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Q: Leg-hair loss ( Answered 3 out of 5 stars,   2 Comments )
Subject: Leg-hair loss
Category: Health > Conditions and Diseases
Asked by: tibetan-ga
List Price: $30.00
Posted: 14 Jan 2006 02:25 PST
Expires: 13 Feb 2006 02:25 PST
Question ID: 433243
I am a 40 year old man and I have suddenly lost all of the hair on my
lower legs, around the calves and ankles. The hair was quite thick and
now there is just shiny smooth skin in a very definate area. No rash,
no infections (eg. ringworm)the area stands out from surrounding leg
hair. Can you help with what might cause this? I had heard it may be
related to either thyroid imbalance or diabetes?
Subject: Re: Leg-hair loss
Answered By: crabcakes-ga on 14 Jan 2006 11:05 PST
Rated:3 out of 5 stars
Hello Tibetan, 

   Hair loss on the legs can be caused by several reasons, from
serious to comical. Poor circulation is the primary cause, which can
be caused or aggravated by diabetes, thyroid disorders, peripheral
artery disease, medications, poor diet, lack of exercise, smoking,
being overweight among others.

   To properly diagnose your condition, and to rule out a serious
condition, you need to be evaluated and tested by a licensed
physician. If necessary, s/he can then refer you to a cardiologist or

Diabetics have a higher incidence and prevalence of large vessel
disease,(31) and develop myocardial infarctions and strokes at a much
younger age than their non-diabetic counterparts. Large vessel disease
(atherosclerosis) may also be present in the lower extremities and
result in skin atrophy, hair loss, coldness of the toes, nail
dystrophy, pallor upon elevation, and mottling on dependence.?


PAD (Peripheral artery disease) is a possible cause of your leg hair
loss. Do you have any other symptoms?
?	 Lower-leg pain that comes on with walking and subsides with rest
?	Lower-leg pain that is worse when you are lying in bed at night or
when legs are elevated
?	Numbness or coldness of toes, feet, or lower legs
?	Pale, hairless, mottled, scaly, or shiny skin on the calves, ankles, or feet
?	Brittle toenails
?	Lower-leg ulcers or hard-to-heal cuts and scratches

Feet with an inadequate blood supply are very susceptible to
infections that can develop into ulcers or even gangrene. If you have
poor circulation in the legs or feet, especially with diabetes:
?	Wash feet daily with gentle soap and blot dry; then apply moisturizing lotion.
?	Wear well-fitting, low-heeled, comfortable shoes that protect the
feet and don't rub or bind. Avoid high heels and open-toed sandals.
?	Keep feet dry; dampness can encourage fungal infections such as
athlete's foot. Wear breathable wool or cotton socks, and treat fungal
infections promptly.
?	Trim toenails carefully, or have them professionally trimmed by a
podiatrist, especially if they are thickened. Never cut corns or
calluses or use drugstore remedies on them without approval of the
doctor or podiatrist.
?	Check feet frequently for small injuries or irritation, especially
if you have poor sensation in the feet or toes. Don't let small
problems turn into large ones.

?Other symptoms of peripheral vascular disease may include:
?	changes in the skin, including decreased skin temperature, or thin,
brittle shiny skin on the legs and feet
?	diminished pulses in the legs and the feet
?	gangrene (dead tissue due to lack of blood flow)
?	hair loss on the legs
?	impotence
?	non-healing wounds over pressure points, such as heels or ankles
?	numbness, weakness, or heaviness in muscles
?	pain (described as burning or aching) at rest, commonly in the toes
and at night while lying flat
?	pallor (paleness) when the legs are elevated
?	reddish-blue discoloration of the extremities
?	restricted mobility
?	severe pain
?	thickened, opaque toenails
The symptoms of peripheral vascular disease may resemble other
conditions. Consult your physician for a diagnosis.?

   ?To assess the condition of your client's legs, note how he
positions them: Are they dependent or elevated? Does he cross them at
the knee or ankle? Does he have evidence of previous misaligned
fractures? All these factors can affect blood flow. Also check the
skin condition, including appearance (thin, shiny, or dry), nail
texture (thick, brittle, or normal), and hair distribution (especially
hair loss, which may occur distal to an occlusion). Characteristic
skin changes of venous PVD include bulging ankles, mottled skin,
visible veins, and current or healed ulcers.?

   ?History and Physical Examination. Patients with arterial ulcers
typically are older than 45 years. They give a history of intermittent
claudication, limb pain at rest, or severe ulcer pain. Pain may worsen
when the leg is elevated and improve when it is dependent. Arterial
ulcers arise after minor trauma and occur over bony prominences. They
are well-demarcated with a dry necrotic base. Associated findings
include weak or absent peripheral pulses, prolonged capillary
refilling time, pallor on limb elevation, dependent rubor, hair loss,
thickened nails, and shiny, atrophic, dry, and cold skin.?

   ?A number of systemic conditions can lead to lower extremity
ulcers. The most common etiology is vascular, such as peripheral
arterial disease or venous disease. By the time a patient develops an
ulcer, the vascular disease process is well under way.

Peripheral arterial disease is a slow and insidious disease process
that affects an estimated 8 to 12 million Americans, and the incidence
continues to increase yearly.1'2 As many as 20% of Americans over age
65 are affected by peripheral arterial disease; of those, only 25%
receive treatment.3 Many individuals with peripheral arterial disease
are asymptomatic. An estimated 10.5 million of those with the disease
are symptomatic; another 16.5 million are asymptomatic.2 Results of
studies on lower extremity ulcers report a prevalence ranging from
0.12% to 1.8%.4

Diagnosis of the disease is often overlooked because patients and
primary care providers (PCPs) are unaware of the disease in its early
stage. It has been shown that PCPs have little knowledge of peripheral
arterial disease and treatment.5 Better education about peripheral
arterial disease would equip PCPs to assess and diagnose patients
early, before the disease becomes limbor life-threatening.?

Alopecia Areata
    ?Not all cases are obvious, and in these the dermatologist must
take a small skin biopsy plug (a small piece of skin less than a 1/4
inch in diameter) for microscopic examination. Habitual hair pulling
(trichotillomania), scalp fungus (black-dot ringworm) and other skin
diseases (lichen planopilaris, cutaneous lupus and telogen effluvium)
cause the most confusion.?

?There is no actual loss of hair follicles (i.e. the "root") even in
the hairless lesions. The follicles are not producing visible hairs
because of the attacking white cells that surround the root. Hair
follicles are capable of taking a lot of punishment. Despite the
attack by immune cells the hair follicles usually remain capable of
re-growing even after years of attack. However in severe cases this
becomes less and less likely as years pass.?

?What causes alopecia areata
Current evidence suggests that alopecia areata is caused by an
abnormality in the immune system. This particular abnormality leads to
autoimmunity. As a result, the immune system attacks particular
tissues of the body. In alopecia areata, for unknown reasons, the
body's own immune system attacks the hair follicles and disrupts
normal hair formation. Biopsies of affected skin show immune cells
inside of the hair follicles where they are not normally present. What
causes this is unknown. Alopecia areata is sometimes associated with
other autoimmune conditions such as allergic disorders, thyroid
disease, vitiligo, lupus, rheumatoid arthritis, and ulcerative
colitis. Sometimes, alopecia areata occurs within family members,
suggesting a role of genes and heredity.?

   ?Most people who have alopecia areata do not have any other medical
condition, but a small proportion do. The exact nature of the
association between these other medical conditions is not clear, but
the association is considered correlational and not causal; that is we
can say there is a link between alopecia areata and another condition;
but we cannot say that one condition causes the other.?

?Case studies have been reported of persons with alopecia areata who
have developed other autoimmune diseases such as lupus erythematosus,
rheumatoid arthritis, pernicious anemia, scleroderma and ulcerative
colitis. The chances of someone with alopecia areata developing one of
these diseases is very low and routine lab tests for these diseases
are not indicated. However, if a patient with alopecia areata develops
unexplained medical symptoms, he or she should go to their doctor and
ask if their hair condition might be related. There appears to be a
higher incidence of diabetes mellitus and rheumatoid arthritis in the
family members of patients with alopecia areata rather than the actual
patients with alopecia areata.?


   While thyroid problems can cause hair loss, it is typically head
hair, not leg hair that is affected. However, a visit to your doctor
for an exam and thyroid and glucose testing is essential.

Common problems with an underactive thyroid and too little thyroid hormone 
?	feeling tired and listless 
?	feeling chilly, especially when other people are comfortable 
?	dry skin 
?	hair loss 
?	constipation 
?	slow-growing and brittle fingernails 
?	slow heart rate 
?	leg cramps 
?	sore muscles 
?	depression 
?	for women, heavier periods 
?	for men, loss of interest in sex, erectile dysfunction 
?	weight gain due to fluid retention, but usually no more than 3-4 pounds

   ?Alopecia areata is sometimes associated with other conditions
(allergic disorders, thyroid disease, vitiligo, lupus, rheumatoid
arthritis, ulcerative colitis). Some cases occur within family members
and indicate a genetic basis.
The characteristic diagnostic finding of alopecia areata is the
exclamation point hair. These can be found in areas of hair loss and
are short broken off hairs that are narrower closer to the scalp and
therefore mimic an exclamation point. In some cases a biopsy is
necessary for diagnosis.
In about half of those affected, the hair regrows within a year
without any treatment. The longer the period of time of hair loss, the
less chance that it will regrow and a variety of treatments can be
tied. Steroid injections and cream to the scalp have been used for
many years. Other drugs include minoxidil, irritants, and topical
immunotherapy which may be used in different combinations.?

   ?This sounds like alopecia areata of the legs. The same smooth,
hairless patches that occur on the scalp or face can affect the legs.
I can't think of another condition which would look like this. No
treatment is likely to be useful. As with any case of alopecia, most
people who have this aren't ill otherwise. It's pretty common--many
who have it don't notice it because it's not in a
cosmetically-sensitive location, or else there's not enough
surrounding hair to make the contrast noticeable.

If your liver enzymes are normal, they're normal. Transient liver
enzyme elevations are common and of no significance if they return to
normal levels. Three confirmations seems like enough to me.
Dr. Rockoff?

   ?At the base of the follicle is thepapilla, which is the "hair
manufacturing plant." The papilla is fedby the blood-stream which
carries nourishment to produce new hair. Male hormonesor androgens
regulate hair growth. Pubic and axillary (armpit) hair areparticularly
androgen-sensitive and grow at lower androgen levels than hair onthe
chest or legs. In boys, most pubic hair is grown by age 15, followed
by thedevelopment of armpit hair two to three years later. In girls,
too, an increasein androgens at puberty triggers growth of pubic and
armpit hair. Scalp hair,not directly androgen-responsive, is
influenced by local amounts of atestosterone derivative,

Non-serious causes:

   Have you recently begun to exercise, march, walk,  bicycle, or
perform any activity that causes your pants to rub or cause friction
on your calves and ankles? Have you recently begun to wear a new,
rougher type of sock, boot or pants?

   I realize you don?t wear curlers or rubber bands on your legs (Or
likely not at all!), but the concept is the same:

   ?TRACTION ALOPECIA Traction alopecia is a non-inflammatory
patterned hair loss syndrome in which the pattern of loss is related
to pulling or friction on specific areas of the scalp. It is usually
caused either by hair styles in which the hair is pulled into tight
braids or held too tightly by rubber bands, or by frequent use of
electronic headsets (e.g., Walkman radios, hands-free telephones,
etc.) for long periods of time. The tension or rubbing damages the
hair shafts and hinders the growth of new hair. In some cases the use
of tight hair rollers at night or frequent use of blow dryers on high
settings contributes to hair loss from traction alopecia.?

?Like skin cells, hair grows and is shed regularly. Shedding anywhere
from 50 to 100 hairs per day is considered normal. The average rate of
growth is about 1/2 inch a month. It is now known that hair grows
fastest in the summer, slowest in the winter, speeds up under heat and
friction, but slows down when exposed to cold. Hair grows the best
between the ages of 15 to 30. But, hair growth begins to wind down
sometime between the ages of 40 and 50. Progressive hair loss begins
naturally in both sex about age 50, accelerating in the 70s. About 40
percent of Caucasian men lose hair to some extent by age 35."*

   Many years ago, I worked in a Doc-in-the-box clinic. A concerned
mother brought in her teenage daughter who was ?suffering? from a
mottles blue condition from her waist down, particularly  in the legs,
stopping just below the ankles. The feet were of normal coloration.
The new young doctor who examined he became tremendously worried,
thinking of the worst ? heart disease, embolism, aneurysm, etc. He
called in the older, most experienced doctor, who took a look, not at
the girl but her brand new unwashed blue jeans. With an alcohol swab
he removed a streak of blue discoloration from her leg! The eager
young doctor turned red! My point is, friction can be causing your
hair loss, and not necessarily any of the more serious conditions

  I hope this has helped you out! I urge you to make an appointment
with your doctor. What a blessing to rule out anything serious. Should
 your hair loss be related to thyroid, diabetes, or PAD, it?s best to
find out as soon as possible to get treatment!

I wish you the best of luck! Please request an Answer Clarification,
and allow me to respond, before you rate, should any part of my answer
is unclear.

Sincerely, Crabcakes

Search Terms
Alopecia Areata
Alopecia + lower extremities
hair loss + calves + ankles
hair loss + calves + ankles + shiny skin
friction + hair loss
diabetes + hair loss + leg
Thyroid disorders + loss + leg hair

Request for Answer Clarification by tibetan-ga on 14 Jan 2006 16:38 PST
Hi Crabcakes,
Many thanks for all the info.

I run regularly, 20 miles per week. I don't drink, smoke or eat fried
food or red meat. I workout 3 times per week at the gym and am more
slim than fat (160lbs) so I feel I can rule out many parts of the
answer. Had glucose tested and its good. Thyroid Free T3 was elevated
but doctor didnt know why this hormone would be high on its
own...maybe that shows hyperthyroid?

Waking real tired and heavy also, so maybe that is it.

Clarification of Answer by crabcakes-ga on 14 Jan 2006 16:51 PST
Well, you certanly sound healthy! I would still have a thyroid panel,
not just T3 run.

In anycase, since you are running 20 miles a week, perhaps your socks
or pants have caused a friction hair loss. Sound slike you have ruled
out most other causes! I'm hoping for your sake that this is a
transient problem and that your hair regrows!

Regards, Crabcakes
tibetan-ga rated this answer:3 out of 5 stars

Subject: Re: Leg-hair loss
From: politicalguru-ga on 14 Jan 2006 02:29 PST
"I had heard it may be related to either thyroid imbalance or
diabetes" - my thought exactly before reaching this final line. You
should visit an endocrinologist promptly.
Subject: Re: Leg-hair loss
From: q_juno-ga on 14 Jan 2006 06:35 PST
Let me add to Politicalguru's comment - endocrinologist appointments
can be hard to come by, and may require a referral from a primary
Your leg hair loss may be due to peripheral vascular problems (which
are frequently due to Diabetes, of course), and you should visit any
medical-type physician - Internist, Cardiologist, Family Practice,
etc. - PROMPTLY!

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