DPM Blog: Hair loss from a dermatologist’s perspective
At least half of women in the U.S. will experience some form of hair loss by the time they are 50 years old. The most common types often occur with the greatest frequency at a time in life when women are experiencing other life stressors such as menopause, empty nest syndrome and the aging of their parents.
Hair loss can be frightening for women since it is often unclear how much hair will be lost when it begins. Hair may cease being a “crowning glory” for the affected woman and may require an adjustment in how she perceives herself and how she presents herself. Women experiencing hair loss often search the internet for remedies, many of which are costly and ineffective. Seeing a board-certified dermatologist can be very helpful in determining the cause of hair loss, and in outlining a regimen to minimize hair loss and possibly reverse it.
There are 2 broad categories of hair loss (alopecia):
1. Non-scarring Alopecia – hair follicles are preserved.
2. Scarring Alopecia – hair follicles are destroyed.
Non-scarring alopecia is caused by many factors. In this type of hair loss, the follicle is preserved and the hair can potentially grow back. The most common causes of non-scarring alopecia are:
a. Heredity – occurs in males and females. Women can get thin hair especially on the vertex or crown of the scalp. The first thing you may notice is your part gets wide, but complete baldness is rare.
— This condition can begin early (teenage years to the early 20’s) or later (early 40’s to 50’s). Hair becomes finer because the individual hairs are smaller or “miniaturized.” Women often notice they can easily see their scalp when styling their hair. Those with female pattern hair loss may also have hirsutism, which is the growth of hair in the beard or moustache area, or persistent acne or irregular menstrual cycles.
— Some women with female pattern hair loss, particularly those with other medical conditions, may have androgen excess– a male hormone such as testosterone-sensitivity causing these problems. Women with this pattern of hair loss should be evaluated with special blood tests to determine their androgen levels. In some cases, female pattern hair loss may be the first sign of an underlying type of diabetes that is more frequent in women with elevated androgens in the blood. Addressing elevated androgen levels in the bloodstream can be the first step in alleviating female pattern hair loss.
b. Telogen effluvium – one to three months after a sudden shock/change to the body (such as high fever, severe illness, major surgery, severe psychological stress, childbirth) large amounts of hair are shed. This shedding usually corrects itself without treatment in 6-9 months.
— Telogen effluvium is characterized by increased shedding of hair over the entire scalp. Hair is lost when combing, brushing and washing the hair. This type of hair loss may be caused by thyroid, hormonal, nutritional or age-related factors, as well as medications being taken or underlying disease.
c. Internal illness – bloodwork may need to be drawn to rule out systemic causes of hair loss. If abnormal, correcting the problem may result in hair regrowth.
d. Alopecia areata – an autoimmune disease in which the body rejects hair in round patches. You see round islands of complete balding within areas of normal hair. It can self-resolve or be treated with monthly corticosteroid injections and/or with minoxidil (Rogaine) applied to the scalp. Newer treatments are on the horizon.
e. Medication – prescribed and over the counter meds can also contribute to hair loss
f. Rashes – seborrheic dermatitis, psoriasis – in which you may even scratch out hair.
Scarring alopecia is caused by several factors. In this type of alopecia the hair follicle is destroyed and the hair loss is permanent. Treatment is targeted at preventing further scarring. The most common causes of scarring alopecia are:
a. Diseases that scar the scalp – diagnosed by physical examination and/or biopsy and/or bloodwork. Treatment of the disease hopefully will prevent further scarring.
b. Overuse of hair chemicals/heat/chronic traction (pulling) of hair – gradually scar the scalp and cause progressive permanent hair loss. Even though you or your hairdresser may not have done anything wrong, chronic irritation of the scalp can cause scarring alopecia.
Treatment of hair loss:
1. Identify the underlying cause and correct it (if possible).
2. Decrease or stop hair chemicals, heat and/or traction to hair and scalp. Be gentle. Avoid tight braids, pony-tails, aggressive combing or washing, excessive drying, straightening, hot combing, and straight ironing.
3. Rogaine (minoxidil) 5% foam/mousse – applied to the scalp once daily – the ONLY FDA approved treatment for hair loss in women. Must be used for at least 6 months to see results (regrowth of hair or prevention of further hair loss). Rogaine works better on the crown of scalp than the frontal scalp.
4. Intralesional injections of corticosteroid – helps certain types of hair loss, only if it is active.
5. Medications for seborrheic dermatitis or psoriasis can make the scalp healthier and encourage normal healthy hair growth.
6. Supplements: My favorites to recommend are VIVISCAL and NUTRA-FOL.
7. Multivitamin daily – in addition to following a healthy and well-balanced diet.
8. Thickening shampoos such as Nioxin, Aveda Pure Abundance, and Pantene Pro-V Thick and Full. (These specific product lines are designed to thicken individual strands of hair).
9. Anti-dandruff shampoos such as Head & Shoulders or Selsun Blue to reduce inflammation. If needed, ketoconazole 2% shampoo is prescribed.
10. Another option is concealer products such as Infinity Hair Loss Concealing Fibers, TOPPIK Hair Building Fibers, Caboki Hair Loss Concealer, Samson Hair Building Fibers, and Finally Hair Building Fibers (among many others). Conceal hair loss and blend in with your natural hair.
11. Reduce stress and avoid going on and off medications – especially hormonal medications such as birth control pills and hormone replacement therapy as that can trigger and exacerbate hair loss.
12. Results from implementing the above measures will vary from patient to patient. All measures should be tried for AT LEAST 6 MONTHS. Female pattern hair loss rarely causes complete baldness and stabilizes over time.
13. Spironolactone: though a blood pressure medication, it has anti-androgenic effects. When taken at doses between 100-200mg daily, it can dramatically improve female pattern hair loss. This should be done under the guidance of a dermatologist.