different illnesses that can cause alopecia.
Why are we talking about alopecia now?
Although you may not be familiar with this issue, it is much more common than you think. We all are familiar with male-pattern baldness and the reason so many men shave their heads now. However, women also suffer with this condition and it is becoming more and more prevalent due to the rise in breast cancer and its treatment.
For a woman, her hair is very much tied up with her internal image of her femininity and the loss of her hair deals her a very heavy blow to her psyche. Even though men also have problems with their public image when they loose hair, women begin to feel less than a woman with this loss.
What should you know about your patient with alopecia?
If you have a female patient who has just learned she has breast cancer, it isn’t really the time to hit her in the face with “and you will lose your hair, too”. As nurses, we expect this issue to be addressed by the oncologist-but don’t count on it. Sometimes the doctors simply state that the chemotherapy will make your hair fall out but don’t worry because it will come back again. The patient takes a big breath but then lets it out because they feel assured that things will get back to normal after treatment. Well, unfortunately, that is not always so and as nurses we need to be sensitive to this growing problem some women are dealing with.
If your patient suffers from any mild form of alopecia before chemotherapy, there is a very good chance that regrowth will be slow if ever or that hair will grow back only in places. This issue needs to be addressed very carefully and if you are a patient-centered nurse you will tread softly, but you will address the issue with your patient.
When a woman loses her hair, she is embarrassed, feels afraid, is upset, feels denigrated, and can become very depressed. Doctors fail to acknowledge the loss and pain she feels because they know that it cannot be avoided and they know that the treatment will save lives. But if you ask your patient what it means to her to lose her hair, she will give you another side of this story. Unfortunately, not enough nurses out in the work force ever think to ask their patients about this aspect of having breast cancer.
How can you help your patient as a nurse, then?
First, be open and honest about the potential for hair loss. Let your patient explore her feelings about being bald. Give her a sounding board that is a safe place. Help her explore options for after she loses her hair. Scarves, hats, and wigs are plentiful in today’s society. Help her look into these various ways to dress herself so she can remain feminine and feel pretty despite the loss.
Remember that this patient will be dealing with great loss. Her grief will be huge and horrible and as her nurse you need to help her deal with this aspect of her illness even before it happens. This care plan can be explored prior to any treatment for breast cancer. Once diagnosed, you owe it to your patient to talk about this issue. Don’t make your patients have to go home and Google it. Don’t be that type of nurse.
Minoxidil is the only FDA approved medication on the market for hair loss. It must be applied twice a day directly to the scalp and takes up to six months to show any results. The real problem with using this drug is that if you stop using it, the hair that grew in may simply fall out again. To me that is a pretty poor solution to a huge problem.
Next week we will talk more about this condition and its clinical manifestation. In the meantime, why not click over to read this article and see pictures of actual patients to see how they are able to deal with this horrible blow to their psyches. This article is about a photographer in Scotland who wanted to show this condition for what it is but he had trouble finding models willing to be photographed. Read his motivation for the article and what he hopes can happen because of it.