Those Fickle Follicles
Treating hair loss effectively
As a dermatologist, I see many patients in my practice with hair loss. It can be a challenging and distressing problem. Individuals of all ages and ethnicities, both male and female, suffer from hair loss due to many different causes. It is important to see a specialist familiar with these conditions and their treatments to treat hair loss appropriately.
When diagnosing hair loss, dermatologists use different tools. Certain conditions such as alopecia areata (when a patient suddenly loses single or multiple circular patches of hair) or telogen effluvium (when more hair than normal is shed from the scalp daily) might be diagnosed from clinical appearance alone. When the diagnosis is uncertain or an inflammatory condition of the scalp is suspected, a scalp biopsy may be necessary. A biopsy is a procedure where your doctor numbs the skin and takes one to two small plugs of skin and hair follicles for the pathologist to analyze under the microscope.
Lab studies may need to be drawn to see any abnormalities in hormones, thyroid function, iron levels or vitamin D. Your doctor may also test for autoimmune conditions such as lupus if deemed appropriate.
Two of the most common types of hair loss that I see are telogen effluvium and androgenetic alopecia. Telogen effluvium is a form of hair loss where abnormally large numbers of follicles shift into the resting or telogen phase. It typically starts about two months after a stressor to the body: This includes illness, severe emotional stress, surgery or childbirth. Individuals with Covid-19 often experience this type of hair loss following their infection.
The good news is that this type of hair loss typically slows over three to six months, and the hair returns to normal. There is no treatment to reverse or stop this process once it has begun. Still, I do recommend a healthy diet, and I often recommend nutraceuticals and supplements containing various vitamins, amino acids and collagen essential for hair growth and nourishment of the follicle.
Androgenetic, or pattern, hair loss affects both men and women. It is often hereditary and worsens with age. It may also be due to an excess amount of androgen hormones in the body, as seen in polycystic ovarian syndrome or treatment with exogenous androgens. Women with androgenetic alopecia typically present with a widening of the central part of the scalp. The front hairline is typically maintained, although thinning may also be seen over the temples. In men, androgenetic alopecia presents with thinning over the frontal hairline and the top of the scalp.
Females may benefit from treatment with topical minoxidil and oral medications, such as low-dose minoxidil, spironolactone and finasteride. Topical minoxidil and oral finasteride are often used for male patients. Both males and females may benefit from nutraceutical vitamins and plateletrich plasma therapy. Platelet-rich plasma (PRP) therapy is a treatment where your blood is drawn and spun in a centrifuge. The nutrient and growth factor-rich platelets are then injected back into the scalp. In severe cases, hair transplantation may be necessary to achieve desired results.
Inflammation in the scalp can also cause hair loss. Inflammatory forms of hair loss such as lichen planopilaris, central centrifugal scarring alopecia, or lupus can ultimately lead to scarring and permanent loss of the hair follicle, so it is very important to diagnose these promptly in order to prevent as much hair loss as possible. These conditions may present with symptoms such as itching, tenderness or burning of the scalp, but there are often minimal associated symptoms.
Treatments are also different for these types of hair loss. Patients may need topical steroids or even steroid injections into the affected areas of the scalp. Oral medications such as anti-inflammatory antibiotics, hydroxychloroquine, finasteride and immunosuppressive medications may be required to treat these conditions, depending on their severity. Avoiding harsh chemicals, excess heat and tight hairstyles that pull on the follicle is often advisable in these forms of hair loss.
Alopecia areata is a unique type of hair loss where white blood cells attack the hair follicle and cause the hair to fall out very suddenly. Patients may notice one or a few circular, well-defined patches of hair loss may involve the entire scalp, eyelashes, beard and other body hair. It affects up to 2% of the population and may be associated with a higher risk of other autoimmune conditions, such as thyroid disease, vitiligo and atopic dermatitis.
Some patients may have spontaneous regrowth of the hair within six months of onset. Treatments include potent topical steroids, topical minoxidil, steroid injections and topical immunotherapy. In extensive cases, oral steroids or immunosuppressive medicines such as Janus kinase inhibitors may be utilized.
In summary, hair loss is often painful emotionally and physically for patients, and their concerns should not be minimized or discounted. It is also often difficult to treat, and outcomes may be improved by early diagnosis and intervention. Anyone suffering from hair loss should discuss their concerns with their dermatologist.
Sarah Baker, MD, is a board-certified dermatologist with Ark-La- Tex Dermatology, part of Willis-Knighton Physician Network.