“My hair is thinning. What do I do?”
I often hear this question from patients, and that’s not surprising. Hair loss is a common problem among men and women, and it can be very distressing. Millions of people suffer from this problem.
People normally lose around 50-100 hairs per day. However, if you note increased shedding, bald patches or a rash in the scalp, you should consult a dermatologist immediately. We have treatments for many types of hair loss, but early intervention is important.
By far the most common type of hair loss in the United States is androgenetic alopecia, or “male- or female-pattern baldness.” Men have a receding hairline or thinning of the hair over the top of the scalp. Women commonly note a gradual widening of the middle part line. This form of hair loss may be hereditary or seen in conditions that involve hormonal imbalances, such as polycystic ovarian syndrome.
People taking anabolic steroids may also experience this form of hair loss.
Fortunately, we have treatments for this condition, which we, ideally, begin in the early stage of the hair loss process. Minoxidil 5% foam or solution is a safe FDA-approved treatment for hair loss in both men and women. It is applied daily to the scalp to stimulate hair growth. I caution patients not to expect results overnight. It takes four to six months of use to achieve significant benefit from this medication.
An oral medication treatment, finasteride, has been FDA-approved for men. It helps to slow hair loss and even stimulates hair regrowth in a significant percentage of users. It works by stopping the production of the male hormone DHT. For femalepattern hair loss, a medication called spironolactone is often prescribed, but the FDA has not yet approved it for this purpose. Other treatments for androgenetic alopecia include laser combs/light devices, hair transplantation and platelet-rich plasma injections.
Another very common form of hair loss is telogen effluvium. This condition occurs when a larger-than-normal number of follicles convert to the shedding phase or telogen phase. Patients find themselves with this condition after childbirth, when they stop or change hormonal contraceptives, or after stressful events such as surgery, illness or emotional distress. We also must rule out underlying conditions such as thyroid disease or iron deficiency anemia. People with eating disorders or diets low in protein may also experience hair loss. Certain medications such as birth control pills, vitamin A derivatives or blood pressure medications may contribute to hair shedding. The good news is that, once the stress has been eliminated or the nutritional or hormonal problem has been corrected, the hair loss should improve.
One type of hair loss that we see most often in African-American female patients at our clinic is central centrifugal scarring alopecia. It appears as a smooth patch on the top of the scalp that radiates outward. Patients may also note tenderness, burning or tingling.
Sometimes hair loss is caused by an autoimmune condition. This is known as alopecia areata. Patients develop circular bald spots throughout the scalp. Skin conditions such as psoriasis or dandruff may cause hair shedding, and infections such as ringworm may also cause hair loss. All of these require medical treatment and should be addressed with a dermatologist.
Hair care is important as certain practices may damage the hair shaft or cause actual hair loss. Bleaching or use of permanents may be damaging to the hair, so limiting the frequency of these is important. When possible, avoid the blow dryer or flat iron and allow your hair to air dry. Tight braids or sew in styles can pull the hair and cause traction alopecia.
Hair is one of those things that can contribute to our self-confidence, but hair loss is very common and has many different causes. If you note any unusual hair loss, don’t delay treatment. A visit to a dermatologist will allow you know the cause and then initiate treatment at the earliest stage. As with most medical problems, the earlier we catch hair loss, the better the treatment outcome.
Sarah Baker is a partner at Ark-La-Tex Dermatology with offices in Bossier City and Shreveport and is part of the Willis-Knighton Physician Network.