Everyone wants the thick, shiny, perfectly bouncy ponytail… but it seems to only exist in Disney fairy tales and fashion bloggers instagram accounts! Over 50% of women will struggle with hair loss (medically called alopecia) during their lifetime. Annually in the US, over $2 BILLION is spent on treatments for loss and thinning of hair. There are many types of hair loss, which occur for different reasons and may require different treatment options.
It is absolutely normal for a man or woman to shed anywhere between 100-200 hairs a day, and almost everyone experiences natural thinning and textural changes to the hair as they age.
There are so many options, both prescription and in office treatments as well as over the counter supplements and at home treatments, to help encourage hair growth. Unfortunately, there is no magic cure for hair loss but most patients can achieve wonderful results once the etiology (cause) of their hair loss is confirmed.
When we see a patient in office with the chief complaint of hair loss, many questions are raised. How long has this been going on? Is the hair loss diffuse and occurring all over the scalp, or is it localized? Is the patient taking new medications, have they had a recent surgery or significant stressor? How old is the patient? What type of hairstyle do they currently wear and do they use chemicals or other products frequently on the hair?
The answers to these questions are clues as to the cause of the patients hair loss. In order to definitively diagnose hair loss cause, a biopsy needs to be taken from the scalp which includes all layers of the skin as well as several hair follicles. This is usually done by punch biopsy technique where we will numb the skin and take a small, cookie cutter sample of skin – usually about 4mm – and send it to the pathologist to look at under the microscope. An absorbable suture or two may be used to help bring the biopsy site together. Sometimes blood work may be evaluated as well to look for hormone abnormalities, vitamin deficiencies and other clues about the patients hair loss.
Read on to make sense of some of the most common types of hairloss and their treatments!
1. Telogen Effluvium: this type of hair loss occurs several months to one year after any significant stress. This may include a stressful life event like loss of a family member or divorce. It occurs frequently in post-partum women, and we also see it after a patient has undergone general anesthesia for a surgical procedure or after “shocks” to the body including drastic weight loss, some medications. This type of hair loss is temporary, but can be extremely worrisome to the patient.
2. Androgenetic Alopecia aka hereditary hair loss: This is most commonly the diagnosis for hair loss, and is responsible for a significant amount of hair loss patients in our office. This type of hair thinning can present as early as the early 20s and usually shows specific patterns. For women, it usually presents as a widening of the hairline part at the top of the scalp (known as the crown of the scalp). For men, they may notice thinning and hair loss on the back of the scalp of the frontal hairline.
3. Alopecia Areata: this type of hair loss happens when your body’s immune system attacks hair follicles. Most commonly it presents as clumps of hair that fall out and leave behind completely smooth scalp. We usually will see round, smooth patches on the scalp with this type of hair loss. Sometimes the hair loss may include the entire scalp, which is called Alopecia Totalis and in some, more rare, cases it may involve the entire body in which case the diagnosis is Alopecia Universalis.
4. Traction Alopecia: This is a more permanent form of hair loss which we see currently in patients who have worn hairstyles that pull on the hairs such as tight braids or extensions. This types of hair loss generally occurs over time and many times the hair loss is permanent. With medical treatments, many patients will see fine regrowth of the hair; however, most patients do not return to the initial thickness or fullness of the hair.
Now that you know about the most common types of hair loss, read below for some common treatments:
1. Rogaine (Minoxidil). Minoxidil helps to stimulate hair growth and is available over the counter. It is safe to use for men or women, but the biggest barrier is that using this medication requires a lifelong committment. If you achieve hair regrowth with Minoxidil and stop using it — bam! the hair will fall out again. Minoxidil is a great option for many types of hair loss.
2. Anti-androgen medications. Spironolactone is a prescription drug FDA approved for use in controlled high blood pressure. It has been used off-label for many years to help treat androgenetic alopecia. This medication works by blocking hormone receptors, thus decreasing androgen (male) hormone surge that can cause hair loss as well as acne and hair growth on the upper lip, chins and cheeks.
3. Supplements. Making sure you have correct vitamin and mineral levels in your body can be essential in maintaining hair growth – this includes protein and fat as well. A few supplements we like are Viviscal, which contains silica and vitamin C and Jarrosil, which is a liquid form of active silicone. Biotin has also been shown to help strengthen hair and is available over the counter at any pharmacy. Your dermatology provider can recommend the best supplements for you specifically.
4. Platelet Rich Plasma (PRP): You’ve probably heard of Kim Kardashian doing “the vampire facial” to stimulate collagen and turn back the clock — this is the same technique, but used on the scalp. This treatment takes the patients blood, spins it down to separate the plasma from the blood and then the plasma is injected into the scalp. This uses the patients own platelets, stem cells and growth factors to stimulate hair growth. Early studies are showing super exciting results using PRP for hair loss treatment.
If you are experiencing hair loss or hair thinning YOU ARE NOT ALONE! This is a super common experience and we can help! You will want to see your dermatology provider to talk about the best options for you.