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Hair loss recently made headlines after a dramatic moment at the Oscars when Will Smith slapped Chris Rock after a joke about Jada Pinkett Smith’s shaved head. Since 2018, Pinkett Smith has publicly shared her struggles with hair loss and shaved her head in December 2021. For millions of Americans, hair loss is a real and very serious issue.

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Hair plays an important role in both how we see ourselves and how we are viewed by others. Hair loss – known medically as alopecia – can bring up complicated feelings and emotions making someone feel self-conscious. The good news is that there are many treatment options available that can be used to help slow, stop or even reverse hair loss.

What Is Hair Loss?

A hair follicle is responsible for hair growth by making new hair cells primarily out of a protein called keratin and pushing the older, dead cells out of the skin creating what we see. Exactly how the loss of hair happens depends on the diagnosis. For example, in male- or female-pattern baldness, hair loss occurs when the hair follicle begins to shrink resulting in finer and shorter hair and eventually, the follicle stops growing new hair.

All hair loss conditions fall into two categories:

  • scarring. Scarring is when the hair follicle is destroyed and scar tissue forms, which causes permanent hair loss.
  • non-scarring. Nonscarring hair loss is when the hair falls out, but the hair follicle is still alive, making it possible for hair to grow back.

The best predictor of success in stopping, minimizing or reversing hair loss is seeing a dermatologist when you first start noticing the hair loss.

Risk Factors for Hair Loss

There are a number of risk factors that may lead to hair loss. The most common include:

  • Hereditary. The most common form of hair loss, male and female pattern baldness, is an inherited condition passed on by your mother or father. “Hereditary hair loss affects about 50% of the United States population,” according to Dr. Paradi Mirmirani, assistant medical director in the department of dermatology at Kaiser Permanente in Vallejo, California.
  • hormonal changes. Pregnancy, childbirth and menopause can result in some hair loss due to hormonal fluctuations.
  • Medical conditions. Certain thyroid disorders, some autoimmune disorders, anemia, psoriasis and polycystic ovary syndrome, or PCOS, are some diseases that cause hair loss.
  • medication Hair loss can be a side effect of medications used to treat cancer, high blood pressure or arthritis among others. If you suspect a medication is causing hair loss, do not stop taking it until you speak to your doctor; sometimes stopping some medications abruptly can cause serious health consequences.
  • Poor nutrition. A deficit of key nutrients including protein, iron, B vitamins and zinc affect the quality and quantity of a person’s hair.

Hair loss in women

Hair loss is perceived more as a problem for men than women, but it’s estimated that more than 50% of women will experience noticeable hair loss in their lifetime. The most common forms in women are:

Androgenetic alopecia, also called female-pattern hair loss, or FPHL, is a genetic condition that affects an estimated 30 million women in the United States. It’s a progressive and nonscarring condition, so someone may notice their hair part looks wider than normal or the hair at their temples have somewhat receded. Without treatment this can develop into widespread hair thinning, so seeking treatment early on is key.

Centrifugal cicatricial alopecia, or CCCA, is a form of scarring hair loss that starts as a circular pattern on the crown of the head. It’s the most common form of scarring hair loss in middle-aged African American and Black women.

Lichen planopilaris, or LPP, occurs when a common skin condition known as lichen planus kills hair follicles that are scarred and leads to permanent, patchy loss of hair. This hair loss includes a few different forms, including follicular lichen planus, frontal fibrosing alopecia and graham little syndrome.

Hair Loss in Men

It’s no wonder that hair loss is typically associated with men, as 70% will lose hair as they age. About one quarter of men will begin to see signs of hair loss before the age of 21.

Hair loss in men ranges from the most common forms like male-pattern hair loss and rare forms like acne keloidalis, dissecting cellulitis and folliculitis decalvans. The most common forms include:

Androgenetic alopecia is better known as male-pattern hair loss, or MPHL. This is the most common type of progressive hair loss in men. In the United States alone, this genetic condition affects an estimated 50 million men. It most commonly begins to affect men in their 20s and 30s. This hair loss normally begins at the crown of the head and some may also develop a receding hair line. Without treatment, this can progress to partial or complete baldness.

Acne keloidalis, also known as folliculitis keloidalis, is a form of scarring hair loss that appears like acne, but is not acne or keloids. This form of hair loss is most common in African American and Black people and is 20 times more common in men than women.

Dissecting cellulitis is a type of scarring alopecia and is caused by blocked or ruptured hair follicles. It can result in lumps filled with pus and nodules forming on the scalp.

Folliculitis decalvansa rare form of alopecia, leads to patchy hair loss with painful sores similar to acne where the hair loss occurs.

Other Forms of Hair Loss

Other common forms of hair loss that affect men and women fairly equally:

Alopecia areata usually begins with small, rounded patches typically on the scalp, but can affect any part of the body where hair is present. It’s an autoimmune disorder that affects about 147 million people worldwide. The good news is that the hair follicles remain alive, so no matter how widespread the hair loss is, regrowth can occur.

Involutional alopecia is the natural, gradual thinning of hair that comes with age. Many follicles stop producing and the remaining ones are fewer in number as well as shorter.

telogen effluvium is temporary hair thinning over the scalp in a fairly uniform, nonpatchy, manner that occurs because of changes in the growth cycle of hair three to four months after a traumatic or stressful event like childbirth, surgery or rapid weight loss.

Hair Loss Treatments

Treatment options vary depending on the severity and type of hair loss. Frequently treatment includes a combination of therapies to attain maximum results.

Hair transplant surgery. Surgery is usually only considered once other treatment approaches have been tried. Not everyone is a good candidate for this procedure, but for those with scarring forms of hair loss, this is the only way to add back hair to areas affected with scarring.

According to Mirmirani, “at the point that surgery is considered, a patient’s hair loss should be stable, which typically happens when they are older, and there needs to be adequate donor site hair density, which is typically at the back of the scalp. When considering surgery, a patient needs to have reasonable expectations as to what the outcome may be. For example, not everyone can expect to fully cover a completely soon scalp with transplanted hair.”

lasers. Low-level laser treatments invigorate circulation and stimulation that encourages hair growth, but exactly how they work is unknown. The results of laser therapy are inconsistent. Lasers seem to work more often for those typically in the early stages of hair loss, but not for all types of hair loss, according to Dr. Amy McMichael, professor and chair of the department of dermatology at Atrium Health Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. “It is unclear how low-level lasers work for hair loss. At this time, they are basically only FDA approved as devices.”

Being classified as medical devices by the Food and Drug Administration means they don’t have the same level of scrutiny and testing that medicines go through prior to approval.

medication There are a variety of medication options available. Medications include antibiotics like oral doxycycline and topical or intralesional (injected into the scalp) corticosteroids. Oral finasteride and topical minoxidil are FDA-approved for men with male-pattern hair loss, and topical minoxidil is FDA-approved for women. In some patients, dermatologists may also use oral minoxidil, oral finasteride or oral spironolactone.

There are no FDA-approved treatments for other nonscarring forms of hair loss so dermatologists may use medications that can range from minoxidil to steroids.

Over the counter products. There are shampoos, supplements like biotin, folic acid and omega-3 fatty acids and even at-home laser treatments that are said to help grow and thicken hair with mixed results.

Platelet-rich plasma. This is a relatively new technique that uses the body’s own blood to stimulate hair growth. “Through a blood draw, platelets are separated and concentrated, then injected into the sites of thinning hair. The platelets have unique regenerative properties and growth factors that can help in treating a wide variety of hair-loss conditions,” according to Dr. Marc Glashofer, a dermatologist practicing at Schweiger Dermatology in Northern New Jersey.

How a Dermatologist Can Help With Hair Loss

When patients notice signs of hair loss, it’s recommended for them to see a board-certified dermatologist to be accurately diagnosed. “There are a lot of look-alike diagnoses that can be mistaken for other things and treatments can be complicated with combination therapies that often need to be monitored,” McMichael says.

An exam at the dermatology office will consist of:

  • A patient history and questions regarding your symptoms including how long you’ve had the hair loss and if it was sudden or gradual.
  • A physical exam where the dermatologist will look closely with a magnification device at any area with hair loss. They will look for things like inflammation, distribution of the hair loss and the overall appearance of the hair shaft.
  • Finally, there may or may not be a need for a scalp biopsy or bloodwork.

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