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Talking to Your Doctor
Today, patients take an active role in their health care. You and your doctor will work in partnership to achieve your best possible level of health. An important part of this relationship is good communication. Here are some questions you can ask your doctor to get your discussion started:
About My Disease or Disorder…
- What is my diagnosis?
- What caused my condition?
- Can my condition be treated?
- How will this condition affect my vision now and in the future?
- Should I watch for any particular symptoms and notify you if they occur?
- Should I make any lifestyle changes?
About My Treatment…
- What is the treatment for my condition?
- When will the treatment start, and how long will it last?
- What are the benefits of this treatment, and how successful is it?
- What are the risks and side effects associated with this treatment?
- Are there foods, drugs, or activities I should avoid while I’m on this treatment?
- If my treatment includes taking a medication, what should I do if I miss a dose?
- Are other treatments available?
About My Tests…
- What kinds of tests will I have?
- What do you expect to find out from these tests?
- When will I know the results?
- Do I have to do anything special to prepare for any of the tests?
- Do these tests have any side effects or risks?
- Will I need more tests later?
Understanding your doctor’s responses is essential to good communication.
Here are a few more tips:
- If you don’t understand your doctor’s responses, ask questions until you do understand.
- Take notes, or get a friend or family member to take notes for you. Or, bring a tape-recorder to assist in your recollection of the discussion.
- Ask your doctor to write down his or her instructions to you.
- Ask your doctor for printed material about your condition.
- If you still have trouble understanding your doctor’s answers, ask where you can go for more information.
- Other members of your health care team, such as nurses and pharmacists, can be good sources of information. Talk to them, too
Talking With Your Doctor
Make the Most of Your Appointment
Patients and health care providers share a very personal relationship. Doctors need to know a lot about you, your family, and your lifestyle to give you the best medical care. And you need to speak up and share your concerns and questions. Clear and honest communication between you and your physician can help you both make smart choices about your health.
Begin with some preparation. Before your health exam, make a list of any concerns and questions you have. Bring this list to your appointment, so you won’t forget anything.
Do you have a new symptom? Have you noticed side effects from your medicines? Do you want to know the meaning of a certain word? Don’t wait for the doctor to bring up a certain topic, because he or she may not know what’s important to you. Speak up with your concerns.
“There’s no such thing as a dumb question in the doctor’s office,” says Dr. Matthew Memoli, an infectious disease doctor at NIH. “I try very hard to make my patients feel comfortable so that they feel comfortable asking questions, no matter how dumb they think the question is.”
Even if the topic seems sensitive or embarrassing, it’s best to be honest and upfront with your health care provider. You may feel uncomfortable talking about sexual problems, memory loss, or bowel issues, but these are all important to your health. It’s better to be thorough and share a lot of information than to be quiet or shy about what you’re thinking or feeling. Remember, your doctor is used to talking about all kinds of personal matters.
Consider taking along a family member or friend when you visit the doctor. Your companion can help if there are language or cultural differences between you and your doctor. If you feel unsure about a topic, the other person can help you describe your feelings or ask questions on your behalf. It also helps to have someone else’s perspective. Your friend may think of questions or raise concerns that you hadn’t considered.
Many people search online for health information. They use Web-based tools to research symptoms and learn about different illnesses. But you can’t diagnose your own condition or someone else’s based on a Web search.
“As a physician, I personally have no problem with people looking on the Web for information, but they should use that information not as a way to self-diagnose or make decisions, but as a way to plan their visit with the doctor,” says Memoli. Ask your doctor to recommend specific websites or resources, so you know you’re getting your facts from a trusted source. Federal agencies are among the most reliable sources of online health information.
Many health care providers now use electronic health records. Ask your doctor how to access your records, so you can keep track of test results, diagnoses, treatment plans, and medicines. These records can also help you prepare for your next appointment.
After your appointment, if you’re uncertain about any instructions or have other questions, call or email your health care provider. Don’t wait until your next visit to make sure you understand your diagnosis, treatment plan, or anything else that might affect your health.
Your body is complicated and there’s a lot to consider, so make sure you do everything you can to get the most out of your medical visits.
Tips for Your Doctor Visit
- Write down a list of questions and concerns before your exam.
- Consider bringing a close friend or family member with you.
- Speak your mind. Tell your doctor how you feel, including things that may seem unimportant or embarrassing.
- If you don’t understand something, ask questions until you do.
- Take notes about what the doctor says, or ask a friend or family member to take notes for you.
- Ask about the best way to contact the doctor (by phone, email, etc.).
- Remember that other members of your health care team, such as nurses and pharmacists, can be good sources of information.
Questions and Answers about Alopecia Areata
This publication contains general information about alopecia areata (al-oh-PEE-shah ar-ee-AH-tah). It describes what alopecia areata is, its causes, and treatment options. Information is also provided on current research. At the end is a list of key words to help you understand the terms in this publication. If you have further questions after reading this publication, you may wish to discuss them with your doctor.
Alopecia areata is just one cause of alopecia, or hair loss. This publication deals only with alopecia areata.
What Is Alopecia Areata?
Alopecia areata is considered an autoimmune disease, in which the immune system, which is designed to protect the body from foreign invaders such as viruses and bacteria, mistakenly attacks the hair follicles, the structures from which hairs grow. This can lead to hair loss on the scalp and elsewhere.
In most cases, hair falls out in small, round patches about the size of a quarter. In many cases, the disease does not extend beyond a few bare patches. In some people, hair loss is more extensive. Although uncommon, the disease can progress to cause total loss of hair on the scalp (referred to as alopecia areata totalis) or complete loss of hair on the scalp, face, and body (alopecia areata universalis).
In alopecia areata, immune system cells called white blood cells attack the rapidly growing cells in the hair follicles. The affected hair follicles become small and drastically slow down hair production. Fortunately, the stem cells that continuously supply the follicle with new cells do not seem to be targeted. So the follicle always has the potential to regrow hair.
Scientists do not know exactly why the hair follicles undergo these changes, but they suspect that a combination of genes may predispose some people to the disease. In those who are genetically predisposed, some type of trigger—perhaps a virus or something in the person’s environment—brings on the attack against the hair follicles.
Alopecia areata affects nearly 2 percent of Americans of both sexes and of all ages and ethnic backgrounds. It often begins in childhood.
If you have a close family member with the disease, your risk of developing it is slightly increased. If your family member lost his or her first patch of hair before age 30, the risk to other family members is greater. Overall, one in five people with the disease has a family member who has it as well.
Alopecia areata is not a life-threatening disease. It does not cause any physical pain, and people with the condition are generally healthy otherwise. But for most people, a disease that unpredictably affects their appearance the way alopecia areata does is a serious matter.
The effects of alopecia areata are primarily socially and emotionally disturbing. In alopecia universalis, however, loss of eyelashes and eyebrows and hair in the nose and ears can make the person more vulnerable to dust, germs, and foreign particles entering the eyes, nose, and ears.
Alopecia areata often occurs in people whose family members have other autoimmune diseases, such as type 1 diabetes, rheumatoid arthritis, thyroid disease, systemic lupus erythematosus, pernicious anemia, or Addison’s disease. People who have alopecia areata do not usually have other autoimmune diseases, but they do have a higher occurrence of thyroid disease, atopic eczema, nasal allergies, and asthma.
It is possible for alopecia areata to be inherited. However, most children with alopecia areata do not have a parent with the disease, and the vast majority of parents with alopecia areata do not pass it along to their children.
Alopecia areata is not like some genetic diseases in which a child has a 50–50 chance of developing the disease if one parent has it. Scientists believe that there may be a number of genes that predispose certain people to the disease. It is highly unlikely that a child would inherit all of the genes needed to predispose him or her to the disease.
Even with the right (or wrong) combination of genes, alopecia areata is not a certainty. In identical twins, who share all of the same genes, the concordance rate is only 55 percent. In other words, if one twin has the disease, there is only a 55-percent chance that the other twin will have it as well. This shows that other factors besides genetics are required to trigger the disease.
To learn more about the genes and other factors involved in alopecia areata risk, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) sponsored the development of an alopecia areata registry. (For more information about the registry, see “What Research Is Being Conducted on Alopecia Areata?”)
There is every chance that your hair will regrow with or without treatment, but it may also fall out again. No one can predict when it might regrow or fall out. The course of the disease varies from person to person. Some people lose just a few patches of hair, then the hair regrows, and the condition never recurs. Other people continue to lose and regrow hair for many years. A few lose all the hair on the scalp; some lose all the hair on the scalp, face, and body. Even in those who lose all their hair, the possibility for full regrowth remains.
In some, the initial hair regrowth is white, with a gradual return of the original hair color. In most, the regrown hair is ultimately the same color and texture as the original hair.
The course of alopecia areata is highly unpredictable, and the uncertainty of what will happen next is probably the most difficult and frustrating aspect of the disease. You may continue to lose hair, or your hair loss may stop. The hair you have lost may or may not grow back, and you may or may not continue to develop new bare patches.
Although there is neither a cure for alopecia areata nor drugs approved for its treatment, some people find that medications approved for other purposes can help hair grow back, at least temporarily. Keep in mind that although these treatments may promote hair growth, none of them prevent new patches or actually cure the underlying disease. Consult your health care professional about the best option for you. A combination of treatments may work best. Ask how long the treatment may last, how long it will take before you see results, and about the possible side effects.
In addition to treatments to help hair grow, there are measures that can be taken to minimize the effects of excessive sun exposure or discomforts of lost hair.
- Sunscreens are important for the scalp, face, and all exposed areas.
- Eyeglasses (or sunglasses) protect the eyes from excessive sun and from dust and debris when eyebrows or eyelashes are missing.
- Wigs, caps, or scarves protect the scalp from the sun and keep the head warm.
- An ointment applied inside the nostrils keeps them moisturized and helps to protect against organisms invading the nose when nostril hair is missing.
This is a common question, particularly for children, teens, and young adults who are beginning to form lifelong goals and who may live with the effects of alopecia areata for many years. The comforting news is that alopecia areata is not a painful disease and does not make people feel sick physically. It is not contagious, and people who have the disease are generally healthy otherwise. It does not reduce life expectancy and it should not interfere with going to school, playing sports and exercising, pursuing any career, working, marrying, and raising a family.
The emotional aspects of living with hair loss, however, can be challenging. Many people cope by learning as much as they can about the disease, speaking with others who are facing the same problem, and, if necessary, seeking counseling to help build a positive self-image.
Living with hair loss can be difficult, especially in a culture that views hair as a sign of youth and good health. Even so, most people with alopecia areata are well-adjusted, contented people living full lives.
The key to coping is valuing yourself for who you are, not for how much hair you have or don’t have. Many people learning to cope with alopecia areata find it helpful to talk with other people who are dealing with the same problems. Nearly 2 percent of Americans have this disease at some point in their lives, so you are not alone. If you would like to be in touch with others with the disease, the National Alopecia Areata Foundation (NAAF) can help through its pen pal program, message boards, annual conference, and support groups that meet in various locations nationwide. To find contact information for NAAF and other organizations that can help people with alopecia areata, see “Where Can People Find More Information About Alopecia Areata?”
Another way to cope with the disease is to minimize its effects on your appearance. If you have extensive hair loss, a wig or hairpiece can look natural and stylish. For small patches of hair loss, a hair-colored powder, cream, or crayon applied to the scalp can make hair loss less obvious by eliminating the contrast between the hair and the scalp. Skillfully applied eyebrow pencil can mask missing eyebrows.
Children with alopecia areata may prefer to wear bandanas or caps. There are many styles available to suit a child’s interest and mood. It is often helpful if a parent informs teachers, coaches, and others that the child has alopecia areata, that it is not contagious, and that the child is healthy.
For women, attractive scarves can hide patchy hair loss, and proper makeup can camouflage the effects of lost facial hair. If you would like to learn more about camouflaging the cosmetic aspects of alopecia areata, ask your doctor or members of your local support group to recommend a cosmetologist who specializes in working with people whose appearance is affected by medical conditions.
Although a cure is not imminent, researchers are making headway toward a better understanding of the disease. This increased understanding will likely lead the way to better treatments for alopecia areata and eventually a way to cure it or even prevent it.
The National Institutes of Health (NIH) and other organizations support research into the disease and its treatment. Here are some promising areas of research:
- Developing animal models. This is a critical step toward understanding any disease, and much progress has been made. By studying mice with problems similar to those encountered in human alopecia areata, researchers hope to learn more about the mechanism of the disease and eventually develop treatments for the disease in people.
- Studying hair follicle development. By studying how hair follicles form, develop, and cycle through growth and resting phases, researchers hope to gain a better understanding of hair growth cycle biology that may lead to treatments for the underlying disease process.
- Understanding stem cell biology. Epithelial stem cells are immature cells that are responsible for regenerating and maintaining a variety of tissues, including the skin and the hair follicles. Stem cells in the follicle appear to be spared from injury in alopecia areata, which may explain why the potential for regrowth is always there in people with the disease. By studying the biology of these cells, scientists hope to gain a better understanding of factors that trigger the disease.
- Finding genes. Scientists have identified genetic variations associated with the development of alopecia areata. They also discovered that alopecia areata has genetic similarities to other autoimmune diseases, namely type 1 diabetes, rheumatoid arthritis, and celiac disease. An understanding of the genetics of the disorder will aid in disease prevention, early intervention, and development of specific therapies. To assist researchers searching for such genetic clues, the NIAMS supported the development of the National Alopecia Areata Registry, a network of five centers, to identify and register patients with the disease and collect information and blood samples (which contain genes). Data, including genetic information, is made available to researchers studying the genetic basis and other aspects of the disease and disease risk. For more information, log onto the registry website at www.AlopeciaAreataRegistry.org.
More information on research is available from the following resources:
- NIH Clinical Research Trials and You helps people learn more about clinical trials, why they matter, and how to participate. Visitors to the website will find information about the basics of participating in a clinical trial, first-hand stories from actual clinical trial volunteers, explanations from researchers, and links to how to search for a trial or enroll in a research-matching program.
- ClinicalTrials.gov offers up-to-date information for locating federally and privately supported clinical trials for a wide range of diseases and conditions.
- NIH RePORTER is an electronic tool that allows users to search a repository of both intramural and extramural NIH-funded research projects from the past 25 years and access publications (since 1985) and patents resulting from NIH funding.
- PubMed is a free service of the U.S. National Library of Medicine that lets you search millions of journal citations and abstracts in the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and preclinical sciences.
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health
National Center for Complementary and Integrative Health
National Institutes of Health
National Alopecia Areata Foundation
American Academy of Dermatology
American Hair Loss Council
Addison’s disease. A condition that occurs when the adrenal glands (a pair of glands situated on top of the kidneys) fail to secrete enough corticosteroid hormones. Without treatment, the disease can be fatal.
Alopecia areata. An autoimmune, often reversible disease in which loss of hair occurs in sharply defined areas usually involving the scalp or beard, but any area of the body where hair grows can be affected.
Alopecia areata totalis. A form of alopecia areata characterized by the total loss of hair on the scalp.
Alopecia areata universalis. A form of alopecia areata in which all hair on the scalp, face, and body is lost.
Autoimmune disease. A disease that results when the immune system mistakenly attacks the body’s own tissues. Rheumatoid arthritis, systemic lupus erythematosus, and type 1 diabetes are autoimmune diseases (“auto” means self).
Diabetes. A disease in which the body does not produce or properly use insulin, a hormone that is necessary to convert sugar, starches, and other food into energy.
Hair follicle. A small, narrow, tube-like structure in the skin from which hair grows.
Immune system. A complex network of specialized cells and organs that work together to defend the body against attacks by “foreign” invaders such as bacteria and viruses. In some autoimmune conditions, it appears that the immune system does not function properly and may attack the body’s own tissues by mistake.
Pernicious anemia. A potentially dangerous form of anemia, usually caused by an autoimmune process, which results in a deficiency of vitamin B-12.
Rheumatoid arthritis. An autoimmune disease that targets primarily the membrane lining the joints, leading to pain, stiffness, swelling, and joint deformity.
Systemic lupus erythematosus. A chronic autoimmune disease of the connective tissue that can attack and damage the skin, joints, blood vessels, and internal organs.
The NIAMS gratefully acknowledges the assistance of the following individuals in the preparation and review of previous versions of this publication: George Cotsarelis, M.D., University of Pennsylvania Medical Center, Philadelphia, PA; Vicki Kalabokes, National Alopecia Areata Foundation, San Rafael, CA; Alan Moshell, M.D., NIAMS/NIH; and David Norris, M.D., University of Colorado Health Sciences Center, Denver, CO. A special acknowledgement goes to Vera Price, M.D., University of California, San Francisco, CA, for assistance in the preparation of an updated version of this publication. Mary Anne Dunkin was the original author of a previous version of this publication.
For Your Information
This publication contains information about medications used to treat the health condition discussed here. When this publication was developed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released.
For updates and for any questions about any medications you are taking, please contact
U.S. Food and Drug Administration
Toll Free: 888-INFO-FDA (888-463-6332)
For additional information on specific medications, visit Drugs@FDA at www.accessdata.fda.gov/scripts/cder/drugsatfda. Drugs@FDA is a searchable catalog of FDA-approved drug products.
For updates and questions about statistics, please contact
Centers for Disease Control and Prevention, National Center for Health Statistics
This publication is not copyrighted. Readers are encouraged to duplicate and distribute as many copies as needed.
Dental Erosion: How to Protect Your Teeth From Acid-Damage
Dental erosion is a form of tooth wear – where enamel and then dentin is worn down (the other forms, abrasion and attrition are discussed here). It is defined as irreversible damage to the teeth caused from chemicals (usually acids).
This acid can come from outside sources (e.g. food and drink) or from inside the body; these are explained below.
Common Causes of Erosive Damage
1. Outside Sources of Acids:
Acid is present in lots of foods and drinks, e.g.:
- Fruits and fruit juices, in particular citrus fruits such as oranges and lemons. Common cause in children
- Sodas/fizzy drinks, including ‘diet’ soft drinks. A major cause!
- ‘Sports drinks’.
- Alcohol consumption, including wine and ‘alcopops’.
- Medicines such as iron supplements and chewable vitamin C.
Rarer sources include factories with acids in the air and chlorine from swimming pools.
2. Inside Sources of Acid:
The acid that causes erosion may also come from stomach fluids inside the body. Acid reflux is where stomach fluids come up towards the throat and mouth. It is often felt as ‘heartburn’ after eating. There are several gastric disorders that can lead to reflux.
Vomiting will also expose the mouth to gastric acid. Frequent episodes of vomiting through illness, alcoholism or eating disorders such as bulimia can cause enamel erosion. Pregnancy may also increase the risk of damage through acid reflux and vomiting associated with morning sickness.
How To Prevent Damage
As with most types of dental diseases, tooth erosion can usually be prevented. The following tips contain general advice on how to prevent the problem. If you have damage already, you will need to pay particular attention to the causes of it, and avoid what is causing it!
- Reduce the overall amount of acidic food and drinks you consume. Also limit these to mealtimes only, if you do consume them. This is to reduce the amount of time that your mouth is under acid-attack each day.
- If taking acidic drinks, best to drink them quickly, again to limit the time your mouth is under attack. Don’t whirl the drink around your mouth or hold the drink in your mouth for long. The use of a straw can help keep the acid away from the teeth better (also good for reducing risk of decay). Chilling acidic drinks also reduces the harm they do.
- After taking an acidic food or drink; drinking milk, water or rinsing your mouth out with water (or a fluoride mouthwash) can help neutralize the acid quicker.
- Chewing sugar-free gum after eating can have a similar effect, by increasing saliva flow which helps neutralize acids.
- Do not brush your teeth immediately after taking acidic foods or drinks. Wait for at least 30 minutes, otherwise you will be increasing damage by brushing when tooth surfaces are ‘softer’ from the chemical attack.
- The same advice as above applies to what to do after any vomiting episodes. In particular, rinse your mouth out after vomiting but do not brush for at least 30 minutes.
- Brush your teeth gently twice a day using fluoride toothpaste. Some new formulations of toothpaste are available for enamel repair. Tooth mousse is similar to toothpaste, but is a little stronger. However these are not a ‘miracle’ cure for dental erosion; the key message is to eliminate whatever is causing the damage.
Dental Erosion Symptoms
The symptoms can vary depending on what type of tooth-wear you have, but common signs include:
- Appearance. The effect will depend on the type of tooth wear, but can include chipping away of the edges and increased transparency of the tips of front teeth. The surfaces may appear smooth, rounded and ‘polished’ (see image above).
- Sensitivity to hot and cold. This can occur when the outer protective enamel wears away exposing the more sensitive dentine. Sensitivity does not always occur, especially if the wear is progressing slowly.
- Changes to your bite.
- Fillings may stand out from the surrounding tooth surfaces- a classic diagnosis marker.
- Gum recession and wearing down of the teeth at the gum-margin (in abrasion and abfraction).
- Overall flattening of the teeth (with attrition).
Dental Erosion Treatment
If you think you have this, or some other form of tooth-wear, visit your dentist. Your dentist will help you to first identify the sources of any damage (via a risk assessment) and advise you on how to eliminate these causes.
Treatment is not always needed, particularly if any enamel wear is minor. In this case, preventive measures are all that is needed, but these are very important. Keep attending the dentist for check-ups and follow any advice given. Regular check-ups allow your dentist to monitor the progression of any damage and best diagnose if and when any therapy is needed.
Treatment will be needed if enamel wear has caused significant loss of the tooth structure and/or is causing problems such as sensitivity and cosmetic defects. Any treatment will depend on the extent and position of any damage.
Treatment aims are to:
- Repair cosmetic appearance if this has been affected.
- Reduce sensitivity by protecting and covering the dentine.
- Help reduce further damage from tooth-wear.
Treatment options may include:
- To help treat sensitivity the dentist may place fluoride gels or varnishes and advise fluoride toothpastes and mouthwashes.
- Repairing tooth enamel loss with white filling materials.
- In the case of extensive damage, fixing veneers or crowns may be necessary.
- Replace missing teeth.
- You may need a bite guard if bruxism is also a factor.
If in any doubt contact your dentist. If left untreated, tooth-wear can cause severe damage. Tooth surface loss from dental erosion and other tooth wear can be very difficult to treat