Jan. 5, 2011 -- Kayla Martell, crowned Miss Delaware in June, will have to prove she has the confidence and poise to become Miss America at its annual pageant next week.
But many people argue that she has already done just that by appearing in several photos and interviews with her bald head out in the open for the world to see.
Martell suffers from alopecia areata, an autoimmune disorder that attacks hair follicles and results in the loss of hair on the scalp and other parts of the body. The skin disease affects more than 4.7 million Americans and about 2 percent of the world's population. Alopecia areata will be Martell's platform in the upcoming pageant.
"I decided to use my crown to show that it is time we redefine what it really means to be beautiful," Martell wrote in an email. "To me, beauty is a part of your soul...You can be 'beautiful' on the outside and 'ugly' on the inside...But confidence and compassion are the real makeup of a beautiful person."
While some people prefer to let their baldness run its course unhidden, many people prefer to use wigs, makeup, hats and scarves to cover up.The condition is not fatal, but alopecia areata can have a major effect on a person's psychological and emotional well-being.
"Alopecia areata is not life-threatening, but it is life-altering," said Dr. Wilma Bergfeld, senior dermatologist at Cleveland Clinic and past president of the American Academy of Dermatology.
But now, as Martell steps into the limelight, not only as a person in the public eye, but also a beauty queen, many people are encouraged by her confidence as a beautiful bald woman.
"[This] lets people with alopecia areata know they are not alone and that they can do anything they want to do," said Vicki Kalabokes, president and CEO of the National Alopecia Areata Foundation.
Martell, now 22 years old, was diagnosed with the autoimmune disorder when she was in the fifth grade after noticing her hair part was becoming wider. She eventually lost all her hair.
Alopecia Areata: Sudden Diagnoses
"Kayla coming out as bald makes other people more comfortable and confident to be themselves," Bergfeld said. "People who have sudden changes in their body image tend to hide, but here is someone who is flaunting it and allowing it to be a part of their beauty."
Jamie Elmore is one of those women who once hid, but now walks around with her condition proudly.
As a Seattle-based hair stylist for more than 20 years, Elmore said she has always loved hair. When her hair started falling out after she gave birth to her daughter, Elmore, 41, said she was in denial, and struggled with depression and anxiety for years because of the loss.
From Loss Comes Empowerment
"Once my hair started falling out, everything hit the fan," Elmore said. "But I had to empower myself. As a hairstylist, it was a little easier for me because I was able to have more options at my fingertips compared to the average person."
Elmore continues styling hair, and she now helps others who have lost their hair due to alopecia or chemotherapy treatments. She also holds a Seattle-based alopecia support group, where up to 20 people join each week.
There is no cure for alopecia areata and therapies are limited, Bergfeld said. Some people get alopecia areata at a very early age, while in others the disorder can strike later in their adult life.
While much about the condition remains unclear, doctors say that alopecia can be triggered by nutrition problems, change in hormones and genetics.
In the Genes
Jodi Schaiman became aware of alopecia areata at a young age while watching her mother suffer from the condition for years.
When she was 19, Schaiman said she started to feel like she was losing some of her hair, but chalked it up to being paranoid.
At 25, she had a battery of tests done to figure out what was wrong, and by age 29, half of her hair had fallen out. Her body followed in her mother's footsteps when doctors diagnosed her with alopecia areata.
"For a while I was in denial, and then people started to make innocent comments like 'oh, did you cut your hair?' and I started getting really self-conscious," said Schaiman, a New York City social worker and peer leader for an alopecia support group.
Wig or No Wig
But now, Schaiman said she is comfortable in her body and coaches other people through the process of accepting the condition, even starting a non-profit and website called the Women's Hair Loss Initiative.
While Schaiman never goes out in public without a wig, she encourages children and other women to decide whether to wear a wig or go bald by considering the best option for them.
"I've gotten calls from women who are suicidal because of their condition," she said. "When you're feeling the most depressed is when you retreat and that's when you need the most help. That's when they need to come to meetings for support."
But Schaiman admits that it's not always easy. She said people often think people with alopecia areata are sick, and when they aren't, people minimize the anxiety and frustration that goes along with the condition.
"According to society's standards, we don't look normal," Schaiman said. "I have received hate mail saying, if you're bald you should go bald. But I think if someone wants to wear a wig, they should."
Wig or no wig, Schaiman said she appreciates Martell bringing awareness to the condition.
"The fact that she showed her bald head on TV is great," she said. "Just being aware of the disease and its psychological effects helps, whether you're wearing hair or going bald."
And it seems that Martell would agree.
"If I am crowned Miss America, it would be an opportunity to lead by example, redefine the 'ideal' and show young people that beauty really does come in all different packages," said Martell. "And even bald can be beautiful."