Hair loss recently made headlines after a dramatic moment at the Oscars when Will Smith punched 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 problem.
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 trigger complicated feelings and emotions that make a person feel self-conscious. The good news is that there are many treatment options available that can be used to slow, stop, or even reverse hair loss.
What is hair loss?
A hair follicle is responsible for hair growth by making new hair cells, mainly from a protein called keratin, and by pushing the older, dead cells out of the skin, creating what we see. Exactly how the hair loss happens depends on the diagnosis. For example, in male or female pattern baldness, hair loss occurs when the hair follicles start to shrink resulting in finer and shorter hair and eventually the follicle stops growing new hair.
All hair loss conditions fall into two categories:
- scars. Scarring is when the hair follicle is destroyed and scar tissue is formed, causing permanent hair loss.
- no scars. Hair loss without scarring is when the hair falls out, but the hair follicles are still alive, allowing the 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 can lead to hair loss. The most common are:
- Heir apparent. The most common form of hair loss, male and female pattern baldness, is a hereditary condition passed down from your mother or father. “Hereditary hair loss affects approximately 50% of the US population,” said Dr. Paradi Mirmirani, assistant medical director of the dermatology department at Kaiser Permanente in Vallejo, California.
- Hormonal changes. Pregnancy, childbirth and menopause can lead to 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.
- Medicines. Hair loss can be a side effect of medications used to treat cancer, high blood pressure, or arthritis, among other things. If you suspect a drug is causing hair loss, don’t stop taking it until you’ve talked to your doctor; sometimes abruptly stopping some medications can have serious health consequences.
- Poor nutrition. Deficiency of key nutrients, including protein, iron, B vitamins, and zinc, affects the quality and quantity of a person’s hair.
Hair loss in women
Hair loss is seen as a problem by men more than women, but it is estimated that more than 50% of women will experience noticeable hair loss during their lifetime. The most common forms in women are:
Androgenetic alopeciaAlso called female pattern hair loss, or FPHL, is a genetic disorder that affects an estimated 30 million women in the United States. It is a progressive condition that does not scar, so a person may notice that their hair section appears wider than normal or that the hair at the temples has receded slightly. Without treatment, this can develop into widespread hair loss, so seeking treatment early is key.
Centrifugal Cicatricial Alopecia, or CCCA, is a form of scarred hair loss that begins as a circular pattern on the crown of the head. It is the most common form of scarred hair loss in middle-aged African American and black women.
Lichen planopilarislichen planus, or LPP, occurs when a common skin condition known as lichen planus kills scarred hair follicles and leads to permanent, patchy hair loss. 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 a quarter of men begin to see signs of hair loss before the age of 21.
Hair loss in men ranges from the most common forms such as male pattern hair loss to rare forms such as keloid acne, dissection cellulitis and folliculitis decalvans. The most common forms are:
Androgenetic alopecia is more commonly known as male pattern hair loss, or MPHL. This is the most common form of progressive hair loss in men. In the United States alone, this genetic condition affects an estimated 50 million men. It usually starts to affect men in their 20s and 30s. This hair loss normally starts at the crown of the head and some may also develop a receding hairline. Without treatment, it can lead to partial or complete baldness.
Acne keloidaliskeloidal folliculitis, also known as keloidal folliculitis, is a form of scarred hair loss that resembles 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 in women.
Dissecting Cellulite is a form of scarring alopecia caused by blocked or ruptured hair follicles. It can result in nodules filled with pus and nodules 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 types of hair loss that affect men and women fairly equally:
Alopecia areata usually starts with small, round patches, usually on the scalp, but can affect any part of the body where hair is present. It is an autoimmune disease that affects approximately 147 million people worldwide. The good news is that hair follicles stay 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 follicles are fewer in number and also shorter.
Telogen effluvium is temporary hair loss on the scalp in a fairly uniform, non-patchy manner that occurs as a result of changes in the growth cycle of the hair three to four months after a traumatic or stressful event such as childbirth, surgery, or rapid weight loss.
Hair Loss Treatments
Treatment options vary depending on the severity and type of hair loss. Often, treatment involves a combination of therapies to achieve maximum results.
Hair transplant operation. Surgery is usually not considered until other treatment methods have been tried. Not everyone is a good candidate for this procedure, but for those with scarring forms of hair loss, it is the only way to regain hair in areas with scars.
According to Mirmirani, “at the time surgery is considered, a patient’s hair loss should be stable, which usually happens when they are older, and there should be adequate density of hair at the donor site, which is usually at the back of the scalp.” When considering surgery, a patient should have reasonable expectations of what the outcome might be, for example, not everyone can expect to completely cover a completely bald scalp with transplanted hair.”
lasers. Low-level laser treatments stimulate circulation and stimulate hair growth, but exactly how they work is unknown. The results of laser therapy are inconsistent. According to Dr. Amy McMichael, professor and chair of the dermatology division at Atrium Health Wake Forest Baptist Medical Center in Winston Salem, North Carolina. “It is unclear how low-level lasers work in hair loss. At the moment, they are really only FDA-approved as devices.
Because they are classified as medical devices by the Food and Drug Administration, they do not undergo the same level of scrutiny and testing as medications before they are approved.
Medicines. There are various medication options. Medications include antibiotics such as 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 forms of hair loss without scarring, so dermatologists can use medications that can range from minoxidil to steroids.
Over the counter products. There are shampoos, supplements such as biotin, folate 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. “By taking a blood sample, platelets are separated and concentrated, and then injected into the areas where the hair is thinning. The platelets have unique regenerative properties and growth factors that can help treat a wide variety of hair loss conditions,” said Dr. Marc Glashofer, a dermatologist at Schweiger Dermatology in Northern New Jersey.
How a Dermatologist Can Help With Hair Loss
When patients notice signs of hair loss, it is recommended that they see a board-certified dermatologist to make an accurate diagnosis. “There are many similar diagnoses that can be mistaken for other things, and treatments can be complicated with combination therapies that need to be monitored often,” says McMichael.
An exam at the dermatology office will consist of:
- A patient history and questions about your symptoms, including how long you’ve had hair loss and whether it was sudden or gradual.
- A physical exam in which the dermatologist looks closely at each area of hair loss with a magnifying device. They look for things like inflammation, distribution of hair loss and the overall appearance of the hair shaft.
- Finally, there may or may not be a need for a scalp biopsy or blood test.