What are some general facts about hair loss?
Hair loss (alopecia) is extremely common, with over half of all men and women experiencing it in their lifetime. In the United States alone, about 35 million men and 21 million women are affected by hair loss. Normally we lose between 50 and 100 hairs a day; excessive loss is cause for concern. The extent of hair loss is dependent on several factors, including age and gender, and has a plethora of possible causes.
In males, the cause can usually be diagnosed clinically and is most often androgenic hair loss (concentrated at the frontal hairline and/or vertex –top– of the scalp). This is also known as male pattern baldness. This condition can be arrested and often reversed with prescription medication. Men usually begin to lose hair in their twenties, with 40% showing noticeable loss by age 35 and 65% by age 60. For women, the situation is often far more complicated. Female androgenic alopecia is mostly post-menopausal, but can start as early as the teens for a small handful of women. In almost all of these cases, however, similar loss is seen in female family members. Androgenic hair loss in women tends to be more subtle than in men and is generally associated with hormonal changes. Telogen effluvium (another type of hair loss very common in women) is due to metabolic problems elsewhere in the body. With this condition, your hair will suddenly and dramatically fall out in clumps. There are also many other causes for hair loss, which will be explored during your consultation.
How will Dr. Davis evaluate your hair loss?
Dr. Davis will begin your hair loss consultation by asking questions about your medical history (including recent surgeries and medications), your family history of hair thinning, your diet, your hair grooming routines, etc. This will help her to uncover some possible causes for your hair loss. Next, Dr. Davis will examine your scalp to see if your hair loss is regional, diffuse, or patchy. A hair-pull test is also done, to see the number of hairs removed with gentle tugging. For women, Dr. Davis will usually need to order comprehensive blood work to evaluate internal conditions that may be triggering hair loss which would not be apparent clinically. This includes thyroid problems (both an underactive or overactive thyroid gland can trigger hair loss), anemia, lupus, among other conditions. If your blood results come back normal, the problem may not be with an illness of the body, but rather a problem of the scalp. In order to examine “inside” the scalp, Dr. Davis will need to perform a scalp biopsy to have a laboratory analyze the scalp follicles and surrounding skin. Typically, two biopsies are taken at close proximity to one another to check for androgenic alopecia, collagen vascular disease, lichen planus, and certain other medical conditions that can cause hair loss and present with normal blood work.
What are some common causes of hair loss that Dr. Davis treats? Hereditary thinning, androgenic alopecia, is common in both men and women. Androgenic alopecia can be inherited from either the mother’s or the father’s side of the family. In men, this pattern is most characteristically seen with receding at the front of the scalp, top of the scalp, or both; and can ultimately leave a horseshoe pattern of hair remaining. Women do not experience balding to this degree. They will generally notice a widening of the center part, but the hairline will be preserved. With androgenic alopecia, the androgens (male hormone levels) in the body are generally normal but are elevated at the scalp. This causes the hair follicles to miniaturize and the hairs to resemble peach fuzz. Though there is no cure for androgenic alopecia, there is therapy that can arrest and often reverse it. Oral medications, like Propecia (available only by prescription), are used to stop the progress of the hair loss. With this therapy, you will retain the hair you now have and in many cases grow new, thick hair. Rogaine, an over the counter topical medication, can be helpful in stabilizing loss in both men and women. Hair transplantation, a surgical procedure, is also effective for concealing this problem once the hair loss has stabilized, and gives natural results for both men and women.
Telogen Effluvium is a form of widespread, sudden hair loss seen when hair follicles enter a resting phase and shed diffusely. This represents a need to conserve making hair; while the body is attempting to correct a more dire problem “elsewhere.” Shedding starts three to six months after a medical stress (while the body is “rebuilding itself”) and usually resolves on its own once the body corrects itself or medical intervention stabilizes the problem. Discovering a hidden medical problem responsible for the shedding is the job of Dr. Davis. There are many common causes of telogen effluvium and they include recovery after major surgery and pregnancy, thyroid disease, severe infection or the flu, cancer treatments, low serum iron, inadequate protein in diet; among others. Once the etiology is revealed, treatments by Dr. Davis or an appropriate specialist will enable hair to regrow back to its pre-illness level.
Alopecia Areata is an autoimmune condition seen when the body makes antibodies to its own hair, which then sheds in spots. This condition can affect anyone; children and adults alike. Alopecia areata can also occur on any hair-bearing body part including the scalp, beard, arm, etc. You will see discrete, smooth round patches of hair loss, usually the size of a coin. If untreated, these can progress to become larger. Unlike other form of hair loss, alopecia areata is usually treated with a series of cortisone injections (or prescription-strength topical cortisone) and the hair generally grows back in full.
Scalp ringworm (Tinea Capitis) is caused by a fungal infection and is contagious. It is most common in children and in adults who are in close contact with children. It can also be contracted from cats and dogs that are infected. It starts as a rash with spots that are red, swollen, and flaking. These can expand, spread, and cause hair loss. If left untreated, scarring can set in and then the hair loss can become permanent. This condition is treated with oral medication (available by prescription only). A fungal culture (scraping) is taken to confirm the diagnosis.
Improper chemical treatments, though rare, can cause your hair to become brittle and break. The scalp can also become red and inflamed. Hair treatments include dyes, bleaches, straighteners, perms, etc. Problems with these chemicals used to occur much more frequently, but the beauty industry has made great strides in safety, working with dermatologists and chemists to create treatments that are usually not harmful. If you lose hair after a salon or home hair treatment, prompt action by Dr. Davis can often help correct the situation and enable you to hold on to your hair.
With the plethora of causes for hair loss, correctly diagnosing and treating the underlying problem is essential for treatment. Dr. Davis will work with you to plan a course of action that is best for your specific situation and try to make this trying time as stress free as possible.
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