By Andrew Lazar, MD
As a dermatologist, I see patients with all kinds of skin concerns—acne, psoriasis, skin cancer. But you might be surprised to learn that many people, both women and men, also come to me with worries about hair loss. I know how emotionally devastating this can be, but finding out why it’s happening and how to slow or prevent it (if possible) can be a big comfort.
First, I tell them they’re not alone. Hair loss, or alopecia, is fairly common; approximately 80 million people in the United States experience it due to heredity alone, according to the American Academy of Dermatology, and women make up about 40 percent of those affected by this condition.
It’s normal to lose about 100 hairs per day, because there’s usually new hair growing in to take the place of old strands. You may notice hair on the bathroom floor or in your shower drain, but that’s often because you do your grooming there. If you feel like you’re losing more strands than usual, though, you might want to make an appointment with a dermatologist to figure out if there’s something afoot.
What causes hair loss?
When patients come in to see me with concerns about losing their hair, we start by discussing where it’s happening, when it started and if they have a family history of it.
Hereditary alopecia, or pattern baldness, accounts for the majority of hair loss. For my male patients, it can be helpful to look at the Norwood Scale, a visual representation of the seven stages of hair loss in males, to get an idea of how and where they’ll notice it as they age. While this can be a helpful guide, the rate of hair loss can’t be predicted with certainty.
Women with hereditary alopecia may observe overall thinning at the top of their heads. But women can also experience hair loss due to other factors. After pregnancy, for instance, it’s not unusual for new mothers to notice tufts of hair coming out in their brush or comb. This usually stops after a few months, once hormone levels return to normal.
Women of African descent are at higher risk for central centrifugal cicatricial alopecia (CCCA). Around half of African-American women experience hair loss, and much of it is caused by CCCA. While CCCA is now believed to have some links to heredity, the risk can increase through use of damaging styling choices, like braids, weaves and chemical relaxers. But there’s good news: The effects of CCCA can be repaired if it’s caught before permanent loss occurs. I’ll sometimes prescribe anti-inflammatory drugs to my female patients with CCCA if they have yet to experience irreversible damage. And I advise them to move away from using harsh chemicals and tight braiding that can pull on the scalp.
I have other patients who come to me with alopecia concerns that aren’t related to genetics or product use. Sometimes they lose hair because they are dealing with a lot of stress, eating poorly or coping with health conditions/treatments, including thyroid disease, lupus, diabetes, connective tissue disorders, high fevers or chemotherapy. It can also be a side effect of physical trauma (surgery or a car crash, for instance), certain medications (such as oral contraceptives and antidepressants) and allergic contact dermatitis (or contact eczema).
Fortunately, this kind of hair loss is often temporary. In some cases, I’ve performed blood work or taken a biopsy to figure out what is causing a patient’s loss of hair, particularly if he or she thinks it may be due to something other than genetics.
Will my hair grow back?
That’s the million-dollar question my patients ask, and it comes down to cause.
There are two varieties of alopecia: scarring and non-scarring. With the former, which affects only about 3 percent of those with hair loss, the hair follicles have been destroyed, meaning no new hair will grow. If it’s the latter, a dermatologist can likely identify the cause.
If your hair loss is caused by something other than heredity, the good news is that once the cause is treated, new hair should grow back. If your hair loss is inherited, see your dermatologist before exploring the wide variety of advertised treatments that are out there. Too many of them don’t work. If a treatment isn’t approved by the Food and Drug Association, it’s best to avoid it.
For patients whose hair loss is caused by genetics, I sometimes suggest over-the-counter, FDA-approved medications that can be applied to the scalp to help regenerate hair follicles and repair damaged follicles.
For some men, using a prescription-only oral medication aimed at male pattern baldness, in tandem with a scalp medication, can slow thinning, thicken the shaft of existing hair and help grow new hair. Though hair coverage often improves on top of the head, these drugs won’t do much for the forehead area. And you’ll need to continue using these medications for as long as you want to see results.
If none of these options work, there are other prescription-required treatments for men and women. Men can try an oral steroid, and women may be prescribed oral contraceptives or other medications.
Some of my patients with hereditary hair loss opt for hair transplant surgery. This can be expensive, involving multiple surgeries to move scalp hair and follicles from another area. Not everyone responds to treatment, and it’s also unlikely all of your hair will grow back. For these reasons I tend to recommend that my patients try other methods first.
Aside from treatment, I sometimes suggest that patients think about wearing a hairpiece or styling their hair another way. Sometimes making just one change, like shifting where your part is or changing the color, can make a big difference.
To learn more about hair loss, including tips for managing it, visit the website of the American Academy of Dermatology.
Andrew Lazar, MD, is a board-certified dermatologist with Mid-Atlantic Permanente Medical Group. He sees patients at the Kaiser Permanente Capitol Hill Medical Center.