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Did you know that the average adult loses around 100 hairs each day? This amount of hair loss is a perfectly normal part of the hair growth cycle, in which follicles continually shed old hairs and grow new hairs.
This normal hair loss isn’t generally noticeable, but when it accelerates, it can become a concern. According to the American Hair Loss Association, about 85 percent of American men are balding; over 50 percent of women are likewise experiencing some level of hair loss.
For many people, this can be emotionally distressing. But hair loss can happen for a variety of reasons—many of them treatable with help from a medical professional who specializes in this condition.
Frequently, patients will come to me saying that they’ve already received a diagnosis of alopecia. But the term “alopecia” simply indicates hair loss. In order to strategize effective treatment, I work with the patient to determine the precise type of hair loss they may be experiencing, and to rule out any potential health problems that might be causing or aggravating the condition.
A typical consultation includes a complete medical history and a physical examination of the area of hair loss. Sometimes, blood tests may be needed to determine if an underlying problem, such as a thyroid condition, anemia, or a vitamin deficiency, might be involved. In some instances, a scalp biopsy may be done to help establish a diagnosis and particular cause for hair loss.
Causes of Hair Loss
Hair is produced from structures known as follicles in the outermost layer of skin. At birth, we already have our lifetime supply of hair follicles—an average of about five million! The scalp itself has approximately 100,000 of these follicles.
Like skin cells, individual hairs grow, rest, and shed in a continual cycle throughout our lives. Hair loss occurs when something disrupts that normal cycle. Common disruptors include:
- Androgenetic alopecia: a hormonally induced hereditary type of hair loss that causes pattern baldness
- Alopecia areata: an autoimmune disorder in which the immune system attacks and shrinks hair follicles, rendering them inactive
- Telogen effluvium: sudden, usually temporary loss of hair that may be caused by physical or psychological stress
- Certain medications
- A nutritional imbalance, particularly of iron or vitamin D
- Physical trauma, such as continual hair pulling or long-term wear of tight hairstyles
- Advancing age, which slows skin growth and causes scalp hair to thin
- Hormonal imbalance, such as a thyroid condition or polycystic ovary disease
- Other genetic and autoimmune conditions
Hair loss can be caused by a number of things and is frequently treatable. For best results, work with a medical professional specializing in hair loss. Advice from Dr. Monique Chheda, dermatologist https://bit.ly/2U6fyYD via @MedStarWHC
Worldwide, the most common and widely recognized form of hair loss is androgenetic alopecia, or pattern baldness. Caused by a variety of factors related to a patient’s hormones, this type of alopecia can affect both men and women.
In men, it causes a characteristic pattern of overall thinning, receding hairline, and loss of hair on the crown (the very top of the head). The loss of hair may begin at any time, but most typically in a man’s 30s. In women, the thinning is generally more subtle but can also cause a visible widening of the hair parts.
Although pattern baldness shrinks hair follicles, the follicles are not permanently damaged and often respond well to medical treatment.
We often first try a prescription-strength formulation of Rogaine® (minoxidil), applied directly to the scalp. Generally well tolerated, Rogaine has proven safe over decades. Rogaine is also available as a pill, and can be used when topical Rogaine does not work or is too cumbersome to use. Use of minoxidil is a long-term commitment—the hair will stop growing if the patient stops using it.
Other oral medications may gradually help to restore hair growth as well. Propecia® (finasteride) can help regrow hair in men with pattern baldness. It’s well tolerated and, like minoxidil, is a long-term treatment. Aldactone (spironolactone) reduces the effects of hormones on the skin and the hair and may help slow or reverse the progress of women’s pattern baldness.
Another approach, platelet-rich plasma therapy (PRP), may show promise in fighting hair loss, especially for people who have not responded to medical treatment. Blood plasma is rich in growth factors that can stimulate follicles and promote growth. An individual’s blood is drawn and spun in a centrifuge to extract those growth factors, which are then injected directly into the scalp, all within the same visit.
Another option in treating hair loss is hair transplantation—in essence, productive follicles are harvested from a donor site, then surgically grafted into the scalp. Costlier and more time-consuming than other options, transplantation is generally used when other treatments fail, and carries the risks normally associated with surgery.
In cases of alopecia areata, the immune system mistakenly targets and disables hair follicles. The condition may begin with patchy hair loss on the scalp, and can progress to other parts of the body, including eyelashes and eyebrows. Although this disorder is not scarring, it may progress to alopecia universalis, a near-total loss of body hair.
We often treat this type of hair loss with topical steroid formulations or steroid injections into the scalp to help reduce the effects of the immune system on the hairs. When the hair loss is more extensive and rapidly progressive, a new category of medicines, JAK inhibitors, have shown great potential to stimulate hair follicles. These inhibitors are in late-phase clinical trials and likely to gain FDA approval in the near future.
Telogen Effluvium (TE)
TE causes hair shedding, often in clumps, with a sudden onset. Almost invariably, TE results from physical, physiologic, or psychological stressors—for example, an emotional shock such as death of a loved one, or a major illness or hospitalization. Stressful situations that place the patient in fight-or-flight mode for an extended period may contribute as well. People with COVID-19 have also experienced TE after recovery, especially in cases of moderate to severe illness requiring hospitalization and medical treatment.
Pregnancy and anemia (low blood iron) may also cause TE—a possible reason why women are more prone to it than men.
In most cases of TE, hair loss resolves on its own over time. If we’ve ruled out other possible causes, watch-and-wait is often the best approach. In the more serious cases, certain medications/therapies may be tried to help reduce shedding and promote hair growth.
Scarring Hair Loss
Certain situations may cause scarring—permanent harm to hair follicles. In these cases, treatment is geared toward halting progression of the condition, because regrowing hair is not always possible. A scalp biopsy is often needed in the case of scarring hair loss to help differentiate the type of hair loss. Examples of scarring hair loss include:
- Tight hairstyles—weaves, braids, or a tight bun worn for an extended period—can damage the roots of hair and lead to a type of hair loss called traction alopecia. It’s important to minimize the tension on the hair associated with these styles, or avoid these hairstyles altogether.
- Traumatic hairstyles/hair styling practices can also contribute to scarring alopecia in genetically predisposed people. Central centrifugal cicatricial alopecia (CCCA) initiates an inflammatory condition in the scalp—often in African American women—that causes a scarring hair loss on the crown of the scalp. Avoiding heat, relaxers, and tight hairstyles is recommended. We often also recommend use of topical steroids, steroid injections, and oral antibiotics to calm the inflammation and help follicles heal.
- Hair-pulling disorder, or trichotillomania, is a compulsive hair-pulling behavioral disorder in which people—most often children or teens responding to stressors—continually pull at and twist their hair, damaging the roots. Behavioral modification and, occasionally, oral medications can help. Psychiatry may be consulted to help co-manage.
- Ringworm, an itchy fungal infection of the scalp, can cause temporary hair loss and requires oral anti-fungal therapy to prevent progression. This is most common in children.
- Lichen planopilaris (LPP) is another rare condition that occurs when the immune system attacks the follicles. Unlike areata, however, it does cause scarring—it can permanently destroy the follicles it affects. Topical and oral anti-inflammatory medications are used to help stabilize this condition.
Hair Loss Treatment
I don’t recommend spending money and time trying any magic formula of vitamins, scalp oil, shampoo, or herbal preparations that you may see advertised.
At the Hospital Center, we can prescribe several types of medications to make a positive difference in hair regrowth; however, sometimes full regrowth of hair is not achievable.
Hair loss treatments can vary depending on the patient’s type of hair loss, age, sex, and medical history. The most important thing is the initial consultation to determine the cause of hair loss. After a diagnosis is determined, a combination of oral, topical, or injection therapy may be recommended. Hair loss treatment may require repeated visits to a dermatologist for monitoring of medications, injection therapy, and assessing response to treatment. Hair regrowth is slow, and results often take months to see. We generally take photos to document regrowth.
In summary, many forms of hair loss are quite treatable, but all of them show best results when they’re addressed early. The more hair is lost, the more time and effort it may take to regrow it.
If you’re experiencing hair loss, consult a dermatologist who specializes in this type of diagnosis and treatment for best results. The doctor can help eliminate other issues as a potential cause of the hair loss, and help plan a treatment strategy that works best for you.
Several effective options are available to manage hair loss and can be tailored to your individual needs. And in many cases, progress can be made toward successfully restoring hair.