Dealing With Hair Loss

If you're struggling with hair loss, don't despair – the problem may respond to treatment or even resolve itself over time. The first step is to consult a board-certified dermatologist and find out what is causing your hair loss. Different causes require different treatments. Moreover, two people with the same type of hair loss won't necessarily respond to treatment the same way.

Heredity – "Pattern hair loss"

Both men and women can inherit genes that cause hair follicles – the tiny tubes hair grows out of – to stop growing hair. This is called male or female pattern baldness. In men, thinning begins as a receding hair line or a bald spot at the top of the head. Women will notice a widening part, or overall thinning.

Age

Even if pattern baldness doesn't run in your family, hair growth slows with age and starts to lose its color.

Hormonal Issues

Women are susceptible to hair loss due to changes in the balance of the female hormone estrogen. This can happen for a variety of reasons:

• Polycystic ovary syndrome (PCOS), a condition in which cysts form on the ovaries, can induce hair loss.
• Stopping some types of birth control pills can cause temporary hair loss.
• Pregnancy and giving birth. In fact, 40-50% of women experience hair loss within the first five months of having a baby.
• Menopause

Medication

Hair loss is a possible side effect of some types of medications, including:

• Retinoids, derived from vitamin A, which has been linked to hair loss
• Certain antidepressants
• Anticoagulants (blood thinners)
• Anticonvulsants
• Beta blockers
• Medication to treat an overactive thyroid
• Certain arthritis medications

Just because you are taking a certain medication does not mean you will experience hair loss as a side effect. What's more, in the majority of cases, hair will grow back once the medication is stopped. Do not stop taking it before talking to your doctor.  Your hair loss could have another cause and suddenly stopping a medication can cause serious health problems.

Cancer treatment

As many cancer survivors know all too well, chemotherapy can cause you to lose most or all of your hair within a few weeks of starting treatment. In recent years, infusion centers have started offering patients cold caps. The cold constricts small blood vessels in the scalp to reduce the amount of medication reaching the hair follicles, so hair is less likely to shed. Radiation treatment to the head or neck and the drug Tamoxifen, used to treat breast cancer or reduce the risk of recurrence, are also associated with hair loss.

Hair Care and Style

Hair dye, perms, and relaxers can damage hair and lead to hair loss over time. If you wear your hair tightly pulled back, you could develop "traction alopecia", a type of hair loss that is permanent. African American hair styles that require the use of weaves, rows, braids, chemical relaxers, or hot combs are especially hard on hair. All of these styling practices inflame the follicles and can lead to a permanent type of hair loss called central centrifugal cicatricial alopecia (CCCA), a circular pattern of hair loss that starts at the crown of the head and radiates out. If your scalp hurts during and after styling, you may be damaging your hair follicles.

Stress

Some people experience temporary hair loss a few months after a stressful experience, such as surgery, serious illness, divorce, or the death of a loved one.

Nutritional Deficiencies

If you're not getting enough biotin, protein, or zinc, you can lose a fair amount of hair. A dermatologist will order a blood test to determine if that is the case. Some supplements, such as iron, are toxic if you take too much, so determine the dose with your doctor.

Medical issues

A variety of medical issues can cause you to lose hair:

• Alopecia areata is an autoimmune disease in which the immune system attacks the hair follicles. Some people will just have a few patches of hair loss but in the most severe cases, people lose hair all over their body, including eyelashes and eyebrows.
• A scalp infection, such as ring worm
• Plaque psoriasis
• Sexually transmitted infections
• Trichotillomania, a form of OCD which causes people to compulsively pull or break their hair

Exposure to toxic substances

A variety of toxic substances can lead to hair loss if ingested. Arsenic, thallium, mercury, lead, warfarin, and lithium are just a few of these. Excess amounts of vitamin A or selenium can also cause you to lose hair.

Treatment for hair loss

Hair loss should be viewed as a symptom. You need to see a dermatologist to determine the cause. The doctor will ask questions and examine your scalp, nails, and other areas of hair loss. They may need to do a blood test or scalp biopsy.

Not every type of hair loss can be treated. If your hair follicles are damaged, there may not be much the doctor can do. On the other hand, you may learn that your condition is temporary, and your hair will grow back. Or you may be prescribed one or more of the following treatments:

• Minoxidil Rogaine® is applied to the scalp–it can't regrow an entire head of hair, but it stimulates hair growth and helps prevent hair loss.
• Oral medications, including Finasteride (Propecia®) and Spironolactone (women of childbearing age should be on birth control because these drugs can cause birth defects.)
• Antibiotics or antifungal drugs if you have a scalp infection.
• Vitamins and supplements may be prescribed depending on the results of your blood. test, and you may also be advised to eat more protein.
• A laser hair cap or comb is effective for some people.
• Microneedling -- a procedure that uses a device with hundreds of tiny needles to stimulate hair growth – is often used in combination with other treatments.
• Corticosteroid injections can be helpful for people with patches of alopecia areata.
• Hair transplants may be used for male or female pattern baldness.
• Platelet-rich plasma (PRP) involves drawing a small amount of your blood, separating out the plasma, and injecting it into the area with hair loss. PRP requires repeat injections, first once a month and then every 3-6 months.

Whatever the cause of your hair loss, be patient! Treatments take time to work, and hair grows back slowly. Find a dermatologist to help you with your hair loss.

This article first appeared in the April 2023 edition of the HealthPerks newsletter.