Quarter-sized bald patches covered the top and back of her scalp and, at one time, grew to the size of oranges at the front of her head.

"It was traumatic at the time," said Black, who purchased a hairpiece, wore a baseball cap for six months, and only confided in co-workers so they wouldn’t think she had cancer. What she suffered from was alopecia areata, an autoimmune deficiency that causes balding.

"This was benign and it would get better," she said. "(But) it’s not a pretty sight to walk around with the front of my hair gone."

From strands shedding in the comb or sink, thinning around the edges or balding spots, more women are experiencing hair loss at younger ages. Many of the conditions are temporary and can be reversed, but others are permanent and often lead to a loss of self-esteem.

"It’s a very neglected epidemic," said Spencer Kobren, founder of the American Hair Loss Association, a non-profit education and consumer advocacy organization. "We call it a disease of the spirit because it tears away at the very fabric of a woman’s being."

According to the American Academy of Dermatology, more than 30 million women suffer from hair loss. Many never regrow the hair. The condition, referred to as androgenetic alopecia or female-pattern baldness, affects 25 percent of pre-menopausal women and 38 percent of post-menopausal women. Visible hair loss symptoms appear in 40 percent of women by age 40.

Usually, a woman loses about 100 hairs a day, with the hair regenerating at a rate of about one-half inch each month. But if she suffers from female-pattern baldness, her hair grows back thinner, shorter and finer until there is little or no growth at all. When she parts her hair in the center, there is a much broader path; the part will continue to grow wider in the front and back. The edges of the hair may remain thick and full, but the hair behind it thins.

Unlike male-pattern baldness, female-pattern baldness occurs around the entire top of the head.

Seventy percent of thinning hair can be attributed to heredity — from one or both parents — but other factors play a role, such as medication, diet, stress, illness and pregnancy. Iron deficiency, hormonal imbalance, and poor hair care also attribute to hair loss.

Kobren said that one of the largest factors is the widespread use of birth control pills, especially by women at an earlier age.

"Women are screwing with their hormones younger in life and besides the other problems, it’s causing hair loss," he said. If women who are predisposed to hair loss knew that there was a strong possibility that they could lose their hair, they would choose another form of birth control, he said.

Successful treatment requires getting to the root of the problem with early diagnosis.

Once you recognize that you are losing your hair, go to someone who can do a hair loss work-up, said Edmond Griffin, an Atlanta dermatologist. The sooner the treatment, the greater the chances of good results, he said.

"(Women) hear about hair weaves and hair extensions from their stylists, but they don’t hear about hair work-ups," said Griffin.

A work-up includes a thorough examination of the head, scalp, nails and skin (checking for acne or excess hair ) and blood work that includes hormone, iron and thyroid evaluations, he said. As a last resort, a biopsy may be ordered to detect medical conditions such as lupus, scarring problems or immune problems.

Diet may reverse problems such as iron or hormonal imbalances, but in most cases, medication is required to help stop the shedding and balding. (NYT)