異常掉髮防治
楊惟婷
維持頭髮健康，需要注意良好的生活作息，健康均衡的飲食及正確的護髮觀念，若發現有異常掉髮情形而且持續達數周，就需要找醫師做適當的診治。
一、影響掉髮之因素
事實上，頭髮除了正常的成長—休止循環，導致掉髮的原因為多重因子所致，而非單一因素造成，針對掉髮問題，一定要先確認有哪一些觸發因素，包括壓力過大、有抽菸習慣、經常熬夜、生活作息失調，或飲食不均衡營養……等原因。
基本上，要改善掉髮情形，最好儘快改善不良的習慣，讓生活、飲食等作息調整到良好，從生理狀況先改變，由內而外，再選擇適合平時使用的洗髮精或髮皂，進行保養清潔與抑菌。
二、自我檢測異常掉髮
一般來說，每天的掉髮量在100根內是不需要擔心的。
所以，自我檢測異常掉髮狀況的方法包括：
1、數掉落的頭髮每天超過100根；
2、輕抓自己的頭髮每次都有超過兩根以上的掉髮；
3、頭髮中間的分線越來越寬；
4、察覺頭髮越來越細。
三、導致異常掉髮的主要原因
1、不適當的美髮與護髮
染髮、燙髮若次數太頻繁，則頭髮可能變得脆弱容易斷裂。
髮型方面喜歡綁馬尾或者編髮的人，最好不要拉得太緊，且應當適時變換較鬆散的髮型，以免因持續拉扯造成掉髮。
頭髮梳洗若過於頻繁，也可能導致頭髮斷裂。頭髮濕的時候較脆弱，此時宜避免大力梳理。
梳子宜選購寬距且齒尖較圓滑者。
2、雄性禿
又稱為遺傳性禿髮，是異常掉髮最常見的原因。其遺傳可來自父系或母系(觀其外公或母舅)。
女性患者在更年期以前由於有女性賀爾蒙的保護作用，通常只是頭頂毛髮變得較稀薄，不至於如男性般變成禿頭。
雄性禿發生的年紀理論上從青春期以後即可開始，臨床上也偶爾會看到十六、七歲的年輕患者。
病因一般認為與皮膚的毛囊系統製造過多的強烈男性賀爾蒙有關。
雄性禿目前並無法根治，迄今經醫學臨床證實有效的藥物只有口服的柔沛與外用的落健生髮水兩種; 前者主要是抑制男性賀爾蒙的生成，後者則可直接刺激毛囊細胞生長。可依嚴重程度搭配使用，效果更佳。
3、圓禿
圓形禿髮，顧名思義就是形狀如銅板大小或更大，界線鮮明的禿髮，頭皮並無其他發炎症狀或疤痕。由於其掉髮常常在不知不覺中進行，且表面光滑，掉的幾乎一根都沒有，因此俗稱”鬼剃頭”。
圓禿病因目前不明，可能與免疫系統失調有關，有些學者認為是一種自體免疫性疾病。不過患者除了掉髮以外，通常身體的一般健康狀況是完全正常的。由於輕微的圓禿多半會自行恢復，治療上可輔以皮質類固醇的外用擦劑或頭皮局部注射，加速其恢復的過程。
4、產後掉髮
孕婦由於女性賀爾蒙的影響，比較多的毛囊處於生長期，因此頭髮比懷孕前較少掉落。產後因為女性賀爾蒙的驟然改變，許多頭髮會同時進入休息的狀態，在兩、三個月之後大量掉落，形成所謂的「產後掉髮」，一般約持續二至六個月，多半會自行恢復，完全恢復約需半年至一年的時間。
5、重病
嚴重的感染、如流行性感冒發高燒，接受大形手術，車禍外傷或其他重病住院之後一至三個月，掉髮會明顯增加，一般持續幾個月後多可自行恢復，不需要任何治療。
其他一些嚴重的慢性疾病，如肺結核、肝硬化、糖尿病等，則可能會有持續掉髮的現象。
6、梅毒性禿髮
感染梅毒數月之後進入二期梅毒，此時可發生兩種不同的禿髮型式，一是所謂「蠹食型禿髮」，如蟲咬般出現多個散在的禿髮斑點，另一種是「瀰散型的掉髮」。
7、頭癬
頭髮被黴菌(皮癬菌)感染也會發生掉髮禿髮。依據不同的菌種，發炎紅腫的程度不一，嚴重時會導致「瘢痕性禿髮」。好發於小孩，多因飼養寵物如貓、狗、天竺鼠、小白兔等而被傳染。
8、藥物
有些內服藥會導致掉髮; 如癌症接受化學治療、治療痛風的秋水仙素、或水銀中毒，很快在服藥後一至三個星期就發生大量掉髮。
另一類型則約在服藥後二、三個月才產生掉髮的現象，如治療乾癬的維生素A酸衍生物、某些精神安定劑/止吐劑/抗憂鬱劑、治療躁鬱症的碳酸鋰、治療深部靜脈栓塞的肝素等。
服用避孕藥的婦女，若家族中有雄性禿的遺傳，則服藥期間可能掉髮會增加，此時可考慮改換別類的避孕藥。此外在停止使用避孕藥後二至三個月可能會發生類似產後掉髮的情形。
9、內分泌與新陳代謝
包括甲狀腺亢進或低下，泌乳素太高，卵巢或腎上腺腫瘤導致的男性賀爾蒙太高，都可能使掉髮增加，尤其是女性，須特別注意。
此外，女性也有可能因缺鐵性貧血或紅斑性狼瘡而導致明顯禿髮。
10、營養障礙
蛋白質的攝取不足時，如吃減肥餐體重急速減輕的人，可能在二至三個月後產生大量掉髮的現象。
預防之道，是減肥時維持足夠的蛋白質攝取。
11、拔毛癖
常見於學齡兒童或青少年，患者會不由自主地拔扯自己的頭髮、眉毛或睫毛。有些是不良的習慣，有些則是因為有心理方面的問題或壓力，此時往往需要專業人士的協助。
四、異常掉髮的處理
禿髮有很多成因，許多禿髮問題有遺傳傾向，但目前還沒有確切找到造成異常的基因。最常見的禿髮是雄性禿，四十歲的男性約有兩成出現明顯的禿髮。
此外還有免疫系統疾病、營養缺乏、服用藥物、荷爾蒙異常、感染等等所造成的禿髮疾病。
熬夜或壓力也會造成短暫性的掉髮，但很少造成長期性的禿髮。
女性也常見缺鐵性禿髮，需要注意飲食或補充營養劑。
研究也發現抽菸與嚴重的禿頭是有關聯性的。
基本上，導致異常掉髮的原因很多，特別是女性患者，常常不只單一因素的影響。一般民眾若注意到有不正常掉髮或禿髮的情形，宜儘速尋求皮膚科專科醫師的協助。
一般而言，醫師多會先詢問患者最近半年來的健康狀況(有無重大疾病)、營養攝取(有無偏食或減肥)、服用藥物、家族史中禿髮的情形以及護髮(包括洗髮、染髮、燙髮)的過程。
在檢查頭髮及頭皮的狀態之後，皮膚科醫師有時會拔取60至100根頭髮在顯微鏡下觀察其變化，必要時則進一步作皮膚切片的病理檢查。
尤其女性方面，則會再評估其內分泌的狀態，包括其月經週期、是否曾經懷孕、是否已經進入更年期，有時還須要抽血檢查。
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